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

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

The Skeptics' Guide to EM

DECEMBER 11, 2021

Date: December 10th, 2021 Guest Skeptic: Dr. Carly Eastin is an Associate Professor, Division of Research and Evidence Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 40

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. It is our job as clinicians to interpret what that means.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

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. The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ).

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Don't Forget the Bubbles

JANUARY 1, 2024

Data collected from 2002 to 2021 revealed a 72% decline in IPD incidence among children (<18 years), with continued reductions after the transition from PCV7 to PCV13. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Outcomes From a Randomized Clinical Trial. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. All ED visits that met the criteria for ‘new onset diabetes’ or DKA (‘decompensation’) were included.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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.

Sepsis 98

Sepsis Outcomes Administration EMS 98

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Outcomes Research 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. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

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. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2021 Sep 10;12:727962. anatomic region).

Stroke 89

Stroke EMS EKG/ECG Radiology 89

EMDocs

JUNE 27, 2024

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. 2021 Sep;194(5):899-907. Epub 2021 Jul 15. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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. Imagine being a few hours old and dealing with this). Or it could be due to a delay in circulatory transition. StatPearls Publishing.

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

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). 0.41), p < 0.001.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

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.

Sepsis 52

Sepsis Outcomes Research Shock 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

RebelEM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021. CHEST 2024. PMID: 37611862 Evans L et al.

Administration 134

Administration Sepsis EMS Shock 134

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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.

Sepsis 91

Sepsis Research Outcomes Stroke 91

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

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.

Sepsis 42

Sepsis Shock Emergency Department Outcomes 42

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. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. N Engl J Med.

Sepsis 52

Sepsis Ultrasounds Hospitals Outcomes 52

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 Administration Resuscitation 52

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 116

Resuscitation Outcomes EMS Sepsis 116

ACEP Now

AUGUST 25, 2023

2 The primary outcome was all-cause mortality at seven days and showed an eight percent absolute increase for patients allocated to the etomidate group. This outcome was no longer statistically different at 28 days. Mortality Outcome: There was a wide range of time points for all-cause mortality (24 hours to 30 days).

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

Don't Forget the Bubbles

AUGUST 21, 2023

Infection/sepsis? What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation. Outcomes at 5 years, though, are better amongst those patients admitted to intensive care. Female sex and younger age favour better outcomes.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

PulmCCM

AUGUST 21, 2023

The study was stopped in November 2021 due to the Covid-19 pandemic, at just over half of its intended enrollment, reducing its power. A larger trial of 2500 patients published in NEJM in 2022 showed no difference in outcomes among patients ventilated with high vs. low oxygenation strategies. However, it’s unlikely.

Telemedicine 88

Telemedicine CDC Sepsis Outcomes 88

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 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

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 68

Radiology Radiology Operations Best Practices 68

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. Articles removed were duplicates, contained irrelevant outcomes, or had a significant risk for bias. Patients were excluded with pre-induction hypotension defined as SBP <100 mmHg.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52