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

EMDocs

JANUARY 11, 2025

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

Taming the SRU

AUGUST 30, 2023

A 2018 USA multi-center prospective RCT involving 1,656 adult patients published in NEJM used varying PCT cut-offs to guide antibiotic initiation in the emergency department. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2018 Aug 1;10(8):a028456. ng/mL, 0.25-0.5

Infectious Diseases 89

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

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

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. N Engl J Med.

Sepsis 52

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. But this was all done in adults, and no comparable prospective trials in children exist. Trauma Surg Acute Care Open.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The Lancet 2018. The Lancet 2018. Their workup reveals a multifocal pneumonia with signs of sepsis. The Lancet 2018. Date: January 28th, 2019 Reference: Chu DK et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

[display_podcast] Date: February 14th, 2018 Reference: Venkatesh S et al. NEJM January 2018. display_podcast] Date: February 14th, 2018 Reference: Venkatesh S et al. NEJM January 2018. This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

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

Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). 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

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., In my experience, patients having a type II MI (unless caused by a tachydysrhythmia) usually have a more gradual onset of symptoms reflecting the more gradual onset of most common clinical entities associated with type II MI (e.g The patient was given aspirin and heparin.

EKG/ECG 131

EKG/ECG Shock Emergency Department Ambulance Services 131

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. 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. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 2013.

Stroke 133

Stroke Outcomes Hospitals Administration 133

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. 2018; 44(5): 652-655. Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock. 2018; 22(1):215. Intensive Care Medicine. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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

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

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. 2018 Apr 26;378(17):1573-1582. anatomic region). PMID: 34054705; PMCID: PMC8160112. Campbell BCV, Mitchell PJ, Churilov L, et al; EXTEND-IA TNK Investigators.

Stroke 107

Stroke EMS EKG/ECG Radiology 107

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. 2018:346-353.e2. Other complications include bleeding and perforation. Cholestatic Liver Diseases: A Primer for Generalists and Subspecialists.

Emergency Department 103

Emergency Department Ultrasounds EMS Radiology 103

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. A., & Koehler, P. The first lumbar puncture. PLOS ONE 13(12): e0208622. C., & Solomon, T.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

RebelEM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). 2018, PMID: 30571262 Gritsenko, Diana, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. 2, 2018, pp. 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. Circulation , 5 Nov.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

EMDocs

JULY 1, 2023

2018; 3: e41-e45. Kawasaki disease: epidemiology and etiology. In: Post TW, ed. UpToDate;2022. Accessed December 31, 2022. link] Ramphul, K., Kawasaki disease: a comprehensive review. Arch Med Sci Atheroscler Dis. link] Clinical Practice Guidelines: Kawasaki Disease. The Royal Children’s Hospital Melbourne. Updated January 2021.

EMS 84

EMS Infectious Diseases Pediatrics Research 84

Mind The Bleep

JULY 23, 2023

Medical Differentials for Bilious Vomiting: Sepsis Incidence : 22 per 1000 liver births Cause: Most commonly group B strep which has colonised the vaginal canal. Other risk factors include prolonged rupture of membranes, preterm and maternal sepsis. Sepsis causes an ileus or functional bowel obstruction. Parikh NS, I.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

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. 2018 Apr;44(4):409-417. Epub 2018 Mar 27. Remember, we can add more if needed, but taking it away is much harder. Intensive Care Med. doi: 10.1007/s00134-018-5147-3. PMID: 29589054; PMCID: PMC5924672.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Taming the SRU

JUNE 11, 2023

Enrollment period was from February 2016 to August 2018. Comparing quick sequential organ failure assessment scores to end-tidal carbon dioxide as mor- tality predictors in prehospital patients with suspected sepsis. All patients 18 years and older, with and ESI designation 2-4 were included. Hunter CL, Silvestri S, Ralls G, et al.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

The Skeptics' Guide to EM

APRIL 20, 2019

The article was called “A lexicon for gender bias in academia and medicine: Mansplaining is the tip of the iceberg” It was published in the December 2018 edition of the BMJ. Esther Choo et al. Theme music is an important part of the SGEM.

Emergency Nursing 40

Emergency Nursing Sepsis EMS Fractures 40

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

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

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 Yamazaki T, Shimada Y, Taenaka N, Oshumi H, Takezawa J, Yoshiya I: Circulatory responses to afterloading with phenylephrine in hyperdynamic sepsis. Yamazaki et al.

Stroke 40

Stroke Sepsis Administration Wellness 40

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.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Dr. Smith's ECG Blog

APRIL 15, 2019

A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis. Although the quality is suboptimal, it appears to me to show a hyperdynamic heart and possibly and apical wall motion abnormality.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

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%

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

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. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

MAY 19, 2020

pulmonary embolism, sepsis, etc.), Shark Fin morphology has been discussed a number of times on Dr. Smith’s ECG Blog ( For review — See the June 11, 2018 post and the January 24, 2020 post , to name just 2 instances ). The diagnosis of MINOCA should exclude: 1) other overt causes for elevated troponin (e.g., myocarditis).

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Mind The Bleep

MAY 12, 2023

These include infection & sepsis, GI bleeding, dehydration, AKI, alcohol consumption, constipation, and certain medications. PMID: 33067334; PMCID: PMC7788190 NICE Technology Appraisal guidance – TA337 (March 2015; reviewed June 2018): Rifaximin for preventing episodes of overt hepatic encephalopathy. 2021 Jan;70(1):9-29.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

EB Medicine

NOVEMBER 1, 2018

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. 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