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. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. Philadelphia, PA: Elsevier; 2022:1-11.

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 95

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

The Trauma Pro

AUGUST 25, 2023

They tried to perform a systematic review and meta-analysis of studies that compared outcomes in splenectomy vs. angioembolization patients. We have no idea if the numbers of T- and B-cells seen and the antibody titers are actually enough to avoid overwhelming post-splenectomy sepsis. Injury 53:3569-3574, 2022.

Sepsis 187

Sepsis Research Outcomes Hospitals 187

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. No difference in their primary outcome of complications and need for emergency surgery (1.9% Patients with sepsis and immunocompromise were not included. 623 patients included. 528 patients included. 5.0%; p = 0.085).

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). 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. Additionally, they found that up to 30% of the troponins sent are positive. Cardiol Rev.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. 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. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. 1,2 The 2022 AHA/ASA Guidelines give several recommendations on this topic. 3 The class (strength) of their recommendation is 2a/2b based upon Level B and Level C quality of evidence.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. Published online January 21, 2024.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Don't Forget the Bubbles

JUNE 19, 2023

It is useful to know that there are two kinds of weight curves: Descriptive , in which nearly all mothers and their children are included with few exclusion criteria, and Prescriptive , in which groups of women with pathologies that affect neonatal morbidity and mortality outcomes have been excluded. Hoftiezer L et al. Roseboom T et al.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

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

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial. Contemp Clin Trials.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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. N Engl J Med. 2023;388(6):499-510. 2018, Kuttab, Lykins et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. 2022; 14: 441–456.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

The Skeptics' Guide to EM

JULY 16, 2022

Date: July 16th, 2022 Reference: Lamontagne F et al. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Date: July 16th, 2022 Reference: Lamontagne F et al. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Guest Skeptic: Dr. Salim R. Guest Skeptic: Dr. Salim R.

Sepsis 40

Sepsis Shock Outcomes EMS 40

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? 2023 Apr 20:fetalneonatal-2022-324835. Tritos NA, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

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

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 89

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

The Skeptics' Guide to EM

JANUARY 15, 2022

Date: January 16th, 2022 Reference: Matchett, G. Date: January 16th, 2022 Reference: Matchett, G. Historically there has been concern about adrenal insufficiency caused by etomidate being harmful for patients with sepsis but this has not been shown to cause increased mortality in the literature [6, 7].

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 2022 Dec 16:emermed-2021-211946. Epub 2022 Nov 21. Epub 2022 Nov 21. 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 Fractures 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. June 26, 2022. anatomic region).

Stroke 110

Stroke EMS EKG/ECG Radiology 110

RebelEM

OCTOBER 5, 2023

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Secondary Outcome By day 90, mortality was 9.3% 5148 excluded 800 enrolled and randomized in the trial. in the hydrocortisone group vs. 11.9%

Research 94

Research Outcomes Administration Shock 94

Taming the SRU

JUNE 11, 2023

The primary outcome was in-hospital mortality. The secondary outcome focused on ICU admissions. The tertiary outcome was the relationship between EtCO2 and serum lactate, anion gap and bicarb. The tertiary outcome was the relationship between EtCO2 and serum lactate, anion gap and bicarb. 2023;(December 2022):1-10.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

PulmCCM

NOVEMBER 27, 2023

Authors wondered if chance resulted in more withdrawal-of-care decisions among the landiolol arm, making their outcomes look worse. Powered by his enthusiasm and reputation, vitamin C caught on widely as a therapy for sepsis for several years—even generating an eponymously-named “protocol.” for benefit of vitamin C.

Sepsis 52

Sepsis Shock Administration Leadership 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. Published May 11, 2022. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Northwestern EM Blog

JANUARY 24, 2022

Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. However, even subclinical hypothyroidism with an elevated TSH but normal T4 increases risk of poor outcomes due to effects on cardiac function. 2) Boyd J, Walley K.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

RebelEM

FEBRUARY 2, 2023

Small sample size limits the power of the study and increases margin of error A patient-oriented outcome such as mortality was not included Follow-up beyond disposition to evaluate hospitalization recurrences related to atrial fibrillation was not included. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). 2022 Sep 7.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

RebelEM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion. in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

PEMBlog

AUGUST 20, 2024

2022; 68:133–152. These could include severe sepsis. And of course, there needs to be more data on outcomes in pediatrics. Future prospective studies should focus on outcomes across a broad array of pediatric patients. ELSO guidelines for adult and pediatric extracorporeal membrane oxygenation circuits.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

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 Dehydration Hospitals Research 96

Taming the SRU

APRIL 13, 2023

2022 Pre-AeRATE Trial: use of HFNC for preoxygenation and apneic oxygenation showed no difference in lowest SpO2 during first intubation attempt when compared with usual care. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs. BOTTOM Line from Today’s Case: As per Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 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. vs. 0.91), positive predictive value (0.27

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91