Pediatric EM Morsels

APRIL 7, 2023

Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy. If Sickle Cell Disease only ever caused Vaso-Occlusive crises, it would be considered one of the most challenging conditions for patients and families to deal with.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis requiring urgent treatment. No other score provided clearly superior accuracy to NEWS2.

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Sepsis Ambulance Services Operations Hospitals 40

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. 2019 Oct;106(11):1542-1548. No evidence of sepsis. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br  Br J Surg.

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Sepsis Best Practices Hospitals Outcomes 100

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 131

EKG/ECG Shock Emergency Department Ambulance Services 131

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.

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Sepsis Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. Critical Care Medicine. Critical Care Medicine. You wonder if giving vitamin C will affect her outcome? Reference: Putzu et al.

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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. 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.

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Sepsis Shock Resuscitation Administration 52

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. In 2019, I wrote about the provocative book Elephant in the Brain --co-authored by George Mason economist Robin Hansen. Yet policies mostly escape this challenge.

Outcomes 110

Outcomes Research Sepsis Emergency Department 110

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 95

Poisoning Burns Sepsis 95

Emergency Medicine Journal

OCTOBER 23, 2024

3 Despite this the UK critical care community has been slow to accept peripheral noradrenaline; fear of extravasation injury persists in some quarters, and at a recent Investigators’ Meeting of the Early Vasopressors in Sepsis (EVIS) trial this was identified as a significant barrier to recruitment.

Sepsis 52

Sepsis Administration Shock Hospitals 52

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 134

EKG/ECG Shock Hospitals Sepsis 134

RebelEM

FEBRUARY 8, 2024

to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 for every change in 1mmHg Higher BMI: aOR 1.04; 95% CI 1.01 to 1.09; p = 0.01 for an increase in 1 Increased Patient Age: aOR 1.31; 95% CI 1.30 to 1.37; p <0.01 for every 10 years Radial Arterial Line Location: aOR 1.74; 95% CI 1.16

Resuscitation 113

Resuscitation Outcomes EMS Sepsis 113

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.

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EMS Resuscitation Blood Transfusions Seizures 107

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 95

CDC Sepsis Research Pediatrics 95

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.

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Emergency Department Blood Transfusions Resuscitation Sepsis 79

Taming the SRU

MARCH 30, 2023

Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. 7 (2019): 654-664. decreased DSI values). Circulatory shock.

Shock 52

Shock Outcomes Sepsis Resuscitation 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. 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

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.

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Sepsis Shock Wellness Documentation/Coding 96

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 Sepsis 52

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 83

Emergency Department Dehydration Burns Sepsis 83

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 103

Shock Emergency Department Pediatrics EKG/ECG 103

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

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

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 2019 Nov 1;179(11):1528-1536. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. JAMA Intern Med.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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

PulmCCM

APRIL 8, 2024

Read in Journal of Palliative Medicine New-onset atrial fibrillation provoked by sepsis: anticoagulate or not? Your elderly patient with sepsis develops new-onset atrial fibrillation that spontaneously converts to normal sinus rhythm. If so, maybe we should allow more patients to experience it.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

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

Don't Forget the Bubbles

JULY 22, 2024

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. References BTS_SIGN Guideline for the management of asthma 2019.pdf. 2019 Aug;9(8):e028511. Corticosteroids impact the child’s immune system.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

EMDocs

JULY 26, 2023

Updated October 8, 2019. McGraw-Hill; 2019. References: Meyer H, Ehmann R, Smith GL. Smallpox in the Post-Eradication Era. 2020;12(2):138. doi:10.3390/v12020138 Smallpox – For Clinicians. Accessed March 19, 2022. link] Moore ZS, Seward JF, Lane JM. 2006;367(9508):425-435. doi:10.1016/S0140-6736(06)68143-9 Delaune D, Iseni F.

CDC 80

CDC Research Pediatrics Wellness 80

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

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

Ken Grauer, MD

OCTOBER 10, 2024

. = Today's C ASE C ontinues: The patient was treated for sepsis. Figure-3: The ECG was repeated after beginning treatment for sepsis. Following treatment for sepsis — the patient improved clinically. Figure-4: Comparison of the repeat ECG with the initial ECG ( after treatment of sepsis ). What has happened?

EKG/ECG 420

EKG/ECG Sepsis Wellness 420

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 87

Emergency Department EMS Burns Wellness 87

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

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

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

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