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

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

RebelEM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. References: Yerke JR et al. CHEST 2024. PMID: 37611862 Evans L et al.

Administration 137

Administration Sepsis EMS Shock 137

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

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

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

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.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

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

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

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.

Sepsis 52

Sepsis Shock Outcomes Stroke 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

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 125

EKG/ECG Shock Emergency Department Ambulance Services 125

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 115

Outcomes Research Sepsis Emergency Department 115

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 82

Poisoning Burns Sepsis 82

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

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

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 126

Resuscitation Outcomes EMS Sepsis 126

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 67

Emergency Department Blood Transfusions Resuscitation Sepsis 67

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 Outcomes 52

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 77

CDC Sepsis Research Pediatrics 77

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

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 88

Stroke EMS EKG/ECG Radiology 88

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 95

EMS Resuscitation Blood Transfusions Seizures 95

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. Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock. 2010; 36: 2019-2029. 2019; 155(1): 242. Curr Opin Crit Care. 2008;14:379-83.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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 113

EKG/ECG Shock Hospitals Sepsis 113

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

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

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 94

Shock Emergency Department Pediatrics EKG/ECG 94

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

Don't Forget the Bubbles

JUNE 30, 2023

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. 2019 Aug;31(4):683-687. d) Something else The PROPPR trial showed us that balanced ratios are important.

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

Don't Forget the Bubbles

JULY 5, 2023

Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Sickle cell patients also qualify to receive the annual influenza vaccine, since influenza virus infection predisposes to bacterial pneumonia and sepsis caused by S. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126