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.

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Sepsis Pediatrics Urgent Care Emergency Department 98

Taming the SRU

APRIL 17, 2024

The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.

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Sepsis Research Stroke Academics 95

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.,

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Sepsis Pediatrics Outcomes Documentation/Coding 75

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2021; 93: 4358–4369.

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

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. The mortality rate for hospitalized patients with SSTI is <0.05% [3, 4].

Emergency Department 52

Emergency Department Sepsis Hospitals Research 52

Taming the SRU

JULY 24, 2023

He was transitioned to cefdinir and fluconazole for a full 7-day course of antibiotics and discharged from the hospital on day three, with instructions to follow up with general surgery for an outpatient cholecystectomy. In those with concern for sepsis, blood cultures, broad spectrum IV antibiotics and fluids should be given as needed.

Ultrasounds 80

Ultrasounds Sepsis Radiology Radiology 80

The Skeptics' Guide to EM

JANUARY 15, 2022

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. Date: January 16th, 2022 Reference: Matchett, G. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial.

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Sepsis Shock Emergency Department Outcomes 43

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. Maren Leibowitz, MD Critical Care Fellow Mount Sinai Hospital How To Cite This Post: [Peer-Reviewed, Web Publication] Goins, E. Peniston, H.L., Sanghavi, D., Mahapatra, S. Acute respiratory distress syndrome. StatPearls.

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Emergency Department Fractures EKG/ECG Wellness 52

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) 3] The type of IV fluid you use will vary depending on which hospital you are working in and what is available. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. How much fluid?

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Fluid Resuscitation Dehydration Hospitals Research 96

EMDocs

JULY 1, 2023

Patients should be admitted to the hospital and cardiology consulted early in their course. Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania. The Royal Children’s Hospital Melbourne. Updated January 2021. Corticosteroids are controversial and not currently recommended. Lakhani, N.

EMS 91

EMS Infectious Diseases Pediatrics Research 91

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663.

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Sepsis Ultrasounds Hospitals Fractures 52

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing. Initially in the emergency department he was generally well-appearing with normal vital signs. His rash is pictured here: He subsequently developed a fever to 38.2C Labs were notable for: WBC 9.1 Mitchell, S.,

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

ACEP Now

AUGUST 25, 2023

A new SRMA was published in 2021 that reported an associated increase in adrenal suppression and mortality with etomidate. Diversity of Patients: These were patients from a variety of settings including out-of-hospital, ED, and intensive care unit. This outcome was no longer statistically different at 28 days. Crit Care Med.

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Outcomes Emergency Department Sepsis Hospitals 52

Critical Care Now

MARCH 10, 2022

On hospital day four, CT venogram reveals cortical vein thrombosis and suboccipital vein thrombosis with extension from the right internal jugular vein, and she is incidentally found to be COVID-19 positive. 2021; 385(9):826-832. She is found to have a subdural hematoma. References Levy JH, Connors JM. N Engl J Med.

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Sepsis Hospitals 52

Sensible Medicine

MARCH 14, 2025

This comment might be one of the reasons I’ve been skeptical of sepsis screening. Sepsis screening, for me, comes in many different flavors -- from EMR alerts based on lab and vital sign data to anyone being able to draw a lactate or call an RRT. Outcomes and patients The primary outcome was 90-day in-hospital mortality.

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Sepsis Wellness Documentation/Coding Fluid Resuscitation 103

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]. 2021, October 1). It is also important to remember that the differential to hypothermia itself is broad itself and not just limited to environmental exposure.

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Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

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. The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. Patients were excluded with pre-induction hypotension defined as SBP <100 mmHg.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Don't Forget the Bubbles

MAY 28, 2024

Hence, PPHN can be idiopathic or secondary to a variety of conditions such as meconium aspiration syndrome , respiratory distress syndrome, sepsis, asphyxia and congenital diaphragmatic hernia. Great Ormond Street Hospital. Imagine being a few hours old and dealing with this). Or it could be due to a delay in circulatory transition.

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Sepsis Ultrasounds Pediatrics Research 52

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.

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Sepsis Fluid Resuscitation Resuscitation Shock 90

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. This post evaluates the recent “Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP)” trial.

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Sepsis Outcomes Administration EMS 98

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. Sheffield Children’s Hospital is a stand-alone tertiary children’s hospital in the heart of Sheffield with a paediatric MTC. mmol/L with the median of 2.6

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. The recurrence rate and length of hospital stay were the same. Patients with sepsis and immunocompromise were not included. No statistical difference in the primary outcome of hospital length of stay (40 vs 46 hours).

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Sepsis Best Practices Hospitals Outcomes 113

ALiEM

FEBRUARY 9, 2024

This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. These in the high-risk category are usually admitted to the hospital to assess for AMI as well as other causes of troponin elevation. as seen in heart failure, arrhythmias, or sepsis). 2021 May 13;:]. 2021 Jun 22;143(25):e1118].

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EKG/ECG Emergency Department Burns Wellness 110

Don't Forget the Bubbles

MARCH 31, 2025

Reviewed by Dr Faye Leggott Article 2: Does fluid overload increase mortality in children with sepsis? Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

RebelEM

SEPTEMBER 21, 2023

Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. Type 4: MI associated with percutaneous coronary intervention (Subtype 4a), or stent thrombosis (Subtype 4b). Type 5: MI associated with coronary bypass surgery.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Date: September 20th, 2021 Reference: Litell et al. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. mg/dl or 107 umol/L).

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Sepsis Emergency Department COPD Hospitals 40

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. 2021, Im, Kang et al.

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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).

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Sepsis Shock Hospitals Infectious Diseases 52

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

Taming the SRU

SEPTEMBER 16, 2024

Incidence and analysis of acute transfusion reactions in a hospital-based hemovigilance system at a tertiary care center in Bangladesh.” Blood transfusion complications and associated factors among blood-transfused adult patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study.” 11, 2 June 2021, p.

Blood Transfusions 91

Blood Transfusions Anaphylaxis Emergency Department Sepsis 91

Don't Forget the Bubbles

JULY 22, 2024

They conclude that their IPD meta-analysis shows that “ children with acute preschool wheeze who received oral corticosteroids had statistically significant improvement in WSS at 4 hours and length of hospital stay.” 2021 Apr;106(4):339–44. 2021 Jul 1;175(7):723–9. But how can we apply these findings in everyday practice?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. JAMA 2021 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in […] The post SGEM#347: It Don’t Matter to Me – Balanced Solution or Saline first appeared on The Skeptics Guide to Emergency Medicine.

Outcomes 52

Outcomes Sepsis Resuscitation Administration 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 93

Radiology Radiology Operations Best Practices 93

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. 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. However, he suddenly developed a series of malignant ventricular arrhythmias.

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EKG/ECG Shock Hospitals Sepsis 130

RebelEM

OCTOBER 31, 2022

Vitamin C can function as an antioxidant and may mitigate endothelial oxidative stress in sepsis. Amrein 2018) A small, single-center, before-and-after study utilized a sepsis cocktail consisting of IV thiamine, hydrocortisone, and vitamin C and discovered a significant decrease in mortality compared to the control group.

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Sepsis Outcomes Research Shock 52

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Population 6171 children from three hospitals in Uganda and one in Malawi were assessed for eligibility. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. Aesthetic Plastic Surgery National Databank Statistics 2020–2021.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52