Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. 2015 Sep;40(7):720-8. Epub 2015 Feb 10. Blood tests: FBC (leukocytosis), CRP, serum urate if suspecting gout as differential. Hand Xray: identify foreign bodies, osteomyelitis/bone changes. Remove all rings!

Operations 52

Operations Sepsis Documentation/Coding 52

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al.,

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

Pediatric EM Morsels

NOVEMBER 17, 2023

Epub 2015 Aug 22. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. 2022 Apr;29(4):406-414. doi: 10.1111/acem.14431. Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. Most SIDS babies have congested lungs, and 75% have a history of a recent cold, or an existing cold. Up to 81% have Clostridium perfringens enterotoxin in their intestinal tracts , compared with 20% of healthy controls.

CDC 73

CDC Sepsis Research Pediatrics 73

EMDocs

JULY 13, 2024

Incidence, treatment and outcome of peripartum sepsis. 2015 Feb 2;2015(2):CD001067. Am J Obstet Gynecol. 1985 Dec 1;153(7):737-9. doi: 10.1016/0002-9378(85)90335-7. PMID: 4073137. Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Acta Obstet Gynecol Scand. 2003 Aug;82(8):730-5. doi: 10.1034/j.1600-0412.2003.00265.x. 1600-0412.2003.00265.x.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

Taming the SRU

JULY 24, 2023

Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). In those with concern for sepsis, blood cultures, broad spectrum IV antibiotics and fluids should be given as needed. 2015 Oct;16(5):509-12.

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

EMDocs

MAY 11, 2024

Cavernous sinus syndrome (B) usually presents with cranial nerve deficits, diplopia, periorbital cellulitis, and facial swelling that may progress to meningitis or sepsis. 2015 Sep;66(3):322-333.e31. Nov 10 th , 2015. anatomic region). Ann Emerg Med. doi: 10.1016/j.annemergmed.2015.06.031. 2015.06.031. Erratum in: Ann Emerg Med.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

EMDocs

JUNE 22, 2024

2015 May;28(7):793-8. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” .” Am J Obstet Gynecol 201(5): 445 e441-413. link] Fong A, Chau CT, Pan D, Ogunyemi DA. Amniotic fluid embolism: antepartum, intrapartum and demographic factors. J Matern Fetal Neonatal Med.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

Emergency Medicine Ireland

OCTOBER 16, 2023

We’ll start with sepsis. Sepsis is a state of low systemic vascular resistance leading to reduced preload and afterload in the heart. Critical Care 19 , 1–8 (2015). We’ll start with sepsis. Sepsis is a state of low systemic vascular resistance leading to reduced preload and afterload in the heart.

Sepsis 52

Sepsis Shock Wellness 52

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

Don't Forget the Bubbles

JULY 5, 2023

Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Sickle cell patients also qualify to receive the annual influenza vaccine, since influenza virus infection predisposes to bacterial pneumonia and sepsis caused by S. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Mind The Bleep

SEPTEMBER 17, 2024

Always consider management as per ATLS protocol and SEPSIS 6 if relevant. Management The management is guided by the examination findings which are covered in the respective chapter, this section will delve into the importance of a number of those steps, as well as further long-term care. Ensure the wound has been adequately washed out.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. 2015 Jul;115(1):76-83. Epub 2015 May 19. Trauma Surg Acute Care Open. Br J Anaesth. PMID: 25991760.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EM Curious

JULY 29, 2015

S-E-P-S-I-S A SEPSIS SMACC-BACK [PODCAST]: If you were at SMACC 2015 you may have been confused after the sepsis expert panel discussion. If you weren't there, you still should listen to this discussion on sepsis 3.0. Read on here.

Sepsis 52

Sepsis EMS Emergency Department Ultrasounds 52

Northwestern EM Blog

JANUARY 24, 2022

Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Guest Skeptic: Dr. Natalie May trained as an emergency physician with subspecialty paediatric emergency medicine in the UK and worked in Manchester and Oxford before moving to Australia in 2015 to work for Sydney […] The post SGEM#190: Wee are the Champions of Pediatric Urine Samples first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. PMID: 26315743 Tapson VF et al.

Stroke 137

Stroke Outcomes Hospitals Administration 137

EMDocs

JUNE 27, 2024

2015 May;169(4):492-505. Epub 2015 Mar 30. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 Br J Haematol.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Their workup reveals a multifocal pneumonia with signs of sepsis. In the 2015 AVOID study there was some suggestion of increased MI size in the group of STEMI patients that received oxygen at 8 L/min compared to a room air control group. This study expands upon that investigation to patients with other conditions as well.

Administration 52

Administration Poisoning Hospitals Outcomes 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. A 2015 study published in the Lancet demonstrated a reduction in hyponatraemia by adopting an isotonic strategy compared with a hypotonic strategy. Remember, we can add more if needed, but taking it away is much harder.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Taming the SRU

FEBRUARY 5, 2024

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Broadstock is a Clinical Instructor and Ultrasound Fellow in Emergency Medicine at the University of Cincinnati and an Assistant Editor of TamingtheSRU. REFERENCES 1. Zambito Marsala, S.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Epub 2015 Sep 14. Osteopathic Family Physician. 2014 Mar;6(2). Barr T, Helms C, Grant K, Messaoudi I. Opposing effects of alcohol on the immune system. Alcohol Res.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

Northwestern EM Blog

FEBRUARY 14, 2022

The study was designed as a phase III multicenter randomized placebo control trial taking place across 75 intensive care units in the United States from 2015 to 2017. This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Pediatric Education

DECEMBER 17, 2023

Imported rickettsial infections to the United Kingdom, 2015-2020. Rickettsioses in Children – A Review. Indian J Pediatr. 2020;87(11):930-936. doi:10.1007/s12098-020-03216-z Warrell CE, Osborne J, Nabarro L, et al. 2023;86(5):446-452. doi:10.1016/j.jinf.2023.03.015 2023.03.015 Author Donna M.

Infectious Diseases 40

Infectious Diseases Pediatrics Sepsis Wellness 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2015; 18 Gilmore AW et al. 2015 Jun;50(6):923-7 Herliczek TW et al. 2015; 3(5):53-56. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Janitz et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Sepsis indicators and malaria positivity did not modify the risk. Published 2015 Feb 2.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Pediatric Emergency Playbook

MAY 1, 2016

meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. 2015; 57(4):659–664. V – Vascular (e.g. V – Vascular (e.g.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

Mind The Bleep

FEBRUARY 7, 2024

This can be caused by high cardiac output in sepsis, uncoupled respiratory chain not producing ATP in hypermetabolic states Relationship between delivery, consumption and extraction of oxygen. Hypoxia can be caused by insufficient oxygen supply, V:Q mismatch, anaemia, poor circulation, ischaemia or sepsis. References Biorender.

Wellness 52

Wellness Sepsis Stroke Shock 52

RebelEM

OCTOBER 31, 2022

Vitamin C can function as an antioxidant and may mitigate endothelial oxidative stress in sepsis. Amrein 2018) A small, single-center, before-and-after study utilized a sepsis cocktail consisting of IV thiamine, hydrocortisone, and vitamin C and discovered a significant decrease in mortality compared to the control group.

Sepsis 52

Sepsis Outcomes Research Shock 52

Mind The Bleep

MAY 12, 2023

These include infection & sepsis, GI bleeding, dehydration, AKI, alcohol consumption, constipation, and certain medications. PMID: 33067334; PMCID: PMC7788190 NICE Technology Appraisal guidance – TA337 (March 2015; reviewed June 2018): Rifaximin for preventing episodes of overt hepatic encephalopathy. 2021 Jan;70(1):9-29.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Pediatric Emergency Playbook

MAY 1, 2017

Check the bilirubin in any neonate you are working up for sepsis. 2015; 135(5):948-53. The neonate may be sleepy but hypotonic or have a high-pitched cry; he maybe irritable or inconsolable, jittery or lethergic. The dehydration and neurologic dysfnction from the hyperbilirubinemia may even cause fever. References Benitz WE.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Taming the SRU

APRIL 26, 2023

J Intensive Care Med 2015. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. References Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. Douma MJ, Aves T, Allan KS, et al. Resuscitation 2020. J Emerg Med 2016.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Volume 21, Issue 6, June 2015, Pages 583-590 Perron T, Emara M, Ahmed S. Neutropenic Fever: Fever (one reading of 38.3C

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

EB Medicine

JUNE 6, 2019

However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. was sensitive for 28-day mortality in sepsis. Jeff: Speaking of HR, tachycardia can be a response to pain, anxiety, fever, blood loss, or sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

NOVEMBER 1, 2018

Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. Thankfully, fatalities are declining, with just 565 in 2015. Thankfully, fatalities are declining, with just 565 in 2015.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40