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

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

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.

Sepsis 98

Sepsis Pediatrics Shock 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

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. 2023 Mar;65:76-83. A 2020 Cochrane review found the pooled sensitivity was 65%. Do not rely on this to rule out bacterial meningitis. Patients require admission. Am J Emerg Med.

Infectious Diseases 83

Infectious Diseases Seizures Poisoning Sepsis 83

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

Board Bombs

APRIL 30, 2023

Lets talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. Lets talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. In fact, it might just decide to kill the patient if you do that. Want to experience the greatest in board studying? Episode 174.

Shock 52

Shock Sepsis 52

Board Bombs

APRIL 30, 2023

Let’s talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. Let’s talk about a lesser common cause of shock. Cardiogenic Shock. April 30th, 2023. In fact, it might just decide to kill the patient if you do that. Want to experience the greatest in board studying? Episode 174.

Shock 52

Shock Sepsis 52

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

The Skeptics' Guide to EM

NOVEMBER 4, 2023

Time for paediatrics to screen out sepsis “screening.” June 2023 Date: Sept 12, 2023 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicester’s SAPPHIRE group. Time for paediatrics to screen out sepsis “screening.”

Sepsis 56

Sepsis Shock Hospitals 56

The Bottom Line

OCTOBER 28, 2023

Landiolol and Organ Failure in Patients With Septic Shock Whitehouse. JAMA Published online October 25, 2023. 2023.20134 Clinical Question In patients with tachycardia and septic shock who are treated with high dose norepinephrine does the use of β-blockade for up to 14 days reduce organ failure compared to standard care?

Shock 65

Shock Sepsis 65

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Suspect LMCA with sudden shock and widespread ST elevations.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). link] Takahashi, N.,

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

JournalFeed

DECEMBER 2, 2023

The JournalFeed podcast for the week of Nov 27th – Dec 1st, 2023. Friday Spoon Feed: A randomized trial of patients in septic shock on norepinephrine found no benefit in those treated with an infusion of landiolol (β1-blocker). These are summaries from just 2 of the 5 article we cover every week!

Sepsis 52

Sepsis Shock 52

Don't Forget the Bubbles

MARCH 4, 2024

Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. It doesn’t help to diagnose or exclude sepsis.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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

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]. 2023 Jul 10.

Infectious Diseases 89

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

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] Published 2023. ESR, CRP: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are also nonspecific but are estimated to be elevated in 68% of patients.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

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. 2021, Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. Brie-liiant!

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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 40

Emergency Department Outcomes Sepsis Research 40

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. About 25% of the excluded patients had septic shock, but the classification of hypotension as septic shock was at the discretion of the treating team.

Research 94

Research Outcomes Administration Shock 94

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

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. 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% Am J Cardiol 2013.

Stroke 136

Stroke Outcomes Hospitals Administration 136

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. Then in 2023, ATS and ESICM released separate, conflicting ARDS guidelines: ESICM did not recommend steroids for ARDS in its guidance, while ATS did. critical care professional societies agree.

Shock 52

Shock Administration Sepsis Fractures 52

Dr. Smith's ECG Blog

JUNE 26, 2023

== MY Comment , by K EN G RAUER, MD ( 6/26 /2023 ): == The tracing in Figure-1 was sent to me — without the benefit of any history. Most occurrences are associated with events such as sepsis, shock, recent infarction, post-operative state, electrolyte disturbance — or "sick patient". How would YOU interpret this tracing?

EKG/ECG 97

EKG/ECG Seizures Sepsis Operations 97

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

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Sepsis Resuscitation 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Available at: [link] (Accessed: April 3, 2023). Crit Care Med. Pediatrics.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

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

Mind The Bleep

FEBRUARY 7, 2024

Lung perfusion can be decreased by pulmonary hypertension, high pulmonary vascular resistance, massive pulmonary embolus (very rare in neonates), air embolism, shock with reduced blood flow and bronchopulmonary dysplasia with pulmonary hypertension. 2023, December 20th). 2023, December 18th). References Biorender.

Wellness 52

Wellness Sepsis Stroke Shock 52

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. 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. vs. 0.91), positive predictive value (0.27

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

EMDocs

JULY 15, 2023

sepsis), immunocompromised patients, IV drug users, patients with prosthetic heart valves or any intravascular device Clinical features may not abe enough to differentiate erysipelas from cellulitis, and in such cases the treatment should be targeted towards cellulitis Labs No laboratory evaluation is required for the diagnosis of erysipelas.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

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.) Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 IV fluid resuscitation as needed.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Taming the SRU

APRIL 26, 2023

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 Emerg Med 2016. Gauer R, Meyers BK. Heat-Related Illnesses. Am Fam Physician 2019; 99:482. Intensive Care Med 2012.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52