RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). 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.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

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. What are the physiologic effects of proning?

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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. perforation).  Br J Surg.

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

Don't Forget the Bubbles

MAY 31, 2023

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

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Pediatric EM Morsels

APRIL 7, 2023

Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! Updated 2022 Jul 18]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Atherosclerosis.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Don't Forget the Bubbles

JUNE 19, 2023

Fetal Growth Restriction (FGR) and dysmaturity are common in neonatology and are a leading cause of morbidity during the neonatal period, as well as later in life. Up To Date, [link] Accessed on: 11 August 2022. According to the Obstetric resident, the placenta looked a little small. Acta Pediatrica 2018;107:981-9. Roseboom T et al.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

EMDocs

JULY 1, 2023

UpToDate;2022. Accessed December 31, 2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. In: Post TW, ed. link] Ramphul, K., Kawasaki disease: a comprehensive review.

EMS 92

EMS Infectious Diseases Pediatrics Research 92

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

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. 2022 Dec;57(12):986-993.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Tachycardia may be present both from many medications or drugs, as well as withdrawal. Treasure Island (FL): StatPearls Publishing; April 30, 2022.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

ACEP Now

OCTOBER 30, 2023

Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech. 2022; 14: 441–456.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

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. 2022 Jul 11;11(14):2163. High serum procalcitonin concentrations in patients with sepsis and infection.

Infectious Diseases 89

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

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. 2022 Jul 2;400(10345):39-47. 2022 Oct;51(10):595-604. 2022 Dec 20;328(23):2296. Epub 2022 Dec 7. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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

JULY 29, 2023

Emergency Medicine Residents’ Association; 2022. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Initial treatment is discontinuing medications that may reduce flow, oral hygiene, hydration, and hard or sour candies to promote flow. doi:10.1097/01.SMJ.0000140830.66461.12

EMS 96

EMS Dehydration Ultrasounds Emergency Department 96

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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. Meyers and Smith illustrate 20 example cases vs "look-alikes" of Swirl ( with my synthesis of "Swirl" ECG findings in My Comment on that post ) from October 15, 2022.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Epub 2022 Aug 28. The PROTECTION trial. Contemp Clin Trials. The PROTECTION trial.

Outcomes 81

Outcomes Hospitals Operations Shock 81

PulmCCM

NOVEMBER 27, 2023

Based on these findings, most intensivists will likely continue the well-established practice of not administering beta-blockers to patients with septic shock requiring vasopressors. To increase power, investigators “harmonized” (combined) the trials, which each enrolled patients during 2020-2022.

Sepsis 52

Sepsis Shock Administration Leadership 52

Taming the SRU

JUNE 11, 2023

It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions. Comparing quick sequential organ failure assessment scores to end-tidal carbon dioxide as mor- tality predictors in prehospital patients with suspected sepsis. West J Emerg Med.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

PEMBlog

AUGUST 20, 2024

2022; 68:133–152. These could include severe sepsis. eCPR is typically performed in specialized centers with highly trained personnel in well coordinated teams. For instance, eCPR is well established as a bridge therapy in pediatric patients with congenital heart disease and increasingly used in in hospital cardiac arrests.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

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

ACEP Now

OCTOBER 10, 2023

1,2 The 2022 AHA/ASA Guidelines give several recommendations on this topic. We have seen other bundles, in conditions like sepsis, that did not ultimately turn out to be better than usual care (ARISE, ProMISe and ProCESS). 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

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. 2022 Feb 8; PMID: 35156050 Higgins TL et al. 2022 Feb 24;7(1):29603.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 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

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. 2022, May 16). Akhentuamhen, A.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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.

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

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. 10, 19 May 2022, p. 2, July 2022, pp. Receiving more than one unit of blood product is also associated with an increased risk for reaction.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

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 Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. address in the article discussed below. JAMA Intern Med.

Sepsis 113

Sepsis Outcomes Administration Shock 113

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. 2022 Sep 4 [cited 2024 Jan 30];60(suppl 66). Corticosteroids impact the child’s immune system.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Taming the SRU

JULY 21, 2023

Accessed April 15, 2022. Accessed April 15, 2022. In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Accessed April 15, 2022. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. WHAT ARE TREATMENT OPTIONS?

Emergency Department 88

Emergency Department EMS Burns Wellness 88

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. 2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11.

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. 2022 Jun:56:113-116.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

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

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 20:archdischild-2022-324884. 2023 Jun 5:archdischild-2022-325148. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. 2023 Jun 12:archdischild-2022-325029. 2023 Jun 15.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98