The Skeptics' Guide to EM

OCTOBER 14, 2023

Time to change the reference ranges of children’s physiological observations in emergency care? March 2023 Date: July 12th, 2023 Guest Skeptic: Dr. Vicki Currie is a paediatric emergency medicine registrar in the West Midlands in the United Kingdom. Does he have sepsis?” Reference: Brennan L et al.

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

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., Time to change the reference ranges of children’s physiological observations in emergency care? Brennan et al. A prospective study.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

EMDocs

OCTOBER 28, 2023

Spoon Feed Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course. 2023 Sep;164(3):667-669. Epub 2023 Apr 20. #2: 2023 Aug 29;148(9):753-764. Epub 2023 Jul 13. #3:

Emergency Department 66

Emergency Department Pediatrics Sepsis Resuscitation 66

EM Literature of Note

OCTOBER 9, 2024

This exploration of LLMs in the emergency department is a bit unique in its conceptualization. emergency departments are general cesspools of aggressive empiric antibiotic coverage, driven by CMS regulations – so it may in fact be the LLM displaying astute clinical judgement, here. For what its worth, of course, U.S.

Radiology 84

Radiology Radiology Emergency Department Documentation/Coding 84

EB Medicine

JANUARY 3, 2023

2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!

Shock 52

Shock Pediatrics Airway Management Sepsis 52

EMDocs

MAY 18, 2024

Ann Emerg Med. Epub 2023 Sep 19. Post-Vaccination Fever in Infants Spoon Feed Serious bacterial infections were exceedingly rare in this study of recently immunized infants 6-12 weeks presenting to the emergency department with a fever. Am J Emerg Med. 3: Who Benefits Most From Early Antibiotics in Sepsis?

Emergency Department 52

Emergency Department Sepsis Pediatrics 52

PEMBlog

OCTOBER 18, 2023

Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. 2023; 40( 2): 349- 351. She did have a remote history of oral cold sores but no recent lesions. His rash is pictured here: He subsequently developed a fever to 38.2C

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. West J Emerg Med.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 7 The operators involved in the trial were mostly emergency medicine residents or critical care fellows, but this fact does not diminish the generalizability of these observations. percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. The other important moment to always think of the heart (sorry, cardiologists, I don’t think about the heart 24/7) is when a collapsed neonate presents to your emergency department, especially if blood pressure is present.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Don't Forget the Bubbles

MAY 6, 2024

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. Each patient was scored using the four sepsis tools. Epub ahead of print.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Surg Neurol Int.

Sepsis 60

Sepsis Academics Operations Wellness 60

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 15.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 88

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

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. 2023 May 17:archdischild-2022-325280. Annals of emergency medicine, 76(6), 788–800. Arch Dis Child. Why was the DIMPLES study needed?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. And although severe underlying coronary disease is often the cause — non-coronary causes may be seen ( See My Comment in the March 1, 2023 post for the common causes of DSI ).

EKG/ECG 125

EKG/ECG Shock Emergency Department Ambulance Services 125

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. 2024 Sep 19:archdischild-2023-326507. Räty S, et al.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 25:archdischild-2023-326533. A silent scream in the pediatric emergency department: child abuse and neglect. 2024 Apr 18:fetalneonatal-2023-326679. 2024 Apr 16:archdischild-2023-326247. 2024 Apr 16:archdischild-2023-326331. 2024 Apr 8:archdischild-2023-326175. JAMA Pediatr. Wong J, et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

ACEP Now

MAY 10, 2024

Patients with flank pain (which would suggest pyelonephritis) as well as patients meeting two or more SIRS criteria (which would suggest sepsis) comprise a higher risk group. Published online 2023. For simplicity, we will focus only on the patients with suspected lower urinary tract infection (UTI). New England Journal of Medicine.

Infectious Diseases 98

Infectious Diseases Sepsis Administration Emergency Department 98

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. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. appeared first on REBEL EM - Emergency Medicine Blog. Click here for Direct Download of the Podcast Paper: Knack SKS et al. Range 5 to 9) Etomidate: 7.0

Outcomes 98

Outcomes Administration Emergency Department Resuscitation 98

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. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. Updated 2023 Jun 24]. Updated 2023 Aug 28].

Stroke 89

Stroke EMS EKG/ECG Radiology 89

Don't Forget the Bubbles

AUGUST 4, 2024

Several case-based variables (older age, mechanism of injury given, location of injury) were associated with diagnostic error, and these variables can be used to close specific skill gaps for clinicians in an emergency department setting to avoid further harm. Neonatal bacterial sepsis. Beaulieu E, Beno S. Paediatr Child Health.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

Don't Forget the Bubbles

JUNE 30, 2023

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. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 West J Emerg Med. Am J Emerg Med. Acad Emerg Med. 2023;(December 2022):1-10.

Hospitals 87

Hospitals Emergency Department EMS Outcomes 87

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. Accessed June 11, 2023. In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. licensed under a Creative Commons Attribution 3.0

Emergency Department 87

Emergency Department EMS Burns Wellness 87

EMDocs

NOVEMBER 27, 2023

A 55-year-old male, with a previous medical history of hypertension, hyperlipidemia, and gout, presents to the emergency department for four days of fever and progressive rash. McGraw-Hill Education; 2023. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

EMS 71

EMS Sepsis Burns EKG/ECG 71

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Antibiotics 2023, 12, 1092. cited 2023 Jan 3]. cited 2023 Jan 3].

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). Indian J Surg.

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

Don't Forget the Bubbles

FEBRUARY 5, 2024

2024 Jan 12:archdischild-2023-326225. Role of diagnostic tests for sepsis in children: a review. 2024 Jan 23:archdischild-2023-325984. 2024 Jan 11:fetalneonatal-2023-325829. 2024 Jan 11:fetalneonatal-2023-326383. 2024 Jan 17:fetalneonatal-2023-326099. 2024 Jan 16:fetalneonatal-2023-326170. Pediatrics.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

PEMBlog

MARCH 27, 2024

This episode will help you better prepare for and manage children with inborn errors of metabolism in the Emergency Department. Updated 2023 Jul 17]. Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEM Currents, the Pediatric Emergency Medicine Podcast.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Mind The Bleep

SEPTEMBER 17, 2024

Introduction Patients regularly present to the emergency department with animal bites. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. The western journal of emergency medicine, 11(5), 435–441. Ensure the wound has been adequately washed out. UK Health Security Agency. link] Chu, D. Eftekari, S.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

EMDocs

JULY 29, 2023

A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. WikEM, The Global Emergency Medicine Wiki. Accessed March 27, 2023. Emergency Medicine Residents’ Association; 2022. Accessed on April 11, 2023. RR 18, SpO2 97% on RA.

EMS 71

EMS Dehydration Ultrasounds Emergency Department 71

PEMBlog

AUGUST 20, 2024

2023; 187:109792. Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast. These could include severe sepsis. Rationale and methods of the advanced R2Eperfusion STrategies for refractory cardiac ARREST (ARREST) trial. Am Heart J.

CPR 52

CPR Resuscitation Pediatrics Hospitals 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.

Sepsis 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Emergency Medicine Journal 2023; 40: 583-587. Lactate as a screening tool for critical illness in a pediatric emergency department. What’s it about?

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Don't Forget the Bubbles

JULY 22, 2024

There is an increased risk of pneumonia and sepsis in the 31-90 days after prescription and an increased risk of fractures, GI bleeds and sub-optimal growth. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105