Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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 Infectious Diseases 52

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 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 136

Stroke Outcomes Hospitals Administration 136

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

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. The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. Critical Care 19 , 1–8 (2015).

Sepsis 52

Sepsis Shock Wellness 52

The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. comparing diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department ( J Emerg Med 2015 ).

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 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. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Remember, we can add more if needed, but taking it away is much harder.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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 Research Outcomes Hospitals 78

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. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Check the bilirubin in any neonate you are working up for sepsis. 2015; 135(5):948-53. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable. References Benitz WE. Pediatrics. Bhutani V et al.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Mind The Bleep

FEBRUARY 7, 2024

Lung perfusion can be decreased by pulmonary hypertension, high pulmonary vascular resistance, massive pulmonary embolus (very rare in neonates), air embolism, shock with reduced blood flow and bronchopulmonary dysplasia with pulmonary hypertension. References Biorender. 2023, December 20th). Alveolar Gas Exchange Template.

Wellness 52

Wellness Sepsis Stroke Shock 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

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. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. was sensitive for 28-day mortality in sepsis.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

SEPTEMBER 1, 2018

As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EMDocs

JULY 15, 2023

sepsis), immunocompromised patients, IV drug users, patients with prosthetic heart valves or any intravascular device Clinical features may not abe enough to differentiate erysipelas from cellulitis, and in such cases the treatment should be targeted towards cellulitis Labs No laboratory evaluation is required for the diagnosis of erysipelas.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

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 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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

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 Fractures Documentation/Coding Administration 95

Pediatric EM Morsels

FEBRUARY 2, 2024

In the 1950’s travel accounted for 25 million international tourists. A study of swiss tourists found they compromised 53.4% However, the destination of travel is also important as helminths have distinct geographical distribution.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

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 97

Pediatrics Dehydration EMS Hospitals 97

EMDocs

JANUARY 16, 2025

Today we cover the Phoenix Sepsis Criteria. years Best performing criteria identified by AUPRC and AUROC 4-organ-system model translated into the Phoenix Sepsis Score had best mortality prediction characteristics AUPRC of 0.23-0.38 Well provide summaries of the evidence to support your decisions at the bedside. but PPV ranges from 25.1-39.5%

Sepsis 95

Sepsis Pediatrics Shock Hospitals 95

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. This sort of sepsis would produce many of the common autopsy findings.

CDC 88

CDC Sepsis Research Pediatrics 88

RebelEM

DECEMBER 17, 2024

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. One side argues that fever places additional physiological stress on patients, who are already ill ( Young 2015 ). NEJM 2015; 373(23): 2215-24. Vitals are BP 114/42, HR 138, T 102.1,

Sepsis 75

Sepsis Shock EMS Emergency Department 75

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of this possible diagnosis, they were commenced on a macrolide antibiotic (azithromycin) in addition to treatment for neonatal sepsis +/- meningitis (ceftriaxone and acyclovir). Post-ET, careful monitoring is essential, particularly for secondary bacterial infections and sepsis.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Pneumococcal sepsis B. Pneumococcal sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

PulmCCM

JANUARY 27, 2025

Intensivists are used to managing respiratory failure, shock, sepsis, pulmonary embolism, acute kidney injury, and hemorrhages—sometimes simultaneously. ASH education program, 2015 Shih HH, Chang HJ, Huang TW. But in people with advanced metastatic cancer, such major acute organ failure is rarely reversible.

Hospice 89

Hospice Outcomes Sepsis Emergency Department 89