ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing. Interdisciplinary Neurosurgery, 13, 66-70.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

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

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. 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. The trauma call goes out.

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. This study expands upon that investigation to patients with other conditions as well. The Lancet 2018. Date: January 28th, 2019 Reference: Chu DK et al. This is Bob’s ninth visit to the SGEM.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

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 130

EKG/ECG Shock Emergency Department Ambulance Services 130

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. C., & Solomon, T.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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

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

Taming the SRU

JUNE 11, 2023

It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions. Enrollment period was from February 2016 to August 2018. It’s association with lactate and anion gap make it an attractive option for identification of critically ill patients.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

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

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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. 2018 Apr;44(4):409-417. Epub 2018 Mar 27. This is likely a combination of pre-renal and renal.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Mind The Bleep

JULY 23, 2023

Management: If well, babies with Hirschsprung’s can be managed in the first weeks-months of life with regular rectal washouts and later in life will have a pull through (Duhamel) procedure Contrast enema of a neonate with Hirschsprung’s disease. Sepsis causes an ileus or functional bowel obstruction.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

PulmCCM

NOVEMBER 11, 2021

Notably, they observed that while phenylephrine rectified hypotension, it significantly reduced heart rate [HR], SV – and, therefore, total cardiac output [CO] – as well as cerebral oxygenation [SctO2]. evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0

Stroke 40

Stroke Sepsis Administration Wellness 40

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 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

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. Let’s move on to treatment.

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. Nachi: Recurrent and late onset coagulopathy after FabAV treatment has also been well described.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Taming the SRU

SEPTEMBER 16, 2024

There are a few other factors as well that may increase risk for a transfusion reaction but are likely not readily available on patient history or are outside the physician’s control. Other factors that could be readily elicited on history include a previous abortion in women and a diagnosis of malignancy in the patient being transfused.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Infection/sepsis? Over a 10-year period from 2008 to 2018, 334 heart transplants were performed on children in the UK. What are your differentials? Bad bronchiolitis ? A metabolic issue? Inflicted injury?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Don't Forget the Bubbles

MAY 15, 2023

Previously well child? “ Pregnancy was uncomplicated and he was well after birth. Physical examination: Joey is well-grown. It usually affects children between 18 months and five years old, who are otherwise well with average growth, development and physical exam. Pregnancy was uncomplicated, and he was well after birth.

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

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

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2018 Aug;46(3):144-151. Epub 2018 Oct 17. C or 100.4 mg/kg, max 0.4

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

RCEM Learning

NOVEMBER 28, 2022

Only 50% were positioned correctly according to a survey done in 2018 7. It is important to closely monitor the patient’s haemodynamic status and repeat the pelvic x-ray post binder removal because a well-applied pelvic binder can mask fracture. When to put the pelvic binder on? Image via NG39 Fig.

Fractures 40

Fractures Blood Transfusions Sepsis Operations 40

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of this possible diagnosis, they were commenced on a macrolide antibiotic (azithromycin) in addition to treatment for neonatal sepsis +/- meningitis (ceftriaxone and acyclovir). They were a well-grown, term infant born in good condition. The Pediatric Infectious Disease Journal 37(3):p 202-205, March 2018. Pediatrics.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. What do we know about SIDS and how effective back sleep is at reducing it?

CDC 94

CDC Sepsis Research Pediatrics 94

PulmCCM

JANUARY 2, 2025

A large proportion have concluded PCT is a safe and effective method to shorten antibiotic courses, including in patients with sepsis. The ADAPT-Sepsis Trial Between 2018 and 2024 at 41 centers in the U.K., Because ADAPT-Sepsis was designed as a noninferiority trial, and the authors chose (arbitrarily) a 5.4%

Sepsis 98

Sepsis Outcomes Stroke Shock 98

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Broome Docs

JANUARY 27, 2025

PMID: 39578750 Bottom line: This is a well done observational study that demonstrates an association between cell phone use and disposition to home, but I think the complexity really highlights the difficulty of making strong conclusions from observational data, and I cant imagine that this data is at all helpful clinically. Epub 2018 Oct 25.

Sepsis 101

Sepsis Anaphylaxis Hospitals Ultrasounds 101

EMDocs

JULY 26, 2023

Mother states that the rash started as flat spots but then became raised bumps. The patient has been itching at the rash. He is otherwise normally healthy and was born at term with an uncomplicated birth history. 3 Incubation period is about 12 days (range 7-19 days). 3-4 There are no asymptomatic carriers. 3-4 There are no asymptomatic carriers.

CDC 88

CDC Research Pediatrics Wellness 88