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

PulmCCM

MAY 16, 2024

The FDA approved the first-ever AI-powered electronic medical record-based prediction model for sepsis: The Sepsis Immunoscore, by Prenosis. If you look under the hood, it suffers from the same fundamental limitation as all the rest: the lack of a reference standard (gold standard) for diagnosing sepsis.

Sepsis 52

Sepsis Operations Hospitals 52

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 137

Administration Sepsis EMS Shock 137

EMDocs

JUNE 15, 2024

. #2: From the Doorway – How Accurate Is Physician Gestalt in Sepsis? Spoon Feed Physician gestalt significantly outperformed existing sepsis screening tools (SIRS, qSOFA, SOFA, and MEWS) in identifying sepsis early in critically ill, undifferentiated patients’ ED courses. JAMA Netw Open. 2024 Apr 1;7(4):e247373.

Sepsis 98

Sepsis Emergency Department 98

Pediatric EM Morsels

NOVEMBER 17, 2023

2021 Jun;31(6):713-719. Epub 2021 Apr 11. References : To YH, Ong YG, Chong SL, Ang PH, Bte Zakaria ND, Lee KP, Pek JH. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. doi: 10.1111/pan.14185. PMID: 33774880. Acad Emerg Med. 2022 Apr;29(4):406-414.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

JournalFeed

JUNE 12, 2021

It’s the JournalFeed Podcast for the week of Jun 7-11, 2021. We cover overuse of antibiotics for ED sepsis alerts, HEART or EDACS with hs-cTn 0-1 hour rule outs, ED-AWARENESS - paralysis awareness after RSI, thoracentesis or chest tubes in coagulopathic patients, and a review on managing the difficult airway.

Sepsis 52

Sepsis 52

JournalFeed

APRIL 24, 2021

It’s the JournalFeed Podcast for the week of Apr 19-23, 2021. We cover leadership through change, IN midazolam for pediatric seizure, hypothermia and young infant sepsis risk, VICTAS RCT, and clinically diagnosing GHB intoxication.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures Sepsis Leadership 52

Emergency Medicine Cases

MARCH 1, 2022

The post EM Quick Hits 36 – Surviving Sepsis, Angle Closure Glaucoma, Bougies, Frostbite, Hot/Altered Patient, Central Cord Syndrome appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis EMS Fluid Resuscitation Hyperthermia / Hypothermia 52

JournalFeed

DECEMBER 25, 2021

It’s the JournalFeed Podcast for the week of December 20-24, 2021. We cover Surviving Sepsis 2021, BOUGIE RCT, the role of humor in medical education, the age old question of rocket science vs brain surgery (who is smarter), and a Christmas reflection.

Sepsis 52

Sepsis 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

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. 2021 Nov 1;274(5):e435-e442. No evidence of sepsis. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br  Br J Surg.

Sepsis 114

Sepsis Best Practices Hospitals Outcomes 114

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. Prevalence and risk factors of cytopenia in hiv-infected patients before and after the initiation of haart. BioMed Research International, 2020, 1-10. link] Lu, W.,

EMS 96

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 96

Emergency Medicine Journal

APRIL 22, 2024

Intra-abdominal infections are the second most common source of severe sepsis and successful treatment relies on early intervention and appropriate resources. 4 5 We examined intra-abdominal infection-related mortality trends from 1999 to 2021, which encompasses the COVID-19 pandemic.

Sepsis 52

Sepsis 52

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. Date: September 20th, 2021 Reference: Litell et al. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

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.

Sepsis 98

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.

Sepsis 94

Sepsis Research Stroke Academics 94

EMergucate

OCTOBER 19, 2021

The ECG below is from a 66 year old diabetic man who has presented with sepsis. Interpretation Rate: 72 Rhythm: … Continue reading →

EKG/ECG 52

EKG/ECG Sepsis 52

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

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

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In 2021, the Surviving Sepsis Campaign International Guidelines advised clinicians to administer antimicrobials within 1h and 3h to sepsis patients with and without shock respectively. We aim to evaluate whether the timing of antibiotic administration in admitted sepsis patients affects mortality.

Sepsis 40

Sepsis Administration Shock 40

Don't Forget the Bubbles

APRIL 22, 2024

Sepsis: The spread of infection through the bloodstream, known as sepsis, is a critical condition that can lead to organ failure and death if not promptly treated. 2021 Jan 2;40(1):18-23. 2021 Dec;21(1):1-7. 2021 Feb 15;37(5):482-7. Isaza G, Arora S. Clinical and Investigative Medicine. 2013 Jun 1:E158-62.

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

EMDocs

JANUARY 9, 2024

McGraw Hill; 2021. Accessed August 28, 2022. link] Zafren K, Thurman R, Jones ID. Marine Dermatitis. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed August 25, 2022. link] Fil LJ, Tunik MG. Food Poisoning. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS.

Poisoning 105

Poisoning Burns Sepsis 105

ALiEM

FEBRUARY 9, 2024

This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. as seen in heart failure, arrhythmias, or sepsis). 2021 May 14;42(19):1908] [published correction appears in Eur Heart J. 2021 May 14;42(19):1925] [published correction appears in Eur Heart J. 2021 May 13;:]. J Am Coll Cardiol.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

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 Pediatrics Outcomes Documentation/Coding 75

EMergucate

OCTOBER 19, 2021

The ECG below is from a 66 year old diabetic man who has presented with sepsis. Interpret the ECG How … Continue reading →

EKG/ECG 40

EKG/ECG Sepsis EMS 40

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. 2021; 93: 4358–4369.

Infectious Diseases 89

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

JournalFeed

JANUARY 30, 2021

It’s the JournalFeed Podcast for the week of Jan 25-29, 2021. We cover Project COVERED, interval likelihood ratios for pediatric UA, sepsis workup for infant otitis media, ARREST RCT - ECMO+CPR, and the best immobilization for dancer’s fractures.

Pediatrics 52

Pediatrics CPR Sepsis Fractures 52

Don't Forget the Bubbles

MAY 31, 2023

The NPDA audit suggests that 2021-2022 was another high incidence year, higher even than the first COVID pandemic year. We have a ringside view in the Children’s Emergency Department – the unique opportunity to see different types of acute presentations, whether DKA, sepsis or asthma, amongst a host of febrile children.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

RebelEM

FEBRUARY 8, 2024

to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 for every change in 1mmHg Higher BMI: aOR 1.04; 95% CI 1.01 to 1.09; p = 0.01 for an increase in 1 Increased Patient Age: aOR 1.31; 95% CI 1.30 to 1.37; p <0.01 for every 10 years Radial Arterial Line Location: aOR 1.74; 95% CI 1.16

Resuscitation 123

Resuscitation Outcomes EMS Sepsis 123

EMDocs

MARCH 9, 2025

Other children at risk for osteomyelitis include those with sickle cell disease , sepsis , an indwelling catheter , and immunodeficiency (e.g., due to chronic granulomatous disease). Children with sickle cell disease are at higher risk of osteomyelitis from Salmonella or Streptococcus pneumoniae. Pediatr Emerg Care. 2022;38(1):e209-e213.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

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

JULY 24, 2023

Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). In those with concern for sepsis, blood cultures, broad spectrum IV antibiotics and fluids should be given as needed. Int J Surg.

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. For example a pt in the ED with sepsis, and a collapsible IVC, dry lungs and no peripheral edema is more likely to benefit from fluid than be harmed Take that same pt, with the same US and physical exam findings and make it 72-hrs later in the ICU after 6-10 L.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

The Skeptics' Guide to EM

OCTOBER 23, 2021

Date: October 20th, 2021 Reference: Talan et al. AEM October 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Date: October 20th, 2021 Reference: Talan et al. Excluded: Unstable comorbidity (e.g.

Emergency Department 52

Emergency Department Sepsis Hospitals Research 52

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

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. 2021 Sep 10;12:727962. 2021 May 14;12:661955. anatomic region). EMCrit Project. June 26, 2022. Available at: [link] Chen D, Tang Y, Nie H, et al. 2021.727962.

Stroke 111

Stroke EMS EKG/ECG Radiology 111