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. N Engl J Med.

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PulmCCM

APRIL 8, 2024

In a 2017 observational study at 43 French ICUs , gradual weaning was associated with less airway obstruction and gasping; families reported no greater incidence of PTSD symptoms after witnessing either type of extubation, while nurses reported more work stress with gradual weaning. If no significant structural heart disease (e.g.

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Sepsis Stroke Hospitals Wellness 40

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. 2017 Jan;104(1):52-61. Patients with sepsis and immunocompromise were not included. No evidence of sepsis. 2017 Jan;104(1):52-61.  Br J Surg. 2012 Apr;99(4):532-9. Open label, multicenter, RCT.  Br J Surg.

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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!!

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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).

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Sepsis Shock Hospitals Outcomes 52

PulmCCM

FEBRUARY 12, 2024

The Society of Critical Care Medicine (SCCM) expanded its prior 2017 guidance, now recommending strongly that corticosteroids be given for severe community-acquired pneumonia, and also suggesting steroids for patients with acute respiratory distress syndrome (ARDS) and septic shock of any severity.

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Taming the SRU

AUGUST 30, 2023

In contrast, an 2017 Cochrane Review update regarding using PCT to initiate or discontinue antibiotics found PCT-guided therapy had a statistically significant d ecrease in mortality for hospitalized patients by 1.4% (primary endpoint) and a statistically significant decrease in antibiotic exposure by 2.4 2017 Dec 14;9(6):7204-7218.

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Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Pediatric EM Morsels

APRIL 7, 2023

Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy. 2017 Jan;26(1):108-115. If Sickle Cell Disease only ever caused Vaso-Occlusive crises, it would be considered one of the most challenging conditions for patients and families to deal with. J Stroke Cerebrovasc Dis.

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Stroke Pediatrics Seizures Sepsis 130

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.

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Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

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Sepsis Ultrasounds Radiology Radiology 52

PHEM Cast

SEPTEMBER 25, 2019

Sepsis Click for UK Sepsis Trust guidance for different clinical settings. Scroll down for the Screening and Action tool for under 5s for prehospital care and ambulance services.

Ambulance Services 52

Ambulance Services Sepsis Burns Hospitals 52

Mind The Bleep

JULY 23, 2023

Sathe M, 2017) Age at onset: Often diagnosed antenatally, but if not presents within a few hours of birth Presentation : Abdominal distension, failure to pass meconium, bilious vomiting. Sathe M, 2017) Barium enema in a neonate demonstrating a diffuse microcolon secondary to meconium ileus.

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Sepsis Blood Transfusions Dehydration Wellness 52

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.,

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Pediatrics Poisoning Emergency Department Sepsis 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. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

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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. 2017 Jul 17;10:1663-1666.

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Sepsis Emergency Department Radiology Radiology 52

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.

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Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 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. Screen time and preschool children: Promoting health and development in a digital world. 2023 Jun 15.

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Pediatrics Emergency Department Outcomes Fractures 98

Emergency Medicine Ireland

JULY 3, 2023

Type 5 is the big bucket where they put all the left over disease that cause both kidney and heart failure eg things like amyloid, or sepsis or cirrhosis. Eur Heart J 38, 1872–1882 (2017). Type 4 is again renocardiac with the kidneys causing the heart failure but on a chronic basis. With me so far? – Mullens, W., Verbrugge, F.

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Sepsis Shock Wellness Documentation/Coding 96

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. The study was designed as a phase III multicenter randomized placebo control trial taking place across 75 intensive care units in the United States from 2015 to 2017.

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Shock Resuscitation Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

JUNE 10, 2024

Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia. How do we diagnose necrotising enterocolitis? ANZNN Annual Report. Battersby, C.,

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Pediatrics Sepsis Fluid Resuscitation Outcomes 40

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Osna 2017) Alcohol can contribute to pancreatitis, CKD, epilepsy, and countless other conditions. 2017 Jul 1;52(4):466-471. Alcohol Alcohol. PMID: 28340112.

Psychiatric 52

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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. 2017 Dec;83(6):1136-1141. d) Something else The PROPPR trial showed us that balanced ratios are important.

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Resuscitation Operations Sepsis Pediatrics 139

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. Non-invasive methods are preferable for all but those at risk of neonatal sepsis or the ill ap. BMJ April 17. BMJ April 17.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 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%

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Outcomes Emergency Department Sepsis Operations 52

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. 2017 Nov;70(5):758. anatomic region). Ann Emerg Med. 2015 Sep;66(3):322-333.e31. doi: 10.1016/j.annemergmed.2015.06.031. 2015.06.031. Erratum in: Ann Emerg Med.

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Stroke EMS EKG/ECG Radiology 89

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

Mind The Bleep

MAY 12, 2023

These include infection & sepsis, GI bleeding, dehydration, AKI, alcohol consumption, constipation, and certain medications. GBD 2017 Cirrhosis Collaborators. 9 Encephalopathy Look closely for a precipitant and treat accordingly! The morphology of cirrhosis: definition, nomenclature, and classification. Bull World Health Organ.

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Fluid Resuscitation Dehydration Resuscitation Administration 52

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 European Journal of Anaesthesiology| EJA 2017, 34(5):315. A lesser-known investigation from nearly 40 years ago offers one explanatory model. Yamazaki et al. In the former group, stroke index [i.e.,

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Stroke Sepsis Administration Wellness 40

Don't Forget the Bubbles

MAY 28, 2024

Hence, PPHN can be idiopathic or secondary to a variety of conditions such as meconium aspiration syndrome , respiratory distress syndrome, sepsis, asphyxia and congenital diaphragmatic hernia. Imagine being a few hours old and dealing with this). Or it could be due to a delay in circulatory transition. StatPearls Publishing.

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Sepsis Ultrasounds Pediatrics Research 52

RebelEM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). Epub 2017 Jan 10. The delay in the onset of effect of digoxin could play a role in the poor rate control and overall success in the IV digoxin group. Journal of Emergency and Critical Care Medicine , vol. 2, 2018, pp. Link to Paper Here Shojaee M, et al. Emerg (Tehran).

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Emergency Department Administration Dehydration EMS 52

Dr. Smith's ECG Blog

JULY 21, 2024

The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy. Unfortunately, he required re-intubation a few days later due to respiratory distress from severe bilateral pneumonia.

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Don't Forget the Bubbles

JANUARY 10, 2024

3,950 children were recruited between September 2014 to May 2017. 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. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

PulmCCM

FEBRUARY 28, 2022

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. 45% of patients were admitted to the ICU directly from operating or recovery rooms, 79% were mechanically-ventilated and 42% had sepsis.

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Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. -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 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

EMDocs

MARCH 4, 2024

Now it is typically only employed if therapeutic procedures are anticipated, such as in patients with sepsis due to ascending cholangitis requiring biliary intervention for source control. doi:10.1136/gutjnl-2017-314924 Kunutsor SK. Other complications include bleeding and perforation. Scand J Gastroenterol. 1993;28(8):732-736.

Emergency Department 87

Emergency Department Ultrasounds EMS Radiology 87

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

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Acute angle closure glaucoma: ED relevant management”, emDocs ; 10 Feb 2017. Disease processes involving surrounding structures of the eye CASE 1 Imrankabirhossain. Accessed April 15, 2022. What is Endophthalmitis?”,

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Emergency Department EMS Burns Wellness 87