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

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. 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.

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

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. This sort of sepsis would produce many of the common autopsy findings.

CDC 96

CDC Sepsis Research Pediatrics 96

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions.

Resuscitation 113

Resuscitation Outcomes EMS Sepsis 113

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. Both agents are considered hemodynamically stable, but any induction agent may precipitate shock in the critically ill.

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

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 Infectious Diseases 52

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

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. 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.

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

University of Maryland CC Project

MAY 19, 2021

About the AuthorJim Lantry Twitter Google+Just your average critical care doc: wandering the ED and ICUs of Maryland, dedicating time to the USAF to travel the globe to cannulate for ECLS wherever the need arises, and trying to keep up with great minds of today. E: JlantryMD@gmail.com Just your average.

Sepsis 40

Sepsis Shock 40

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

EMDocs

JULY 1, 2023

Updated January 2021. Kawasaki disease: a comprehensive review. Arch Med Sci Atheroscler Dis. 2018; 3: e41-e45. link] Clinical Practice Guidelines: Kawasaki Disease. The Royal Children’s Hospital Melbourne. Accessed December 31, 2022. Kawasaki disease: clinical features and diagnosis. In: Post TW, ed. UpToDate;2022. link] Sundel, R.

EMS 76

EMS Infectious Diseases Pediatrics Research 76

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. Sepsis indicators and malaria positivity did not modify the risk. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

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 groups were unbalanced, with more patients with sepsis and more patients with difficult airway characteristics in the ketamine group.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. 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.

Sepsis 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. Right now, though, Ranulf’s’ Mum looks whiter than he does. “Is

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. Blood Tests: Can help identify underlying causes such as infection (sepsis), anaemia, or electrolyte imbalances. Sepsis: The risk of sepsis increases after the first 24 hours, particularly in preterm infants.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

PulmCCM

NOVEMBER 11, 2024

Severe bleeding, limb ischemia, and sepsis with bacteremia were also increased in the Impella group, with the composite outcome of adverse events occurring four times more often in Impella patients (24% vs 6%). But while the number needed to save a life was 8, the number needed to harm in DanGer-Shock was 6.

Shock 98

Shock Sepsis Outcomes Research 98

Taming the SRU

NOVEMBER 13, 2024

opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line. mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). link] Takahashi, N.,

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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 88

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

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

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

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. West J Emerg Med 2021. J Emerg Med 2016. Gauer R, Meyers BK. Heat-Related Illnesses. Am Fam Physician 2019; 99:482. Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

EMDocs

JUNE 27, 2024

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 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 Br J Haematol.

Pediatrics 88

Pediatrics Dehydration EMS Hospitals 88

Don't Forget the Bubbles

JULY 3, 2024

Trends in C-Reactive Protein Use in Early-Onset Sepsis Evaluations and Associated Antibiotic Use. Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Pediatrics. 2024 Jun 18:e2023065373.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

Mind The Bleep

FEBRUARY 27, 2024

saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] They concluded that some evidence in the literature shows a shorter length of hospital stay associated with prescribing balanced isotonic fluids (Plasma-lyte) over non-balanced (0.9%

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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

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

EMDocs

DECEMBER 9, 2024

encephalitis, sepsis, or conditions requiring hospitalization). Characterizing the Rise of Disseminated Gonococcal Infections in California, July 2020July 2021. Toxic Shock Syndrome: A Literature Review. Special populations that might be considered for treatment include: Patients with severe disease (e.g., 2022;2:e1353.

CDC 68

CDC Documentation/Coding Infectious Diseases Dehydration 68

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Inwald et al.

Dehydration 69

Dehydration Fluid Resuscitation Sepsis Resuscitation 69

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Volume resuscitation has historically been the first-line therapy for patients in septic shock. septic shock, oncology patients), or where RV function may be compromised [19, 20] (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78