Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. 2016, Andrews, Semler et al. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 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. Injury 2016; 47: 797– 804. Laan DV, Vu TD, Thiels CA et al.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 Thrombolysis Compared with Heparin for the Initial Treatment of Pulmonary Embolism: A Meta-Analysis of the Randomized Controlled Trials. PMID: 15262836 Sharifi M et al. Pulseless Electrical Activity in Pulmonary Embolism Treated with Thrombolysis (from the “PEAPETT” Study).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Pediatric Emergency Playbook

APRIL 1, 2016

Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. The acute recognition and treatment of sepsis is first and foremost, clinical. We should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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. We’ll start with sepsis.

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Sepsis Shock Wellness 52

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. 2016 Dec;115(6):317-21.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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 66

CDC Sepsis Research Pediatrics 66

Emergency Medicine Ireland

OCTOBER 30, 2023

As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Vasopressin versus norepinephrine infusion in patients with septic shock. Jama 316 , 509–518 (2016).

Shock 52

Shock Sepsis Wellness Outcomes 52

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. This can be the result of hypotension, tachycardia, sepsis, PE, etc. MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. 2016; 5(1):5-12. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

JUNE 27, 2024

2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. -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 Am J Hematol.

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

EB Medicine

MARCH 4, 2020

No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. Specifically, Salmonella, shigella, Campylobacter, and Yersinia 2016 ACG guidelines recommend them for patients with watery diarrhea and moderate to severe illness with fever for at least 72 hours.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 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. 2016 Jan 7;4(1).

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EB Medicine

JULY 8, 2019

While it was < 15% in 1990, by 2016 it reached 40%. 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. Jeff: Well that’s kind worrisome. That’s almost half of the population. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. vs. 0.91), positive predictive value (0.27

Sepsis 66

Sepsis Fluid Resuscitation Resuscitation Shock 66

Don't Forget the Bubbles

MARCH 4, 2024

This study retrospectively identified 1,414 children, presenting to 15 UK EDs (2016 -2017), who had been screened for malaria. Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

PulmCCM

DECEMBER 3, 2024

Maintaining a mean arterial pressure (MAP) of 65 mm Hg has been advised for patients with sepsis and other forms of vasodilatory shock. More than a dozen randomized controlled trials (RCTs) have sought to identify whether higher or lower MAP targets produce better outcomes in critically ill patients with shock.

Shock 75

Shock Sepsis Outcomes Hospitals 75

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 87

Psychiatric Seizures Emergency Department Pediatrics 87

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. Epub 2016 Dec 29. Neutropenic Fever: Fever (one reading of 38.3C Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 97

Infectious Diseases Administration Sepsis Anaphylaxis 97

Taming the SRU

APRIL 26, 2023

J Emerg Med 2016. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

PulmCCM

SEPTEMBER 23, 2021

Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Critical care 2016, 20(1):270. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Don't Forget the Bubbles

JULY 3, 2024

Trends in C-Reactive Protein Use in Early-Onset Sepsis Evaluations and Associated Antibiotic Use. Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Pediatrics. Pediatrics.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105