Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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. Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Am J Emerg Med.

Sepsis 119

Sepsis Fluid Resuscitation Resuscitation Administration 119

EMDocs

JANUARY 9, 2024

McGraw Hill; 2019. link] Fil LJ, Tunik MG. Food Poisoning. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Goldfrank’s Toxicologic Emergencies, 11e. Accessed August 28, 2022. link] Waldor MK, Ryan ET. Cholera and Other Vibrioses. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J.

Poisoning 83

Poisoning Burns Sepsis 83

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. It was Dr. Paul Marik who has been a big advocate for Vitamin C sepsis. Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 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

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. ETCO 2 correlates with blood pressure, lactate, and base excess in critically ill patients. Further Reading : [link] [link] References: Long B, Koyfman A, Vivirito MA. Ann Emerg Med. 2017;70(5):758.

Emergency Department 68

Emergency Department Blood Transfusions Resuscitation Sepsis 68

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. Most SIDS babies have congested lungs, and 75% have a history of a recent cold, or an existing cold. Up to 81% have Clostridium perfringens enterotoxin in their intestinal tracts , compared with 20% of healthy controls.

CDC 71

CDC Sepsis Research Pediatrics 71

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. This post evaluates the recent “Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP)” trial.

Sepsis 98

Sepsis Outcomes Administration EMS 98

Taming the SRU

AUGUST 27, 2024

Mortality rates related to bullous skin lesions are typically related to disruption of the skin barrier and include subsequent dehydration, electrolyte imbalances, hypothermia, increased metabolic needs, and secondary infection leading to bacteremia and/or sepsis. J Am Acad Dermatol 2019; 81:686.

Emergency Department 82

Emergency Department Dehydration Burns Sepsis 82

PulmCCM

MARCH 1, 2022

General topics include: sepsis, resuscitation, COVID and ventilation, advanced hemodynamics, advanced POCUS, with spotlights on nephrology, general surgery, POCUS for hospitalists and lots else. For my previous H & R offerings, please see these old posts from 2018 , 2019 [ IVC , Doppler , ventilator waveforms ] and 2020.

Ultrasounds 40

Ultrasounds Resuscitation Sepsis 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. 2019 Mar 19;10:215. Epub 2019 Dec 9. anatomic region). Available at: [link]. Baek JH, Kim BM, Heo JH, et al. Front Neurol. doi: 10.3389/fneur.2019.00215.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

EMDocs

JUNE 22, 2024

“Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” “Amniotic fluid embolism: diagnosis and management.” ” Am J Obstet Gynecol 215(2): B16-24. link] j.ajog.2016.03.012 2016.03.012 Patel, P., ” Clin Appl Thromb Hemost 25: 1076029619843338.

EMS 96

EMS Resuscitation Seizures Blood Transfusions 96

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). A Nonconcurrent Cohort Study. Ann Emerg Med. 2017;70(3):268-276.e2.

Shock 95

Shock Emergency Department Pediatrics EKG/ECG 95

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. Nagendran 2019 in CCM. Intens Care Med 45 , 844–855 (2019). As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis.

Shock 52

Shock Sepsis Wellness Outcomes 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

Dr. Smith's ECG Blog

JULY 21, 2024

The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy. Unfortunately, he required re-intubation a few days later due to respiratory distress from severe bilateral pneumonia.

EKG/ECG 108

EKG/ECG Shock Hospitals Sepsis 108

Intensive Blog

MARCH 11, 2024

multi organ dysfunction, severe sepsis, age, frailty, co-morbidities) What investigations and treatment has the patient had to date? What information are you going to relay? Show answer It’s important to establish the patient’s suitability for ECMO. Are there any contraindications? What has been the patient’s trajectory?

Hospitals 69

Hospitals Radiology Radiology Sepsis 69

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

The Skeptics' Guide to EM

MAY 9, 2020

Steroids * Surviving Sepsis Campaign : guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. AEM May 2020. Intensive Care Med. 2020 Mar 28.

Sepsis 40

Sepsis EMS Research Operations 40

Emergency Medicine Ireland

DECEMBER 3, 2020

2019 Feb;38(1):48-79. ESPEN immediately embarks on a new cold war with their American colleagues by rejecting something like the NUTRIC score as definition of critical illness malnutrition stating nothing has been particularly well validated as yet. The acute phase has an early period of instability and pressor use. doi: 10.1016/j.clnu.2018.08.037.

Burns 52

Burns Sepsis EMS Wellness 52

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.

Administration 52

Administration Poisoning Hospitals Outcomes 52

Emergency Medicine Ireland

JULY 3, 2023

Type 5 is the big bucket where they put all the left over disease that cause both kidney and heart failure eg things like amyloid, or sepsis or cirrhosis. Circulation 139, e840–e878 (2019). Type 4 is again renocardiac with the kidneys causing the heart failure but on a chronic basis. With me so far? – Mullens, W., Verbrugge, F.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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]. It is also important to remember that the differential to hypothermia itself is broad itself and not just limited to environmental exposure. Hamilton, R. Joglar, J. Marine, J.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

ACEP Now

MAY 9, 2024

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. 7 The impact of this latest set of regulations on the complication rate has yet to be reported.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 Journal of clinical monitoring and computing 2019, 33(3):377-384. A lesser-known investigation from nearly 40 years ago offers one explanatory model. Yamazaki et al.

Stroke 40

Stroke Sepsis Administration Wellness 40

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

Don't Forget the Bubbles

MAY 31, 2023

We have a ringside view in the Children’s Emergency Department – the unique opportunity to see different types of acute presentations, whether DKA, sepsis or asthma, amongst a host of febrile children.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Updated 2019 Mar 14]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Elsevier,2019,Pages 580-597. HOW DOES TREATMENT BETWEEN INFANTS (< 1 year old) AND ADULTS DIFFER? Taylor RS, Ashurst JV.

Emergency Department 86

Emergency Department EMS Burns Wellness 86

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

EMDocs

JUNE 27, 2024

2019 Jan 24;14:263-292. -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 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). The patient was given aspirin and heparin.

EKG/ECG 99

EKG/ECG Shock Emergency Department Ambulance Services 99

Pediatric EM Morsels

NOVEMBER 17, 2023

2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. 2022 Apr;29(4):406-414. doi: 10.1111/acem.14431. West J Emerg Med. 2023 Apr 28;24(3):579-587. doi: 10.5811/westjem.59560.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

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

SEPTEMBER 18, 2023

This is true in life-threatening conditions such as sepsis. However, when children do not have features of sepsis, oral antibiotics are equally effective. The take home is that although IV antibiotics are key in sepsis management, oral antibiotics are equally as effective as IV antibiotics for children without critical illness.

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143