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

PulmCCM

JANUARY 6, 2025

In the past decade, so-called “sepsis alerts” came out of nowhere to become a ubiquitous and resource-intensive component of inpatient medical care. “Sepsis alerts” are automated notifications that flag patients who meet certain criteria compatible with severe infection discernible from the electronic medical record.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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 94

Pediatrics Sepsis Urgent Care Emergency Department 94

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

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

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

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

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 88

EMS Sepsis Shock Fluid Resuscitation 88

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 130

Stroke Outcomes Hospitals Administration 130

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

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 100

Sepsis Best Practices Hospitals Outcomes 100

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

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 90

Outcomes Administration Emergency Department Resuscitation 90

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

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 99

EMS Pediatrics Sepsis Airway Management 99

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

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

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 87

Hospitals Emergency Department EMS Outcomes 87

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

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 80

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

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 Psychiatric 52

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

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

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

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

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 116

Sepsis Fluid Resuscitation Resuscitation Administration 116

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

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

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 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

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

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

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 101

Stroke EMS EKG/ECG Radiology 101