The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. Background: Sepsis is a serious condition with high morbidity and mortality.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. PMID: 30025734 Sharifi M et al.

Stroke 133

Stroke Outcomes Hospitals Administration 133

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. We like it that way.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. ng/mL, 0.25-0.5

Infectious Diseases 89

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

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The Lancet 2018. The Lancet 2018. Their workup reveals a multifocal pneumonia with signs of sepsis. Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. The Lancet 2018.

Poisoning 52

Poisoning Administration Hospitals Sepsis 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. 2018, Kuttab, Lykins et al. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., He was later transferred back to his local hospital neurologically intact and without serious sequela. See this case and this case for more examples of ACS involving the LMCA Learning points: LMCA occlusion carries a poor prognosis, most patients do not make it to the hospital.

EKG/ECG 130

EKG/ECG Shock Emergency Department Ambulance Services 130

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. But this was all done in adults, and no comparable prospective trials in children exist.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ALiEM

SEPTEMBER 9, 2024

Patients are at high risk of bacterial spread to the abdomen or retrograde spread up the ventriculoperitoneal shunt leading to peritonitis, peritoneal abscess, ventriculitis, meningitis, or sepsis. Further indicated invasive/surgical interventions should be deferred to general surgery and neurosurgery consultants.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

Taming the SRU

JULY 24, 2023

He was transitioned to cefdinir and fluconazole for a full 7-day course of antibiotics and discharged from the hospital on day three, with instructions to follow up with general surgery for an outpatient cholecystectomy. In those with concern for sepsis, blood cultures, broad spectrum IV antibiotics and fluids should be given as needed.

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

The Skeptics' Guide to EM

FEBRUARY 10, 2018

[display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

PulmCCM

JULY 10, 2023

Continuous meropenem infusion for critically ill patients with sepsis Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

EMDocs

JULY 1, 2023

Patients should be admitted to the hospital and cardiology consulted early in their course. Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania. 2018; 3: e41-e45. The Royal Children’s Hospital Melbourne. Corticosteroids are controversial and not currently recommended. Lakhani, N.

EMS 84

EMS Infectious Diseases Pediatrics Research 84

Don't Forget the Bubbles

NOVEMBER 15, 2023

Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. Many years ago, there was a large body of evidence in reports from Northern Irish hospitals showing children who received large volumes of hypotonic IV fluids subsequently developed hyponatraemic encephalopathy and cerebral oedema.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

RebelEM

FEBRUARY 2, 2023

Average time control HR in the amiodarone group was on par with the study’s average ED length of stay Limitations: Single center, retrospective hospital study may not be able to produce generalizable results. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). 2018, PMID: 30571262 Gritsenko, Diana, et al.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. The first lumbar puncture. Journal of the history of the neurosciences, 6(2), 147–153.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

Mind The Bleep

SEPTEMBER 12, 2023

Were there any risk factors for sepsis? Increased work of breathing with grunting and tachypnoea could be due to sepsis, hypoglycaemia or acidosis due to an inborn error of metabolism. Birth History How long was the labour? Postnatal History Ask about respiratory effort since birth.

Sepsis 52

Sepsis Seizures Poisoning Wellness 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. Hamad General Hospital. 2018:346-353.e2. Other complications include bleeding and perforation. Mayo Clin Proc. 2020;95(10):2263-2279.

Emergency Department 103

Emergency Department Ultrasounds EMS Radiology 103

ACEP Now

MAY 9, 2024

1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.” Or Helly Larson describing the first week after her Miami BBL as “absolute hell” to a Vox reporter. References Garcia SE.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

RebelEM

MARCH 9, 2023

Klein 2018) Despite the high risk of pathology and decompensation, many patients with presumed alcohol intoxication can be evaluated and discharged without any labs or imaging. Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Northwestern EM Blog

JUNE 16, 2024

For example, hypothyroidism, adrenal insufficiency, sepsis, neuromuscular disease, malnutrition, thiamine deficiency, hypoglycemia can all lead to hypothermia [11-13]. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Joglar, J. Marine, J. McLeod, C. Patton, K.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9% Do not transport to an alternative location.

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. Miranda DF, Lobo AS, Walsh B, et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. was sensitive for 28-day mortality in sepsis. So fairly sensitive, but not too specific.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Mind The Bleep

MAY 12, 2023

These include infection & sepsis, GI bleeding, dehydration, AKI, alcohol consumption, constipation, and certain medications. A Gastroenterology or Hepatology specialist review should ideally be sought within 24 hours of admission to the hospital. 9 Encephalopathy Look closely for a precipitant and treat accordingly!

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

EB Medicine

NOVEMBER 1, 2018

Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. In total, they pulled references from 1966 until 2018.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

SEPTEMBER 1, 2018

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. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Sheffield Children’s Hospital is a stand-alone tertiary children’s hospital in the heart of Sheffield with a paediatric MTC. mmol/L with the median of 2.6

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

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.

Sepsis 52

Sepsis Outcomes Research Shock 52

Taming the SRU

SEPTEMBER 16, 2024

Blood transfusion complications and associated factors among blood-transfused adult patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study.” Mild Reactions Transfusion Reaction Frequency Timeline Presentation Management Allergic - 1-3% with platelet and plasma components - 0.1-0.3% 2, July 2022, pp.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

EMDocs

OCTOBER 17, 2023

A 2018 risk score incorporates the presence of abdominal guarding, WBC, and CRP. Those with abdominal guarding, WBC over 20,000, and CRP over 25 mg/dL demonstrated a risk of complicated diverticulitis of over 85% (Bolkenstein 2018). Patients with complicated acute diverticulitis should be admitted to the hospital.

Radiology 87

Radiology Radiology Operations Best Practices 87

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. 2018 May;26(5):1465-1470. Neutropenic Fever: Fever (one reading of 38.3C Support Care Cancer. Clarke, R.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. There is an increased risk of pneumonia and sepsis in the 31-90 days after prescription and an increased risk of fractures, GI bleeds and sub-optimal growth.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Don't Forget the Bubbles

MAY 15, 2023

As such, thresholds for intervention remain under debate and vary across different hospitals and countries. In general, management centres around education focusing on avoiding prolonged fasts (<12hrs) and emphasising low threshold for admission to hospital if the child is not eating or is vomiting. Frontiers in Endocrinology.

Wellness 103

Wellness Seizures Hospitals Dehydration 103

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 101

Sepsis Outcomes Administration Shock 101

The Skeptics' Guide to EM

JUNE 15, 2018

[display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al. Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

EMDocs

JUNE 27, 2024

2018 Aug;46(3):144-151. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94