The Skeptics' Guide to EM

JUNE 6, 2020

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. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

JournalFeed

OCTOBER 3, 2020

28- Oct 2, 2020. 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. It’s the JournalFeed Podcast for the week of Sept.

Dislocations 52

Dislocations Sepsis Shock 52

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. J Crit Care 2020. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98

Resuscitation 125

Resuscitation Outcomes EMS Sepsis 125

EMDocs

MARCH 9, 2025

2020 Jun;8(6):e19.00202-e19.00202. Other children at risk for osteomyelitis include those with sickle cell disease , sepsis , an indwelling catheter , and immunodeficiency (e.g., Pediatric osteomyelitis treatment algorithm. 4 Adapted from: Gornitzky AL, Kim AE, ODonnell JM, Swarup I. JBJS Reviews. due to chronic granulomatous disease).

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

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 93

Operations Radiology Radiology Fluid Resuscitation 93

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 97

EKG/ECG Seizures Sepsis Operations 97

Taming the SRU

AUGUST 30, 2023

Pneumonia A 2020 meta-analysis of 8 studies including 2,215 adults with confirmed community acquired pneumonia in different settings found PCT with a cutoff of 0.5 Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2020 Nov 20;99(47):e23315. J Med Virol.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. 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). I’ll let that sink in. With me so far?

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Leadership 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. Troponin I rose to 44.1

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

RebelEM

NOVEMBER 3, 2022

Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% April 2020 ) RebelEM recently reviewed The EvK trial , which found a higher 7-day survival rate with ketamine but no difference in 28-day survival. April 2020 NEAR registry study represents 1/3rd the weight of this meta-analysis.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

of all cases, and 62% of Veritas® misdiagnoses). == MY Comment , by K EN G RAUER, MD ( 1/5/2020 ): == This case illustrates a number of important teaching points. In our study, even physicians' overread of the Veritas® algorithm disagreed with the reference interpretation in 38 cases (7.6%

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 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 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

PulmCCM

APRIL 10, 2025

SEPSIS Aspirin For Sepsis (ASP-SEPSIS trial) Could a simple aspirin help cure sepsis? Among 166 patients with “sepsis” who were randomized to aspirin 200 mg or placebo at five ICUs in Brazil, those receiving aspirin had no improvement in organ failure scores or other outcomes. Of course not.

CDC 40

CDC Stroke Sepsis Radiology 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Suspect LMCA with sudden shock and widespread ST elevations.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

EMDocs

OCTOBER 19, 2024

Blood cultures: Blood cultures are rarely positive; however, should be obtained if suspicion for sepsis is present or if the patient is immunocompromised. [2][3] Published 2020. ESR, CRP: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are also nonspecific but are estimated to be elevated in 68% of patients.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

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. 2021, Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 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 Infectious Diseases 52

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. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? 2020 Nov 21;41(44):4258]. Ann Emerg Med.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. 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.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

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. The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. We’ll start with sepsis.

Sepsis 52

Sepsis Shock Wellness 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

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 Academics 40

Taming the SRU

APRIL 26, 2023

Resuscitation 2020. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. J Intensive Care Med 2015. Douma MJ, Aves T, Allan KS, et al. Druyan A, Janovich R, Heled Y. Misdiagnosis of exertional heat stroke and improper medical treatment.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

RebelEM

AUGUST 12, 2024

2020 Mar 14; PMID: 32183395 Post Peer Reviewed By : Salim Rezaie, MD (Twitter/X: @Srrezaie ) The post The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection appeared first on REBEL EM - Emergency Medicine Blog. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Resuscitation Sepsis 40

PulmCCM

SEPTEMBER 23, 2021

Annals of Translational Medicine 2020, 8(12). Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Mind The Bleep

FEBRUARY 9, 2024

48 hours) to help her through the initial period of sepsis while her antibiotics take time to work. Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this? Breathing Is there evidence of respiratory failure?If Is it reversible?

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

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 Shock 52

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Sepsis indicators and malaria positivity did not modify the risk. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PulmCCM

DECEMBER 3, 2024

Maintaining a mean arterial pressure (MAP) of 65 mm Hg has been advised for patients with sepsis and other forms of vasodilatory shock. More than a dozen randomized controlled trials (RCTs) have sought to identify whether higher or lower MAP targets produce better outcomes in critically ill patients with shock.

Shock 75

Shock Sepsis Outcomes Hospitals 75

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Volume resuscitation has historically been the first-line therapy for patients in septic shock. septic shock, oncology patients), or where RV function may be compromised [19, 20] (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

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 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

Emergency Medicine Journal

FEBRUARY 21, 2025

Methods We conducted a prospective observational study of adult and paediatric patients who suffered cardiac arrest in an academic hospital ED in central Haiti from January 2019 to August 2020. Patients were identified prospectively at the time of clinical care. Results We identified 161 patients who suffered cardiac arrest in the ED.

Outcomes 40

Outcomes Emergency Department Sepsis Academics 40

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 95

Sepsis Pediatrics Shock Hospitals 95

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75