ALiEM

FEBRUARY 9, 2024

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 13;:]. 2021 May 13;:].

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

EMDocs

JANUARY 11, 2025

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

Don't Forget the Bubbles

MAY 6, 2024

This multicentre retrospective cohort study looked at 202 children in California aged 1- 24 months who presented acutely between 2010 and 2021. Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Each patient was scored using the four sepsis tools. Schlapbach, L.J.,

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

OCTOBER 23, 2021

Date: October 20th, 2021 Reference: Talan et al. Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections. Date: October 20th, 2021 Reference: Talan et al. He has no fever, and his white blood cell count is 12,500. Reference: Talan et al.

Emergency Department 52

Emergency Department Sepsis Hospitals Research 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. What can you do from the Emergency Department if suspected?

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Broome Docs

AUGUST 2, 2022

Vitamin C in sepsis: STOP IT, we do not LOVE IT Lamontagne F, Masse MH, Menard J, et al; LOVIT Investigators and the Canadian Critical Care Trials Group. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. PMID: 35704292 Bottom line: Sepsis is not treated with vitamins. Epub 2021 Dec 7. N Engl J Med.

Sepsis 52

Sepsis Emergency Department Radiology Radiology 52

Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). World J Emerg Surg 13, 9 (2018).

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

The Skeptics' Guide to EM

JANUARY 15, 2022

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Reference: Matchett, G.

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

Downeast Emergency Medicine

DECEMBER 9, 2021

Case presentation A 37-year-old female with a history of mild intermittent asthma, hepatitis C, and opioid abuse disorder (in remission for the past year being maintained on buprenorphine) presents to the emergency department after being called due to positive blood cultures. Arrow highlighting the small pericardial effusion.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Sepsis 52

EMDocs

JANUARY 25, 2025

PCP Pneumonia, Sepsis) can be discharged with initiation of Antiretroviral Therapy in consultation with Infectious Disease (ID) physician with full ID evaluation outpatient. A 45-year-old outdoor enthusiast presents to the emergency department with fever, headache, myalgias, and malaise. No rash is identified. link] Lu, W.,

EMS 80

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Emerg Med J. 2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. N Engl J Med. 2023 Jan 21. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. HOW DOES TREATMENT BETWEEN INFANTS (< 1 year old) AND ADULTS DIFFER?

Emergency Department 87

Emergency Department EMS Burns Wellness 87

EMDocs

JULY 26, 2023

Mother states that the rash started as flat spots but then became raised bumps.

CDC 80

CDC Research Pediatrics Wellness 80

RebelEM

NOVEMBER 3, 2022

What They Did: Performed a search of the following databases: Pubmed, Embase, Cochrane, and ClinicalTrials.gov up to and including June 1, 2021. Included studies assessed patients in the emergency department and prehospital setting, which limits the external validity to other treatment areas such as the ICU.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Sepsis indicators and malaria positivity did not modify the risk. 29842 Global status report on blood safety and availability 2021: World Health Organization. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Don't Forget the Bubbles

JUNE 30, 2023

In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. In 2021, Kulvatunyou, Bauman and colleagues compared the insertion of traditional 28-32Fr chest tubes with 14Fr pigtail catheters for drainage of traumatic haemothorax. Is he going to be OK?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

DECEMBER 18, 2023

Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician.

Sepsis 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. 2021 Jun;31(6):713-719. Epub 2021 Apr 11. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS).

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line.

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. The other important moment to always think of the heart (sorry, cardiologists, I don’t think about the heart 24/7) is when a collapsed neonate presents to your emergency department, especially if blood pressure is present.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Taming the SRU

APRIL 26, 2023

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Evidence-Based Heatstroke Management in the Emergency Department. West J Emerg Med 2021. West J Emerg Med 2021. Intensive Care Med 2012. Pileggi DJ, Cook AM.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Taming the SRU

SEPTEMBER 16, 2024

In the era of modern medicine, blood transfusions are commonplace, especially in the emergency department. While they are a lifesaving staple of medicine, they also come with risks that emergency providers must be aware of. 11, 2 June 2021, p. 389–398, [link] Peyrony, Olivier, et al. Journal of Clinical Medicine , vol.

Blood Transfusions 89

Blood Transfusions Anaphylaxis Emergency Department Sepsis 89

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. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med.

Stroke 101

Stroke EMS EKG/ECG Radiology 101

PEMBlog

OCTOBER 18, 2023

Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. She did have a remote history of oral cold sores but no recent lesions. His rash is pictured here: He subsequently developed a fever to 38.2C Labs were notable for: WBC 9.1

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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. 2021, Jarczak, Kluge et al. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

JUNE 27, 2024

2021 Sep;194(5):899-907. Epub 2021 Jul 15. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 Am J Hematol.

Pediatrics 88

Pediatrics Dehydration EMS Hospitals 88

Mind The Bleep

SEPTEMBER 17, 2024

Introduction Patients regularly present to the emergency department with animal bites. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. Sci Rep 11, 1767 (2021). This article aims to help guide you through managing these patients and what factors you might want to consider. Tulloch, J.S.P.,

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

EMDocs

JULY 15, 2023

sepsis), immunocompromised patients, IV drug users, patients with prosthetic heart valves or any intravascular device Clinical features may not abe enough to differentiate erysipelas from cellulitis, and in such cases the treatment should be targeted towards cellulitis Labs No laboratory evaluation is required for the diagnosis of erysipelas.

EMS 76

EMS Infectious Diseases Shock Ultrasounds 76

ACEP Now

AUGUST 25, 2023

Case A critically ill patient presents to the emergency department (ED) requiring an emergent, definitive airway. A new SRMA was published in 2021 that reported an associated increase in adrenal suppression and mortality with etomidate. This outcome was no longer statistically different at 28 days. Crit Care Med.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. 2023 Oct 1;39(10):735-8. What’s it about?

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. This is true in life-threatening conditions such as sepsis. Hibberd, O.;

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. These centres have a close relationship with their patients, but this does not mean they may not turn up at your emergency department! Consider sepsis and treat it accordingly. How does your differential diagnosis change?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EMDocs

OCTOBER 17, 2023

American Gastroenterological Association (2021) Best Practice Advice 1: Computed tomography should be considered to confirm the diagnosis of diverticulitis in patients without a prior imaging-confirmed diagnosis and to evaluate for potential complications in patients with severe presentations. 2021 Mar 24;372:n72. Am Fam Physician.

Radiology 79

Radiology Radiology Operations Best Practices 79

RebelEM

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 In 2021, Buckley et. Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. 3 The same year, Ross et.

Sepsis 98

Sepsis Outcomes Administration Shock 98