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

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. Circulation. 2024 Oct 27.

Shock 98

Shock Sepsis Outcomes Research 98

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 88

Sepsis Best Practices Hospitals Outcomes 88

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

PulmCCM

AUGUST 21, 2023

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. A meta-analysis also found no clear difference in outcomes between liberal and conservative oxygenation strategies, with low certainty in the results.

Telemedicine 88

Telemedicine CDC Sepsis Outcomes 88

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

EMDocs

JANUARY 11, 2025

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. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Outcomes From a Randomized Clinical Trial. Pawlowski TW, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. 2023 Jun 20:archdischild-2022-324884.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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 Outcomes Dehydration 98

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. In some cases, surgical ligation may be required.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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

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

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. C or 100.4 mg/kg, max 0.4

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

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 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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

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 42

Sepsis Shock Emergency Department Outcomes 42

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

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

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 86

Hospitals Emergency Department EMS Outcomes 86

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 Hospitals 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

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). That was in NEJM Aug 18 2022. Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. and FT4 (0-7.8

Infectious Diseases 52

Infectious Diseases Outcomes Hyperthermia / Hypothermia Sepsis 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 89

Stroke EMS EKG/ECG Radiology 89

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 EMS Dehydration 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 Documentation/Coding Academics 52

Don't Forget the Bubbles

NOVEMBER 6, 2024

Survival of Infants Born at 22 to 25 Weeks’ Gestation Receiving Care in the NICU: 2020-2022. Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort. Rotavirus Vaccine Effectiveness Against Severe Acute Gastroenteritis: 2009-2022. Pediatrics. 2024 Oct 1;154(4):e2024067390. Edwards EM, et al.

Pediatrics 52

Pediatrics Sepsis Fractures Hospitals 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

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