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. There is now some flow in the LMCA!

EKG/ECG 125

EKG/ECG Shock Emergency Department Ambulance Services 125

ALiEM

FEBRUARY 9, 2024

Let’s apply the ESC 2020 0/1 hour pathway [2], with some modifications based on the 2022 ACC guidelines [1]: Figure 1. Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

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

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

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

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

EMDocs

OCTOBER 19, 2024

Leukocytosis, as well as mild leukopenia, are common. 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. 2][3] Evaluation Labwork CBC: A white blood cell count is variable and nonspecific.

EMS 86

EMS Pediatrics Sepsis Airway Management 86

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

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. million babies born in 2020, and the CDC reports there were about 1,389 SIDS deaths.

CDC 77

CDC Sepsis Research Pediatrics 77

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. Tachycardia may be present both from many medications or drugs, as well as withdrawal. 2020 Nov 21;41(44):4258]. In short: yes, but it depends.

Shock 94

Shock Emergency Department Pediatrics EKG/ECG 94

Mind The Bleep

SEPTEMBER 12, 2023

Were there any risk factors for sepsis? Increased work of breathing with grunting and tachypnoea could be due to sepsis, hypoglycaemia or acidosis due to an inborn error of metabolism. Birth History How long was the labour? Postnatal History Ask about respiratory effort since birth.

Sepsis 52

Sepsis Seizures Poisoning Wellness 52

PulmCCM

NOVEMBER 27, 2023

Based on these findings, most intensivists will likely continue the well-established practice of not administering beta-blockers to patients with septic shock requiring vasopressors. To increase power, investigators “harmonized” (combined) the trials, which each enrolled patients during 2020-2022.

Sepsis 52

Sepsis Shock Administration Leadership 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 66

Operations Radiology Radiology Fluid Resuscitation 66

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Mintegi, S., & Country Leads (2020). Which patients were involved? Bressan, S.,

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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 days (secondary endpoint) [51].

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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. But of course you’ll only be doing this after a high quality, well interpreted echo that shows a hyperdynamic LV so that should give you a little reassurance. Chauvet, J.-L.

Sepsis 52

Sepsis Shock Wellness 52

Don't Forget the Bubbles

NOVEMBER 6, 2024

Digital Detox and Well-Being. Survival of Infants Born at 22 to 25 Weeks’ Gestation Receiving Care in the NICU: 2020-2022. Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort. Trends in C-Reactive Protein Use in Early-onset Sepsis Evaluations and Associated Antibiotic Use.

Pediatrics 59

Pediatrics Sepsis Fractures Hospitals 59

ACEP Now

OCTOBER 30, 2023

Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

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. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now.

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Sepsis Shock Wellness Documentation/Coding 96

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Pawlowski TW, et al. Eur J Pediatr. Weiss SL, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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

EM Updates

JUNE 15, 2021

In the last week of March and first week of April 2020, hospitals across New York City were overwhelmed with critically ill COVID-19 patients, many of whom had unprecedented oxygen requirements. From April 6 to May 3, 2020, 90 patients were admitted to the EDAT. The study was approved by the MMC institutional review board.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Dr. Smith's ECG Blog

OCTOBER 12, 2023

The patient was admitted with a suspicion of sepsis. The ECG could as well fit with acute myopericarditis. 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.

EKG/ECG 104

EKG/ECG Hospitals Sepsis Wellness 104

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. The patient was already intubated and sedated.

EKG/ECG 113

EKG/ECG Shock Hospitals Sepsis 113

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Mind The Bleep

SEPTEMBER 17, 2024

Management The management is guided by the examination findings which are covered in the respective chapter, this section will delve into the importance of a number of those steps, as well as further long-term care. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. link] Jakeman, M., Owczarczak-Garstecka, S.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Pediatric Education

DECEMBER 17, 2023

He complained of neck stiffness, nausea without emesis and general malaise as well. The patient was clinically well enough 5 days later to be discharged and all bacterial testing was negative. Imported rickettsial infections to the United Kingdom, 2015-2020. Rickettsioses in Children – A Review. Indian J Pediatr.

Infectious Diseases 40

Infectious Diseases Pediatrics Sepsis Wellness 40

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. Dacryocystitis.

Emergency Department 87

Emergency Department EMS Burns Wellness 87

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2020 Jul 3;1(5):898-907. This month, we are discussing the medical management of patients with mild to moderate agitation.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. Trends in Reasons for Human Papillomavirus Vaccine Hesitancy: 2010-2020. Paediatr Child Health. 2023 May 16;28(3):184-202. Van Rossem EJD, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2020 Feb 12;10(1):2470. C or 100.4 mg/kg, max 0.4 C or 100.4 mg/kg, max 0.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

EMDocs

JULY 29, 2023

September 9, 2020. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial surgeons. 2002;60(4):446-448. doi:10.1053/joms.2002.31234

EMS 70

EMS Dehydration Ultrasounds Emergency Department 70

PulmCCM

FEBRUARY 28, 2022

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. 45% of patients were admitted to the ICU directly from operating or recovery rooms, 79% were mechanically-ventilated and 42% had sepsis. On the other hand, those randomized to 0.9%

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. Seven provided individual participant data (1728 children between 12-71 months) for the IPD meta-analysis.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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. Groups were well matched at baseline. Were the study groups similar at the start of the trial?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Mind The Bleep

FEBRUARY 9, 2024

48 hours) to help her through the initial period of sepsis while her antibiotics take time to work. She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. References and further reading Smith G, Nielsen M.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52