Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 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.

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. 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 5: MI associated with coronary bypass surgery. Who should have troponins sent?

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

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

ALiEM

FEBRUARY 9, 2024

Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 13;:]. Eur Heart J.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Which patients were involved? How good was this paper? Do you believe the results?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

MARCH 9, 2025

Well keep it short, while you keep that EM brain sharp. Other children at risk for osteomyelitis include those with sickle cell disease , sepsis , an indwelling catheter , and immunodeficiency (e.g., Infectious disease expertise is useful as the optimum duration of treatment is not well established. Pediatr Emerg Care.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Adjust all tubing and reassess connections.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2021; 93: 4358–4369. High serum procalcitonin concentrations in patients with sepsis and infection. J Med Virol.

Infectious Diseases 89

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

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

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6). 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. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. It is our job as clinicians to interpret what that means. For this we use clinical judgement, US findings, PE findings.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. Bacteremia and sepsis occur in 30-50% of patients, with a 3-4x increase in mortality rates. J Am Acad Dermatol 2021; 84:1782.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

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

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing. Mitchell, S.,

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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

Dr. Smith's ECG Blog

JULY 21, 2024

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. Unfortunately, he required re-intubation a few days later due to respiratory distress from severe bilateral pneumonia. What About Procainamide?

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Mind The Bleep

FEBRUARY 27, 2024

1] It is worth mentioning this formula was designed for well, euvolaemic children, which does not represent the popluation of children who require IV fluids. The curve on this graph can be split into 3 linear sections corresponding to the following weight categories: 0-10kg, 10-20kg, and 20-70kg. [1]

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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. Casey The CLOVERS trial: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 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 92

EMS Infectious Diseases Pediatrics Research 92

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. Groups were well matched at baseline. Were the study groups similar at the start of the trial?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

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 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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 92

EMS Infectious Diseases Shock Ultrasounds 92

Taming the SRU

SEPTEMBER 16, 2024

There are a few other factors as well that may increase risk for a transfusion reaction but are likely not readily available on patient history or are outside the physician’s control. 11, 2 June 2021, p. Receiving more than one unit of blood product is also associated with an increased risk for reaction. 3, 30 Sept.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. 2021 Apr;106(4):339–44. 2021 Jul 1;175(7):723–9. Corticosteroids impact the child’s immune system. Arch Dis Child.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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 113

Sepsis Outcomes Administration Shock 113

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Infection/sepsis? The ED team helpfully did a gas while you headed down to review, and as you scan the numbers, you see that the baby has a severe mixed respiratory/lactic acidosis. What are your differentials?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

Pediatric EM Morsels

FEBRUARY 2, 2024

Abdel-Haq 2021). Travel dates can help to exclude certain infections by their incubation periods (Abdel-Haq 2021) Physical examination can sometimes reveal concerning features including hepatomegaly , jaundice or a rash that may guide differential. A study of swiss tourists found they compromised 53.4%

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2021 Sep;194(5):899-907. Epub 2021 Jul 15. C or 100.4 mg/kg, max 0.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. and Neal P.

Emergency Department 88

Emergency Department EMS Burns Wellness 88

Thinking Critical Care

NOVEMBER 28, 2021

So after much deliberation, we have decided and are excited to bring the fourth edition of H&R back for 2022 – we had skipped 2021 to focus on some research papers and developing some courses (Flipping the Vent and The VExUS Course), but mostly because the virtual conferencing experience simply did not measure up to the live event.

Sepsis 52

Sepsis Airway Management Wellness Resuscitation 52

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 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. According to CDC data , 544 infants died per 100,000 live births in 2021.

CDC 88

CDC Sepsis Research Pediatrics 88

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Pawlowski TW, et al. Eur J Pediatr. Weiss SL, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98