Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Identify the percentage of children whose heart or respiratory rate would exceed the “severe” cut-off from the UK Sepsis Trust and NICE guidelines.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

The Skeptics' Guide to EM

OCTOBER 14, 2023

We have been reading online about something called sepsis that can be deadly. Does he have sepsis?” Specifically, heart rate and respiratory rates are used in early attempts to detect sepsis. His parents look at the monitor and ask you, “Is that heart rate normal for him? It seems awfully high. A prospective study.

Pediatrics 89

Pediatrics Sepsis Urgent Care Emergency Department 89

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. After 40ml/kg of IV 0.9% The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Pediatric EM Morsels

FEBRUARY 2, 2024

However, the destination of travel is also important as helminths have distinct geographical distribution. Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

JournalFeed

OCTOBER 3, 2020

28- Oct 2, 2020. It’s the JournalFeed Podcast for the week of Sept. We cover the new ACEP opioid policy statement, PE response teams during COVID-19, a SMART balanced fluid trial spin-off in septic shock, an AHA statement on drug-induced arrhythmia, and use of POCUS for shoulder dislocation.

Dislocations 52

Dislocations Sepsis Shock 52

JournalFeed

AUGUST 1, 2020

Here is the JournalFeed Podcast for the week of July 27-31, 2020. We cover pros and cons of antibiotics for dog bites, risk of delayed antibiotics in severe infection, immediate (<1h) vs early (<3h) antibiotic outcomes, and the largest meta-analysis to date on POCUS for cellulitis vs abscess.

Sepsis 52

Sepsis Outcomes 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

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 ). These cases provide insight to assessment for MAT: The January 5, 2020 post in Dr. Smith’s ECG Blog — for an example of MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Date: June 2nd, 2020 Reference: Permpikul et al. Background: I think we have covered sepsis more often than any other topic on the SGEM. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019. Respir Crit Care Med 2019.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

Sensible Medicine

AUGUST 14, 2024

This sort of sepsis would produce many of the common autopsy findings. The CDC reports that in the US in 2020 there were 93 Sudden Unexpected Infant Deaths per 100,000 live births (Fig. million babies born in 2020, and the CDC reports there were about 1,389 SIDS deaths. Subscribe now How Many Infants Die of SIDS?

CDC 77

CDC Sepsis Research Pediatrics 77

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. N Engl J Med. 2023;388(6):499-510. 2019, Bauer, Gerlach et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 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 106

Sepsis Fluid Resuscitation Resuscitation Administration 106

EMDocs

JANUARY 9, 2024

McGraw Hill; 2020. Food and Waterborne Illnesses. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. Accessed August 28, 2022. link] Zafren K, Thurman R, Jones ID. Marine Dermatitis. In: Knoop KJ, Stack LB, Storrow AB, Thurman R.

Poisoning 82

Poisoning Burns Sepsis 82

EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., 2020 Aug;59(2):216-223. The key is a patient who is on an AV nodal blocker and who has some sort of risk factor for renal insufficiency.

Shock 87

Shock Dehydration Sepsis EKG/ECG 87

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. Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 40

PulmCCM

NOVEMBER 27, 2023

More recently, another late-career scientist caught a strange fever for high-dose vitamin C, this time as a treatment for sepsis, based on his anecdotal experiences as a treating physician at a Virginia health system. Vitamin C was also tested during the Covid-19 pandemic, in two separate randomized trials (REMAP-CAP and LOVIT-COVID).

Sepsis 52

Sepsis Shock Administration Outcomes 52

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

The Skeptics' Guide to EM

MAY 9, 2020

Date: May 9th, 2020 Guest Skeptic: Dr. Sean Moore is an Assistant Professor at the Northern Ontario School of Medicine (NOSM), Chief of Emergency Services at Lake of the Woods Hospital in Kenora, Medical director with Ornge, and Associate Medical Director with CritiCall Ontario. April 11th, 2020 * Tang et al. AEM May 2020.

Sepsis 40

Sepsis EMS Research Operations 40

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. Salim Rezaie, “Thrombolysis in Acute Ischemic Stroke: Now We Have No Positive RCTs”, REBEL EM blog, July 27, 2020. 2020 Feb;19(2):115-122.

Stroke 88

Stroke EMS EKG/ECG Radiology 88

Emergency Medicine Ireland

OCTOBER 16, 2023

We’ll start with sepsis. Sepsis is a state of low systemic vascular resistance leading to reduced preload and afterload in the heart. Echocardiogr Mt Kisco N Y 37 , 822–831 (2020). We’ll start with sepsis. Perhaps it’s best to start by identifying contexts where we should be on the look out for this.

Sepsis 52

Sepsis Shock Wellness 52

Don't Forget the Bubbles

JANUARY 1, 2024

During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. Pawlowski TW, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

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. Mintegi, S., & Country Leads (2020). Bressan, S., Buonsenso, D., Farrugia, R., Oostenbrink, R., Titomanlio, L., Nijman, R.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Dr. Smith's ECG Blog

JUNE 26, 2023

As I discuss in detail in My Comment at the bottom of the page in the May 24, 2020 post in Dr. Smith's ECG Blog — AV dissociation is not the same as AV block. Most occurrences are associated with events such as sepsis, shock, recent infarction, post-operative state, electrolyte disturbance — or "sick patient".

EKG/ECG 79

EKG/ECG Seizures Sepsis Operations 79

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. Accessed March 6, 2024. Aesthet Surg J.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

ACEP Now

OCTOBER 30, 2023

Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. Published September 16, 2020. The inverse is also true; what’s normal for most may be significantly abnormal for that patient and be the first red flag. One commonly used example is tachycardia. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

Dr. Smith's ECG Blog

OCTOBER 12, 2023

The patient was admitted with a suspicion of sepsis. We review ECG findings in Takotsubo Cardiomyopathy in the March 25, 2020 post of Dr. Smith's ECG Blog. What do you think? ECG#1 - day 1 The above ECG shows sinus rhythm with a narrow QRS and normal axis. There is Brugada type I STE in lead V1-V2.

EKG/ECG 102

EKG/ECG Hospitals Sepsis Wellness 102

The Skeptics' Guide to EM

JANUARY 25, 2020

Date: January 9th, 2020 Reference: Casey et al. Date: January 9th, 2020 Reference: Casey et al. Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults.

EMS 40

EMS Airway Management Administration Resuscitation 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. Eur J Heart Fail 22, 584–603 (2020). Type 4 is again renocardiac with the kidneys causing the heart failure but on a chronic basis. With me so far? With me so far?

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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 112

EKG/ECG Shock Hospitals Sepsis 112

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. Circulation , 45 (3), 703–722.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Thinking Critical Care

NOVEMBER 28, 2021

Essentially the F2F conference will be 100% interactive, as the long conversations are meant to address the topics that don’t lend themselves well to, or require hands-on workshops (eg sepsis and complex hemodynamics). If all goes well the remainder of the live registration cost will be required 4 weeks prior to the event.

Sepsis 52

Sepsis Airway Management Wellness Resuscitation 52

Don't Forget the Bubbles

FEBRUARY 12, 2024

Complications include corneal ulceration, meningitis, or sepsis. Swabs should be sent for (urgent) gram stain and culture, and the baby should be started immediately on IV cefotaxime. Chloramphenicol drops can also be given. What do the guidelines say about the management of infective conjunctivitis in children? cks.nice.org.uk/topics/conjunctivitis-infective/management/management-in-primary-care/

Sepsis 59

Sepsis 59

Thinking Critical Care

MAY 18, 2023

To everybody outside Glasgow glucocorticoids seemed to be the answer and Chicago surgeon William Schumer was their chief flag waver, claiming in 1976 that steroid therapy reduced the mortality of saline-treated sepsis in his service from 33% to around 10%. [5] We did not achieve a publishable consensus until 2020. 10.1016/j.jcrc.2023.154317

Shock 40

Shock Research Sepsis Resuscitation 40

Don't Forget the Bubbles

JUNE 10, 2024

Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia. How do we diagnose necrotising enterocolitis? ANZNN Annual Report.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Northwestern EM Blog

FEBRUARY 14, 2022

This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation. Published online October 21, 2020. But what does that mean to us clinically in the ED and ICU? 2021;159(2):596-605. doi:10.1016/j.chest.2020.08.2074 J Emerg Med.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52