RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. Crit Care 2023. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). Paper: Ibarra-Estrada, M et al. 95% CI 15.4 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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

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). 2023 Apr 28;24(3):579-587. That sounds reasonable, so what has changed?

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

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 17. 2023 Apr 25;329(16):1386-1398.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

OCTOBER 14, 2023

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. 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.

Pediatrics 105

Pediatrics Sepsis Urgent Care Emergency Department 105

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings. Additional material on MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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. Updated 2023 Aug 23]. Gedefie, A.,

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 95

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., 2023 Mar;59(3):480-486 Who were the patients? Yes Was the outcome accurately measured to minimize bias? Brennan et al.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Broome Docs

SEPTEMBER 3, 2024

In a surprise to no one who reads First10EM, clinical judgment is better than all decision tools for sepsis Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients.

Sepsis 95

Sepsis Emergency Department Outcomes Hospitals 95

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. After 40ml/kg of IV 0.9% The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 2023 Jan 21. 2023 Feb;64:206.e1-206.e3. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2023 Jan 30. 2023 Jan 13;76(2):185-191.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

EMDocs

NOVEMBER 25, 2023

2023 Apr;98(4):620-627. Epub 2023 Feb 6. #2: 2023 Mar 30;110(4):432-438. 3: High or Low Fluid Volume in Sepsis? Source Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. 2023 Oct;164(4):892-912. Epub 2023 May 2.

Sepsis 70

Sepsis Emergency Department Pediatrics Academics 70

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. The primary outcome was the successful intubation on the second attempt. Of the 74.9%

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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

JANUARY 29, 2024

Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7%

Stroke 136

Stroke Outcomes Hospitals Administration 136

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

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. Background There have been a couple of large and influential trials published on BP management after an intracranial hemorrhage (ICH). Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 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. 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 110

Stroke EMS EKG/ECG Radiology 110

AENJ: Current Issue

MAY 8, 2024

The article titled “Using Artificial Intelligence to Predict Adverse Outcomes in Emergency Department Patients With Hyperglycemic Crises in Real Time,” authored by C.

Emergency Department 40

Emergency Department Outcomes Sepsis Research 40

Don't Forget the Bubbles

MAY 31, 2023

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

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

RebelEM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum SOFA Score: A Randomized Clinical Trial. Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4

Outcomes 98

Outcomes Emergency Department Administration Resuscitation 98

EMDocs

OCTOBER 19, 2024

Blood cultures: Blood cultures are rarely positive; however, should be obtained if suspicion for sepsis is present or if the patient is immunocompromised. [2][3] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Published 2023. Georgiaemsacademy.com. Accessed August 11, 2024.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

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

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. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 52

Taming the SRU

AUGUST 30, 2023

Specific Evidence: Septic arthritis: According to the European Journal of Bone and Joint Infection’s 2023 guidelines for septic arthritis of native joints (SANJO), no blood tests have adequate sensitivity or specificity to either diagnose or exclude SANJO. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. 2022 Jul 11;11(14):2163.

Infectious Diseases 89

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

JournalFeed

OCTOBER 21, 2023

The JournalFeed podcast for the week of Oct 18-20, 2023. However, they were also associated with a higher rate of adverse outcomes. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.

Sepsis 52

Sepsis Resuscitation Outcomes 52

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

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. Accessed October 10, 2023.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Taming the SRU

JUNE 11, 2023

Acad Emerg Med 2023; 10.1111/acem.14703 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. 2023;(December 2022):1-10. 6/11/2023 West J Emerg Med. 2018;19(3):446-451.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. 2024 Apr 25:archdischild-2023-326533.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

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

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

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

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. Available at: [link] (Accessed: April 3, 2023). Crit Care Med. Pediatrics.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

PEMBlog

AUGUST 20, 2024

2023; 187:109792. 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. Am Heart J. 2020;229:29–39. Bartos JA, Yannopoulos D. Resuscitation. asthma, heart failure, and more.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism. As a result, our current data on AFT complications likely underestimates the actual incidence.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52