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 99

Sepsis Emergency Department Outcomes Hospitals 99

JournalFeed

DECEMBER 2, 2023

The JournalFeed podcast for the week of Nov 27th – Dec 1st, 2023. 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 Shock 52

EMDocs

APRIL 6, 2024

. #1: Phoenix Criteria – New Pediatric Sepsis Score Spoon Feed The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock. 2023-062755.

Sepsis 76

Sepsis Pediatrics Shock 76

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

First 10 EM

APRIL 10, 2023

Apparently this paper was entirely fictional (or perhaps the […] The post Research Roundup (April 2023) appeared first on First10EM. Obviously the study was satire, and did an excellent job in making us laugh, but most satire studies (like those in the Christmas edition of the BMJ) are real studies.

Research 52

Research Sepsis Fractures EMS 52

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. 2023; 40( 2): 349- 351. Initially in the emergency department he was generally well-appearing with normal vital signs. His rash is pictured here: He subsequently developed a fever to 38.2C Labs were notable for: WBC 9.1 x 10E+09/L with ANC 4.46 Pediatr Dermatol. doi:10.1111/pde.15165

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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

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 90

Pediatrics Sepsis Urgent Care Emergency Department 90

Board Bombs

APRIL 30, 2023

April 30th, 2023. April 30th, 2023. Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Cite this podcast as: Briggs, Blake; Husain, Iltifat. Episode 174. Cardiogenic Shock. link] Accessed [date] Hypotensive patient? Turns out, the heart could really care less. Episode 174.

Shock 52

Shock Sepsis 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

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

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

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

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 Outcomes Pediatrics Documentation/Coding 75

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

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

AENJ: Current Issue

MAY 8, 2024

2023), investigates through a randomized control trial, the effectiveness of artificial intelligence as a practical tool compared with the traditional predicting hyperglycemic crisis death score to clinically predict adverse outcomes in individuals presenting to the emergency department with hyperglycemic crises.

Emergency Department 41

Emergency Department Outcomes Sepsis Research 41

EM Literature of Note

OCTOBER 9, 2024

Before even considering the results, there are multiple fundamental considerations taking this published exploration into the realm of curiosity rather than insightfulness: This communication was submitted in Oct 2023 – meaning the LLMs used, while modern at the time, are debatably becoming obsolete. For what its worth, of course, U.S.

Radiology 85

Radiology Radiology Emergency Department Documentation/Coding 85

ALiEM

SEPTEMBER 9, 2024

Patients are at high risk of bacterial spread to the abdomen or retrograde spread up the ventriculoperitoneal shunt leading to peritonitis, peritoneal abscess, ventriculitis, meningitis, or sepsis. Further indicated invasive/surgical interventions should be deferred to general surgery and neurosurgery consultants. Surg Neurol Int.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

EMDocs

MAY 18, 2024

Epub 2023 Sep 19. 3: Who Benefits Most From Early Antibiotics in Sepsis? Spoon Feed This pig cadaver study argues that jam is a reasonable alternative (if honey and sucralfate are unavailable) to give patients while awaiting definitive endoscopic removal after button battery ingestion. Ann Emerg Med. 2024 Apr;83(4):351-359.

Emergency Department 52

Emergency Department Sepsis Pediatrics 52

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.) Therefore, his presentation is most consistent with sepsis due to acute complicated UTI. Updated 2023 Nov 12]. J Antimicrob Chemother.

EMS 74

EMS Infectious Diseases Sepsis Hospitals 74

JournalFeed

MARCH 4, 2023

The JournalFeed podcast for the week of Feb 27 – Oct 3, 2023. Spoon Feed This unblinded superiority trial found no significant difference in mortality among patients who were randomized to a restrictive fluid strategy with earlier use of vasopressors or liberal fluid administration for treatment of sepsis-induced hypotension.

Sepsis 52

Sepsis Administration 52

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

Taming the SRU

SEPTEMBER 16, 2024

Journal of Blood Medicine , Volume 14, June 2023, pp. 2023, www.ncbi.nlm.nih.gov/books/NBK482202/#:~:text=often%20overlapping%20symptoms.-,The%20most%20common%20signs%20and%20symptoms%20include%20fever%2C%20chills%2C%20urticaria,indicate%20a%20more%20serious%20reaction. 389–398, [link] Peyrony, Olivier, et al. 11, 2 June 2021, p.

Blood Transfusions 88

Blood Transfusions Anaphylaxis Emergency Department Sepsis 88

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. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Am J Emerg Med.

Sepsis 119

Sepsis Fluid Resuscitation Resuscitation Administration 119

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

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

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. Open-label, non-inferiority RCT including patients with uncomplicated diverticulitis, no significant comorbidities, no immunosuppression, and no signs of sepsis.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. StatPearls Publishing; 2023. Blood tests: FBC (leukocytosis), CRP, serum urate if suspecting gout as differential. Hand Xray: identify foreign bodies, osteomyelitis/bone changes. Remove all rings! Hermena S, Tiwari V.

Operations 52

Operations Sepsis Documentation/Coding 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

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 67

Operations Radiology Radiology Fluid Resuscitation 67

Mind The Bleep

JULY 23, 2023

S, 2023) An image of bilious gastric aspirates. Parikh NS, 2023) Meconium ileus mostly occurs in cystic fibrosis because of the mutation that affects the CFTR. Medical Differentials for Bilious Vomiting: Sepsis Incidence : 22 per 1000 liver births Cause: Most commonly group B strep which has colonised the vaginal canal.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

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 96

EMS Resuscitation Seizures Blood Transfusions 96

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

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. Pfizer projects $8 billion in Paxlovid sales in 2023.

Hospitals 98

Hospitals Emergency Department COPD CDC 98

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