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. Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. Updated 2023 Aug 23].

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 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. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

EMDocs

MARCH 4, 2025

Start resuscitating with fluids, and add a vasopressor like norepinephrine. 2023 Mar;65:76-83. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults [published correction appears in J Infect. MAP minus the ICP equals CPP. Am J Emerg Med.

Infectious Diseases 83

Infectious Diseases Seizures Poisoning Sepsis 83

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 93

Emergency Department Pediatrics Sepsis Resuscitation 93

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? This then leads to open the possibility of sepsis being missed when it is indeed present.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

EMDocs

JUNE 22, 2024

2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” J Matern Fetal Neonatal Med. 2015 May;28(7):793-8. doi: 10.3109/14767058.2014.932766. Epub 2014 Jun 30. PMID: 24974876. Amniotic fluid embolism: a reappraisal.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

Don't Forget the Bubbles

JUNE 30, 2023

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 6, 2024

2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

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 References: Knack SKS et al.

Outcomes 98

Outcomes Emergency Department Administration Resuscitation 98

Thinking Critical Care

MAY 20, 2023

With help from the usual suspects (Rory Spiegel, Andre Denault, Korbin Haycock) we are focusing on some core areas in acute and critical care – sepsis, arrest and respiratory failure are perennials, but this year we are also adding neurocrit as a core component, which I think is a bit underserved and certainly deserving of more.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

JournalFeed

OCTOBER 21, 2023

The JournalFeed podcast for the week of Oct 18-20, 2023. Friday 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.

Sepsis 52

Sepsis Resuscitation Outcomes 52

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] Management/Disposition ABCs and resuscitation if indicated Assessment for need of definitive airway is imperative as rate of intubation is high (38-100%) in various studies. [2][3][9]

EMS 110

EMS Pediatrics Sepsis Airway Management 110

Taming the SRU

MARCH 30, 2023

Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. 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).

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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. A Myriad of Infectious Disease Papers The use of steroids in severe sepsis remains challenging, primarily as proper patient selection is necessary to tease out those with the greatest likelihood of benefit.

Research 52

Research Airway Management Stroke Outcomes 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

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Most drugs are chosen to be dissolved in 0.9%

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

PEMBlog

AUGUST 20, 2024

This episode of PEM Currents discusses ECPR (Extracorporeal Cardiopulmonary Resuscitation), an advanced procedure used in cases of cardiac arrest when traditional CPR fails. Extracorporeal Cardiopulmonary Resuscitation. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

Taming the SRU

JULY 24, 2023

Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). Patients should be resuscitated as deemed appropriate. Reference article, Radiopaedia.org (Accessed on 11 Jun 2023) [link] Niemeier OW.

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 25:archdischild-2023-326533. 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. 2024 Apr 29:e240806. Wong J, et al. Arch Dis Child. Arch Dis Child Fetal Neonatal Ed. Hannah R et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

Mind The Bleep

SEPTEMBER 12, 2023

Were there any risk factors for sepsis? Did the baby need resuscitating? Increased work of breathing with grunting and tachypnoea could be due to sepsis, hypoglycaemia or acidosis due to an inborn error of metabolism. Birth History How long was the labour? What were the APGAR signs? Were they cooled? Were the cord gases poor?

Sepsis 52

Sepsis Seizures Poisoning Wellness 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] I do not recall one experiment getting as far as the resuscitation stage.

Shock 40

Shock Research Sepsis Resuscitation 40

ACEP Now

OCTOBER 10, 2023

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). Goal-directed resuscitation for patients with early septic shock. Accessed September 17, 2023. Accessed September 17, 2023. Which part of the intervention caused the benefit?

Outcomes 52

Outcomes Stroke Emergency Department 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. vs. 0.91), positive predictive value (0.27

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

Don't Forget the Bubbles

NOVEMBER 1, 2023

Emergency Medicine Journal 2023; 40: 583-587. This is not always feasible in an acute resuscitation scenario. 2023 Oct 1;39(10):735-8. This retrospective observational cohort study looked at whether lactate can be used to predict the need for acute resuscitation in paediatric emergency department (PED) patients.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

OCTOBER 5, 2024

8 Workup and Diagnosis Evaluation should be tailored to the patient presentation, but may include studies such as: CBC, CMP, UA, lactate (if concern for sepsis), Cultures (blood, urine, etc.) IV fluid resuscitation as needed. Therefore, his presentation is most consistent with sepsis due to acute complicated UTI.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Taming the SRU

APRIL 26, 2023

Resuscitation 2020. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. April 26, 2023) Acute Hyperthermia in the Emergency Department. J Intensive Care Med 2015. Douma MJ, Aves T, Allan KS, et al. Druyan A, Janovich R, Heled Y.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

EMDocs

JUNE 27, 2024

Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 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 C or 100.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

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

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Don't Forget the Bubbles

OCTOBER 2, 2024

Impact of in situ simulation training on quality of postnatal stabilization and resuscitation-a before-and-after, non-controlled quality improvement study. 2024 Sep 19:archdischild-2023-326507. Corticosteroids for Managing Pediatric Sepsis and Septic Shock: A Systematic Review and Meta-analysis. Mileder LP, et al. Eur J Pediatr.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

EMDocs

JANUARY 20, 2025

2023 10 found that clinicians were 56% accurate in their assessments of patients admitted for heart failure when compared to the gold standard of blood volume measurement – a nuclear study utilizing radiolabeled red blood cells and albumin. 9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. He has had some additional episodes of hypotension post-intubation, which is treated with further volume resuscitation. J Ultrasound Med, 2023. Clinical Kidney Journal, 2023.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

NOVEMBER 18, 2024

Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. Blood Tests: Can help identify underlying causes such as infection (sepsis), anaemia, or electrolyte imbalances. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Don't Forget the Bubbles

JULY 3, 2024

2023 Oct 16;29(3):171-173. Trends in C-Reactive Protein Use in Early-Onset Sepsis Evaluations and Associated Antibiotic Use. 2024 Jun 26:fetalneonatal-2023-326691. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Barlabà A, et al. Eur J Pediatr. 2024 Jun 13.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105