The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Nov 2017. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. The Lancet Nov 2017. The Lancet Nov 2017. Reference: Alam N et al.

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Sepsis Hospitals Fluid Resuscitation Administration 40

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.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

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

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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Sepsis Emergency Department Seizures Pediatrics 52

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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Sepsis Shock Fluid Resuscitation Hospitals 40

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.

Infectious Diseases 89

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

RebelEM

OCTOBER 31, 2022

Vitamin C can function as an antioxidant and may mitigate endothelial oxidative stress in sepsis. Amrein 2018) A small, single-center, before-and-after study utilized a sepsis cocktail consisting of IV thiamine, hydrocortisone, and vitamin C and discovered a significant decrease in mortality compared to the control group.

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Sepsis Outcomes Research Shock 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

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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Sepsis Shock Administration Resuscitation 52

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

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 Infectious Diseases 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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Shock Administration Sepsis Fractures 52

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.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

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

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].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 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. 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

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.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 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.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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.

Stroke 111

Stroke EMS EKG/ECG Radiology 111

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.,

Pediatrics 52

Pediatrics Poisoning Emergency Department Sepsis 52

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. 2017 Jan;151(1):215-224. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020 Dec;46(12):2385-2396. Scholten EL, Beitler JR, Prisk GK, Malhotra A. Treatment of ARDS With Prone Positioning.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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

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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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.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

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

Psychiatric Emergency Department Fractures Documentation/Coding 52

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

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

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 105

Emergency Department Ultrasounds EMS Radiology 105

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 Research Outcomes Hospitals 78

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.,

Stroke 40

Stroke Sepsis Administration Wellness 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.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 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.,

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

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).

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

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.

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

EB Medicine

JULY 8, 2019

Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EB Medicine

JUNE 6, 2019

However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. was sensitive for 28-day mortality in sepsis. Jeff: Speaking of HR, tachycardia can be a response to pain, anxiety, fever, blood loss, or sepsis. Oxford UK: John Wiley and Sons; 2017.

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Ultrasounds Radiology Radiology Sepsis 40