Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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

Sensible Medicine

AUGUST 14, 2024

The death has an “unknown cause” rather than SIDS if the investigation or autopsy is missing, or an alternative diagnosis cannot be ruled out (see Duncan and Byard, 2018 , p. This sort of sepsis would produce many of the common autopsy findings.

CDC 77

CDC Sepsis Research Pediatrics 77

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.” This should be suspected in patients with intraoperative cardiac arrest or shock.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

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! An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 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

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. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. 2018 Apr;44(4):409-417. Epub 2018 Mar 27. Ann Intensive Care.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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 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. Am J Cardiol 2013. PMID: 23102885 Aykan AC et al.

Stroke 137

Stroke Outcomes Hospitals Administration 137

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Pneumococcal sepsis B. Pneumococcal sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 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. Trauma Surg Acute Care Open.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

JUNE 27, 2024

2018 Aug;46(3):144-151. Epub 2018 Oct 17. -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 0.4 PMID: 35788790.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

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 65

EMS Infectious Diseases Pediatrics Research 65

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. Troponin I rose to 44.1

CPR 52

CPR EKG/ECG Shock Ultrasounds 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 52

EKG/ECG Sepsis Documentation/Coding Shock 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. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 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. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. was sensitive for 28-day mortality in sepsis.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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

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. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. First are pregnant patients.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. In 2021, Buckley et. 3 The same year, Ross et. JAMA Intern Med.

Sepsis 84

Sepsis Outcomes Administration Shock 84

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. 2018 May;26(5):1465-1470. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Neutropenic Fever: Fever (one reading of 38.3C Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

The Skeptics' Guide to EM

JUNE 15, 2018

[display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52