Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 119

Resuscitation Outcomes EMS Sepsis 119

Sensible Medicine

JULY 29, 2024

Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good. The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats.

Outcomes 105

Outcomes Research Sepsis Emergency Department 105

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. No difference in their primary outcome of complications and need for emergency surgery (1.9% Patients with sepsis and immunocompromise were not included. 2019 Oct;106(11):1542-1548. 623 patients included.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Date: September 11th, 2019 Reference: Putzu et al. You wonder if giving vitamin C will affect her outcome?

Sepsis 52

Sepsis Shock Outcomes Stroke 52

The Skeptics' Guide to EM

JUNE 6, 2020

Respir Crit Care Med 2019. Respir Crit Care Med 2019. Background: I think we have covered sepsis more often than any other topic on the SGEM. However, it has become evident that patients are often over-resuscitated with IV fluids which adversely impacts outcome. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Date: February 22nd, 2019 Reference: Lane et al. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Background: Sepsis is a serious condition with high morbidity and mortality.

Sepsis 52

Sepsis Administration Documentation/Coding 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. 2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Taming the SRU

AUGUST 30, 2023

The 2019 Journal of Arthroplasty practice guidelines to screen for periprosthetic joint infections recommend using ESR at 30mm/hr and CRP at 10mg/L, citing pooled sensitivities and specificities ranging from 75%-86% and 70-72.3%, respectively, for ESR and 88% and 73-74%, respectively, for CRP [32]. days (secondary endpoint) [51].

Infectious Diseases 87

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

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. All ED visits that met the criteria for ‘new onset diabetes’ or DKA (‘decompensation’) were included.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

Outcomes 81

Outcomes Hospitals Operations Shock 81

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. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2019 Mar 19;10:215. Epub 2019 Dec 9.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Date: January 28th, 2019 Reference: Chu DK et al. Date: January 28th, 2019 Reference: Chu DK et al. Their workup reveals a multifocal pneumonia with signs of sepsis. 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 Outcomes 52

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). There have been at least two randomized control trials published that do not support the use of Vitamin C in sepsis. no statistical difference in primary outcome of SOFA scores at 72 hours or the secondary outcome of 30-day mortality.

Sepsis 40

Sepsis Shock Outcomes Research 40

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. Paediatr Child Health. Van Rossem EJD, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

The Skeptics' Guide to EM

JANUARY 25, 2020

NEJM February 2019 Guest Skeptic: Andrew Merelman is a critical care paramedic and second year medical student at Rocky Vista University in Colorado. NEJM February 2019 Guest Skeptic: Andrew Merelman is a critical care paramedic and second year medical student at Rocky Vista University in Colorado. Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2019 Nov 1;179(11):1528-1536. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 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. However, even subclinical hypothyroidism with an elevated TSH but normal T4 increases risk of poor outcomes due to effects on cardiac function. 2010; 36: 2019-2029.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

The Skeptics' Guide to EM

APRIL 20, 2019

Date: April 17th, 2019 Reference: Little et al. Injury 2019 Guest Skeptic: Alison Armstrong is a Certified Emergency Nurse, Trauma Program Coordinator and TNCC Course Director. This was a special episode of the SGEM done live at the Talk Trauma 2019 Conference help in London, Ontario.

Emergency Nursing 40

Emergency Nursing Sepsis EMS Fractures 40

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

JUNE 27, 2024

2019 Jan 24;14:263-292. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort.

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

Emergency Medicine Ireland

OCTOBER 30, 2023

As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. Primary outcome here was kidney based rather than mortality. Nagendran 2019 in CCM. Intens Care Med 45 , 844–855 (2019). 400 pts here, no clear benefit for vaso. Jama 316 , 509–518 (2016).

Shock 52

Shock Sepsis Wellness Outcomes 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

RebelEM

FEBRUARY 2, 2023

Based on 2019 American Heart Association (AHA) guidelines, amiodarone and digoxin have been suggested as alternative options in controlling ventricular rate refractory to first-line BBs and non-DHP CCBs. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc).

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. Now there is a paper published in 2019 that proves the point beyond doubt, though makes it clear that this pattern is associated with very high mortality. American Journal of Medicine 132(5):622-630; May 2019. J Electrocardiol 2013;46:240-8 2. Harhash AA, Huang JJ, Reddy S, et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

EM Updates

JUNE 15, 2021

Every patient admitted to the EDAT was followed to the conclusion of their hospital course; the development of this unit and patient outcomes resulting from its execution are presented here. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). N Engl J Med.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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

Don't Forget the Bubbles

AUGUST 21, 2023

Infection/sepsis? What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation. Outcomes at 5 years, though, are better amongst those patients admitted to intensive care. Female sex and younger age favour better outcomes.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Don't Forget the Bubbles

SEPTEMBER 23, 2024

Consider sepsis and treat it accordingly. Consider CMV, EBV and BK-polyoma virus infections: Patients are often on prophylaxis for a variable length of time, with differing outcomes. Obesity: Obesity, whether before or after transplant, is linked to worse outcomes. CAKUT, catheterization requirement). Peruzzi, L., and Coppo, R.,

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

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 84

Sepsis Outcomes Administration Shock 84

EMDocs

JANUARY 16, 2025

Today we cover the Phoenix Sepsis Criteria. years Best performing criteria identified by AUPRC and AUROC 4-organ-system model translated into the Phoenix Sepsis Score had best mortality prediction characteristics AUPRC of 0.23-0.38 Well provide summaries of the evidence to support your decisions at the bedside. but PPV ranges from 25.1-39.5%

Sepsis 69

Sepsis Pediatrics Shock Hospitals 69