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 Outcomes Pediatrics Documentation/Coding 75

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 56

Sepsis Emergency Department Pediatrics Academics 56

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 91

Pediatrics Sepsis Urgent Care Emergency Department 91

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 22. 2023 Dec 21. 2023 Dec 19. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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

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

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

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 Outcomes 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 88

Sepsis Best Practices Hospitals Outcomes 88

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

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

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med.

Sepsis 113

Sepsis Fluid Resuscitation Resuscitation Administration 113

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 23, 2023

Cefepime crosses the blood-brain barrier, and dozens of case reports have associated the drug with seizures, encephalopathy, delirium, and coma, with a possibly increased incidence of neurologic adverse effects among patients with renal failure or sepsis. Read in JAMA Does Paxlovid Improve Covid-19 Outcomes in the Omicron Era?

Hospitals 98

Hospitals Emergency Department COPD CDC 98

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

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

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 Outcomes Dehydration 98

Don't Forget the Bubbles

FEBRUARY 5, 2024

Their main outcome measure was the proportion of pictures inconsistent with current safety recommendations. 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. Anagnostou A, et al. 2024 Jan 13.

Pediatrics 52

Pediatrics Research Resuscitation Outcomes 52

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. This post evaluates the recent “Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP)” trial.

Sepsis 98

Sepsis Outcomes Administration EMS 98

EMDocs

JUNE 27, 2024

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

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 Hospitals 52

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

PulmCCM

FEBRUARY 12, 2024

Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia. Then in 2023, ATS and ESICM released separate, conflicting ARDS guidelines: ESICM did not recommend steroids for ARDS in its guidance, while ATS did.

Shock 52

Shock Administration Sepsis Fractures 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

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 Outcomes 52

Thinking Critical Care

MAY 18, 2023

To everybody outside Glasgow glucocorticoids seemed to be the answer and Chicago surgeon William Schumer was their chief flag waver, claiming in 1976 that steroid therapy reduced the mortality of saline-treated sepsis in his service from 33% to around 10%. [5] Co-Published on Osler [link] on May 18 th , 2023 [1] J Crit Care 2023 Apr 29.

Shock 40

Shock Research Sepsis Resuscitation 40

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

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 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

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 183

Pediatrics Emergency Department Outcomes Sepsis 183

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

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

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

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

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 93

Research Outcomes Administration Shock 93

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 133

Stroke Outcomes Hospitals Administration 133

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

Don't Forget the Bubbles

AUGUST 4, 2024

They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. Neonatal bacterial sepsis. The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care. More studies on this topic will surely follow. Beaulieu E, Beno S. JAMA Pediatr.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52