The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 89

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

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. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. Hemoglobin and platelets are helpful if HUS is suspected.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

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. 2017, Silversides, Major et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

[display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. Case: You are working the afternoon shift in the paediatric emergency department. Your shift is almost over and the department finally seems to be under control.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. In 2017, these were performed 60%, 18%, and 3% of the time. I hope everybody enjoyed a fantastic conference. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

ACEP Now

JULY 8, 2023

To better address this question, we begin with a prospective observational cohort study of 239 children that evaluated the diagnostic ability of clinical recognition signs (CRS) to identify sepsis. A separate 2017 prospective observational study by de Vos-Kerkhof, et al., BMC Emerg Med. References Scott HF, et al. 2014;14:24.

Pediatrics 52

Pediatrics Poisoning Emergency Department Sepsis 52

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med.

Stroke 110

Stroke EMS EKG/ECG Radiology 110

Broome Docs

AUGUST 2, 2022

Vitamin C in sepsis: STOP IT, we do not LOVE IT Lamontagne F, Masse MH, Menard J, et al; LOVIT Investigators and the Canadian Critical Care Trials Group. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. PMID: 35704292 Bottom line: Sepsis is not treated with vitamins. Am J Emerg Med. N Engl J Med.

Sepsis 52

Sepsis Emergency Department Radiology Radiology 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Annals of Emergency Medicine.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 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. Emergency Medicine Clinics of North America. 2017; 45(9): 1443-1449.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

RebelEM

NOVEMBER 3, 2022

In 2017, a single-centered, retrospective study found a lower incidence of clinical hypotension with ketamine compared to etomidate following endotracheal intubation in septic patients. ( Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. 3,950 children were recruited between September 2014 to May 2017. Sepsis indicators and malaria positivity did not modify the risk. Were the study groups similar at the start of the trial?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. was sensitive for 28-day mortality in sepsis. Emerg Med Clin North Am.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

OCTOBER 5, 2024

A 62-year-old female patient with a history of recurrent urinary tract infections (UTIs) presents to the emergency department with fever, chills, and dysuria. 4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Epub 2017 Nov 22. Ann Emerg Med.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Taming the SRU

SEPTEMBER 16, 2024

In the era of modern medicine, blood transfusions are commonplace, especially in the emergency department. While they are a lifesaving staple of medicine, they also come with risks that emergency providers must be aware of. Adverse reactions to transfusion of blood products and Best Practices for Prevention.” 11, 2 June 2021, p.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

EMDocs

OCTOBER 17, 2023

Systematic review found increasing age, diffuse rather than localized abdominal pain, guarding or pain with rebound, initial episode of diverticulitis, steroid use, fever, constipation and vomiting, elevated CRP, and elevated WBC count were associated with greater risk of complication such as abscess or perforation (Bolkenstein 2017).

Radiology 94

Radiology Radiology Operations Best Practices 94

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

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. address in the article discussed below. JAMA Intern Med.

Sepsis 113

Sepsis Outcomes Administration Shock 113

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. This is true in life-threatening conditions such as sepsis. Hibberd, O.;

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Accessed April 15, 2022. English: A Swollen, Pus-Filled Eye with Conjunctivitis.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm. coli urine tract infections in children treated in primary care and emergency department.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. Am J Emerg Med. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 Am J Hematol.

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

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. A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ).

Sepsis 75

Sepsis Shock EMS Emergency Department 75

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

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. Volume status Assessing volume status, especially in critically ill patients, can be challenging. Andrews et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

PulmCCM

JANUARY 27, 2025

” —Palliative Care for Patients With Cancer: ASCO Guideline Update, July 1 2024 Every day, patients with advanced metastatic cancer arrive in emergency departments and ICUs with the terrible complications that signal they are in the final days of their lives. .” Answer: Yes, unequivocally.

Hospice 89

Hospice Outcomes Sepsis Emergency Department 89

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. The other important moment to always think of the heart (sorry, cardiologists, I don’t think about the heart 24/7) is when a collapsed neonate presents to your emergency department, especially if blood pressure is present.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Taming the SRU

FEBRUARY 3, 2025

Work-up and Diagnosis in the Emergency Department Initial presentation of TLS typically includes generalized symptoms such as gastrointestinal distress, decreased appetite, muscle cramping, palpitations, hematuria / oliguria, and altered mental status. 2017-0278-RS 3. 2017-0147 4. in females and 2.5-7.0 doi:10.5858/arpa.2017-0278-RS

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

PulmCCM

FEBRUARY 10, 2025

There’s no diagnostic test for sepsis, which leads to high rates of overdiagnosis, delayed care from missed cases, and flawed clinical research. Several new blood tests claim to solve the problem of diagnostic imprecision in the early management of suspected sepsis. and you may soon see them in your emergency department or ICU.

Sepsis 52

Sepsis Urgent Care Emergency Department Pediatrics 52