Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Adjust all tubing and reassess connections.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. 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.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

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

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e., REFERENCES 1. Zambito Marsala, S.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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.

Poisoning 52

Poisoning Administration Hospitals 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. But of course you’ll only be doing this after a high quality, well interpreted echo that shows a hyperdynamic LV so that should give you a little reassurance. Chauvet, J.-L.

Sepsis 52

Sepsis Shock Wellness 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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. Remember, we can add more if needed, but taking it away is much harder. Lancet (London, England).

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

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 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. Groups were well matched at baseline. Published 2015 Feb 2. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Mind The Bleep

FEBRUARY 7, 2024

After a red cell transfusion they have some adult Hb which shifts the curve to the right and you then need a high partial pressure of oxygen to saturate well. Well, a baby in a prone position can better equally inflate both lungs, overall compliance of the chest wall is better and the alveoli are better inflated.

Wellness 52

Wellness Sepsis Stroke Shock 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As for other invasive therapies , intra-aortic balloon counterpulsation (12, 13) appears to work well in non-randomized studies, and this would also make sense: the balloon in the aorta inflates in diastole, increasing diastolic pressure and thus coronary flow. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 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. You may have heard of the recommendations for incision / excision, use of venom extraction devices, tourniquets, chill methods and even electroshock therapy – well these methods are all OUT.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

FEBRUARY 17, 2024

1,3 Although well-recognized in the drug-user population, the incidence and prevalence of cotton fever are unclear as few publications or epidemiological data exist. Cotton fever: an evanescent process mimicking sepsis in an intravenous drug abuser. Wolters Kluwer; 2015. 130 NA 21,700 12 23 M Heroin 15 40.3 Torka P, Gill S.

EMS 98

EMS Sepsis Hospitals Wellness 98

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

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Infection/sepsis? The ED team helpfully did a gas while you headed down to review, and as you scan the numbers, you see that the baby has a severe mixed respiratory/lactic acidosis. What are your differentials?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

EMDocs

OCTOBER 23, 2023

She had been feeling well until yesterday when she had a follow-up with her surgeon, at which time she reported that they performed an internal exam and inserted a ‘medication disk’ into her vagina. The patient is noted to be mildly tachycardic as well as febrile. She is status post (s/p) hysterectomy 2 weeks ago.

OB/GYN 93

OB/GYN Operations EMS Ultrasounds 93

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

Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries. In the 1950’s travel accounted for 25 million international tourists. A study of swiss tourists found they compromised 53.4%

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2015 May;169(4):492-505. Epub 2015 Mar 30. C or 100.4 mg/kg, max 0.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Pediatric Education

DECEMBER 17, 2023

He complained of neck stiffness, nausea without emesis and general malaise as well. The patient was clinically well enough 5 days later to be discharged and all bacterial testing was negative. Imported rickettsial infections to the United Kingdom, 2015-2020. Rickettsioses in Children – A Review. Indian J Pediatr.

Infectious Diseases 40

Infectious Diseases Pediatrics Sepsis Wellness 40

EMDocs

JANUARY 16, 2025

Well provide summaries of the evidence to support your decisions at the bedside. 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 0.38 (95% CI 0.20-0.39)

Sepsis 95

Sepsis Pediatrics Shock Hospitals 95

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. What do we know about SIDS and how effective back sleep is at reducing it?

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. You order antibiotics, an initial fluid bolus as well as blood cultures. One side argues that fever places additional physiological stress on patients, who are already ill ( Young 2015 ).

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). They were a well-grown, term infant born in good condition. The other investigations are unremarkable, including a normal CT head.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

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. It’s impossible to do all these things well at once. ASH education program, 2015 Shih HH, Chang HJ, Huang TW. LeBlanc, Areej El-Jawahri. Am J Hosp Palliat Care.

Hospice 89

Hospice Outcomes Sepsis Emergency Department 89

Don't Forget the Bubbles

SEPTEMBER 23, 2024

This is particularly crucial in younger children who have received a large adult kidney and typically have relatively low creatinine levels when stable and well. Consider sepsis and treat it accordingly. Changes in TAC concentrations related to changes in haematocrit should not lead to a prompt dose adjustment. Clin Pharmacokinet.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Mind The Bleep

SEPTEMBER 17, 2024

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. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. References Kennedy, S. E., & Lauder, A.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52