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

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

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 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

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 54

Sepsis Shock Hospitals 54

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 131

EKG/ECG Shock Emergency Department Ambulance Services 131

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. 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.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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

Taming the SRU

DECEMBER 17, 2024

There is substantial evidence that IV fluids can be beneficial in patients with sepsis complicated by hypotension and labor. Other contraindications include those who are unable to drink liquid (respiratory problems or impaired unconsciousness) and patients in shock, persistent vomiting, or with an ileus. Updated 2023 Oct 22].

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

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

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 99

EMS Pediatrics Sepsis Airway Management 99

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

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 78

Operations Radiology Radiology Fluid Resuscitation 78

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 130

Stroke Outcomes Hospitals Administration 130

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

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 Resuscitation Sepsis 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

Don't Forget the Bubbles

OCTOBER 2, 2024

2024 Sep 19:archdischild-2023-326507. Corticosteroids for Managing Pediatric Sepsis and Septic Shock: A Systematic Review and Meta-analysis. 2024 Sep 17:archdischild-2023-326556. Language ability and virtual mental healthcare utilisation among immigrant and refugee youth: a population-based cohort study. Mohamud H, et al.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

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 116

Sepsis Fluid Resuscitation Resuscitation Administration 116

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 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

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

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. Sepsis: The risk of sepsis increases after the first 24 hours, particularly in preterm infants.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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

Taming the SRU

NOVEMBER 13, 2024

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 88

Psychiatric Seizures Emergency Department Pediatrics 88

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

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 76

EMS Infectious Diseases Shock Ultrasounds 76

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 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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

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 86

EMS Infectious Diseases Sepsis Hospitals 86

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

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 Am J Hematol.

Pediatrics 88

Pediatrics Dehydration EMS Hospitals 88

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

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

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