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. Should we prone non-intubated patients in the ED?

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. Published 2016 Jan 29. In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause. Other organ system involvement & hypotension/low perfusion affect EtCO 2. BMC Emerg Med.

Emergency Department 94

Emergency Department Blood Transfusions Resuscitation Sepsis 94

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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. Injury 2016; 47: 797– 804.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing. 2016 Dec 28;7(Suppl 44):S1150-S1153.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41. decreased DSI values).

Shock 52

Shock Outcomes 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. C., & ESCMID Study Group for Infections of the Brain (ESGIB) (2016). WHO - Who Needs an LP in the ED?

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2016 Dec;115(6):317-21. High serum procalcitonin concentrations in patients with sepsis and infection. Brigden ML.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

In 2016, the American Academy of Pediatrics (AAP) reaffirmed their clinical practice guidelines for the diagnosis and management of UTIs. However, if the child is looks well, but the clinician determines that the febrile infant is not in the low risk group for a UTI, the AAP recommends two options.

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.

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Anaphylaxis Shock Sepsis Resuscitation 52

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. Well this is where the fun beings. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016.

Shock 52

Shock Sepsis Wellness Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. 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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

JUNE 11, 2023

It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions. Enrollment period was from February 2016 to August 2018. It’s association with lactate and anion gap make it an attractive option for identification of critically ill patients.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

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

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

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. While it was < 15% in 1990, by 2016 it reached 40%. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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. Groups were well matched at baseline. 2016 Jan 7;4(1). Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PEMBlog

MARCH 27, 2024

2016 Jan;37(1):3-15; quiz 16-7, 47. Or, well, the ringer called me. However, sometimes you might hear of siblings or other relatives who had early onset neurologic or GI dysfunction or died early in life, and this can often be attributed to sepsis or sudden infant death syndrome because the symptoms of these overlap with IEMs.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

PulmCCM

NOVEMBER 11, 2021

Notably, they observed that while phenylephrine rectified hypotension, it significantly reduced heart rate [HR], SV – and, therefore, total cardiac output [CO] – as well as cerebral oxygenation [SctO2]. evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0

Stroke 40

Stroke Sepsis Administration Wellness 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. For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

DECEMBER 18, 2023

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. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. vs. 0.91), positive predictive value (0.27

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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. 2016) compares vital sign abnormalities and symptom duration between available case reports. 4 True incidence is likely more common than recognized by medical community.

EMS 98

EMS Sepsis Hospitals Wellness 98

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

Taming the SRU

SEPTEMBER 16, 2024

There are a few other factors as well that may increase risk for a transfusion reaction but are likely not readily available on patient history or are outside the physician’s control. 10, 26 July 2016, pp. NUEM Blog , NUEM Blog, 5 May 2016, www.nuemblog.com/blog/transfusion-reactions. Transfusion , vol. Muche, Yalew, et al.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

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? European Journal of Pediatrics; 2016: 175; 1461-1462 Cox, GF. What are your differentials? Bad bronchiolitis ? Congenital cardiac disease – maybe a duct-dependent lesion? A metabolic issue?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Don't Forget the Bubbles

JULY 22, 2024

The most recent meta-analysis , published in 2016 (comparing eleven studies from 1986 to 2009), struggled to reach a consensus because the trials were too heterogeneous to make robust conclusions. 2016 Aug;51(8):868–76. 2016 May;67(5):593-601.e3. So, an up-to-date, high-quality meta-analysis iss much needed. Pediatr Pulmonol.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Emergency Medicine Ireland

OCTOBER 28, 2020

This has relevance to the ICU population in 2 major ares * Sepsis. * EF does not correlate with particularly well with mortality in sepsis though diastolic dysfunction does * It may be due to under filling and the reduced diastolic filling due to the ubiquitous tachycardia in sepsis. . *

Sepsis 40

Sepsis Documentation/Coding Ultrasounds Wellness 40

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. Conjunctivitis."

Emergency Department 88

Emergency Department EMS Burns Wellness 88

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. 2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. C or 100.4 mg/kg, max 0.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

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 94

CDC Sepsis Research Pediatrics 94

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. 2016 Oct;74(7):ftw087. Clin Infect Dis. 2008;47:32838 Carbonetti. Pathog Dis.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

PulmCCM

MARCH 31, 2025

What drove the society to make this significant change to its 2016 ultrasound guidelines? This all might impose some inconvenience or expense, but it will be well worth it—it’s a simple matter of professionalism, and lives are at stake. ” Ultrasound Saves Lives, Speeds Diagnoses and Vent Weans (?) Is it true?

Ultrasounds 72

Ultrasounds Shock Sepsis Outcomes 72

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Venous Congestion in Adult Critical Care In adults, venous congestion is a well-recognized contributor to organ dysfunction in many conditions, including septic shock and heart failure.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78