Don't Forget the Bubbles

MARCH 31, 2025

Reviewed by Dr Faye Leggott Article 2: Does fluid overload increase mortality in children with sepsis? Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis. 2023 Nov;7(1):e002094. doi: 10.1136/bmjpo-2023-002094. BMJ Paediatr Open. Whats it about? Am J Emerg Med.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Board Bombs

OCTOBER 29, 2023

In the Spirit of Halloween let's cover Pediatric Sepsis- the tricks of the trade and how to not miss infections, as well as what to know for the test. Peds Sepsis: Nightmare on Epi Street. October 30th, 2023. Peds Sepsis: Nightmare on Epi Street. October 30th, 2023. Cite this podcast as: Briggs, Blake.

Sepsis 52

Sepsis Pediatrics Wellness 52

Board Bombs

OCTOBER 29, 2023

In the Spirit of Halloween let's cover Pediatric Sepsis- the tricks of the trade and how to not miss infections, as well as what to know for the test. Peds Sepsis: Nightmare on Epi Street. October 30th, 2023. Peds Sepsis: Nightmare on Epi Street. October 30th, 2023. Cite this podcast as: Briggs, Blake.

Sepsis 52

Sepsis Pediatrics Wellness 52

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? However, there has been continued debate on what ‘normal’ is in relation to HR and RR.

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Sepsis Pediatrics Urgent Care Emergency Department 98

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. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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. 2023 Jan 30. 2023 Jan 13;76(2):185-191. 2023 Feb 03;: PMID: 36367144 Justin’s excellent critical appraisal and Full write up here. 2023 Feb;30(2):144-146. 2023 Mar 17;380:p601.

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Sepsis Ultrasounds Hospitals Fractures 52

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. 2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” She had a precipitous delivery while the ambulance was pulling in.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. No evidence of sepsis.

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Sepsis Best Practices Hospitals Outcomes 113

ACEP Now

MAY 10, 2024

Patients with flank pain (which would suggest pyelonephritis) as well as patients meeting two or more SIRS criteria (which would suggest sepsis) comprise a higher risk group. Published online 2023. For simplicity, we will focus only on the patients with suspected lower urinary tract infection (UTI). 2000;343(14):992-997.

Infectious Diseases 98

Infectious Diseases Sepsis Emergency Department Administration 98

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

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Arch Dis Child. Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Infectious Diseases 89

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

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. Many clinicians staffing emergency departments intubate infrequently, as well, and these results are likely applicable to a wide scope of practice. How Best to Stop the Bleeding in Trauma? percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

Pediatric EM Morsels

APRIL 7, 2023

Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy. Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

EMDocs

OCTOBER 19, 2024

Leukocytosis, as well as mild leukopenia, are common. 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. 2][3] Evaluation Labwork CBC: A white blood cell count is variable and nonspecific.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. 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. The trauma call goes out.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing. Surg Neurol Int.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

EMDocs

NOVEMBER 27, 2023

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. McGraw-Hill Education; 2023. Rule out confounding viral or autoimmune hepatitis. 2013;68(5):693.e1-693.e14.

EMS 96

EMS Sepsis Burns EKG/ECG 96

RebelEM

JULY 17, 2023

Got FDA exemption as well as went to the community and made sure their community was ok with the trial). 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 95% CI -1.4

Outcomes 98

Outcomes Emergency Department Administration Resuscitation 98

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41. decreased DSI values).

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., And although severe underlying coronary disease is often the cause — non-coronary causes may be seen ( See My Comment in the March 1, 2023 post for the common causes of DSI ). The patient was given aspirin and heparin. There is now some flow in the LMCA!

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

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

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

ACEP Now

OCTOBER 30, 2023

Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech. Am J Public Health.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Taming the SRU

JUNE 11, 2023

Acad Emerg Med 2023; 10.1111/acem.14703 It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions. 2023;(December 2022):1-10. 6/11/2023 Cost is an additional limiting factor, as disposable nasal cannulas are not cheap.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

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

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

Mind The Bleep

SEPTEMBER 12, 2023

Were there any risk factors for sepsis? 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? Postnatal History Ask about respiratory effort since birth.

Sepsis 52

Sepsis Seizures Poisoning Wellness 52

EMDocs

JULY 29, 2023

Accessed March 27, 2023. Accessed on April 11, 2023. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. WikEM, The Global Emergency Medicine Wiki. September 9, 2020. Available at: [link]. EMRA Antibiotic Guide. Arch Otolaryngol Head Neck Surg.

EMS 96

EMS Dehydration Ultrasounds Emergency Department 96

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

PEMBlog

AUGUST 20, 2024

2023; 187:109792. These could include severe sepsis. eCPR is typically performed in specialized centers with highly trained personnel in well coordinated teams. For instance, eCPR is well established as a bridge therapy in pediatric patients with congenital heart disease and increasingly used in in hospital cardiac arrests.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. Available at: [link] (Accessed: April 3, 2023). Available at: [link] (Accessed: April 3, 2023).

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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). Accessed September 17, 2023. Accessed September 17, 2023. Bundle: The bundle treatment included addressing hypertension, hyperglycemia, pyrexia, and hypercoagulability. Spiegel R.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

PulmCCM

FEBRUARY 12, 2024

Severity of pneumonia was not formally defined in the recommendation, owing to the heterogeneity of analyzed trials, but mechanical ventilation, severe sepsis, high pneumonia severity scores, ICU admission, or need for vasopressors were some heuristics used. SCCM joined neither ATS nor ESICM’s 2023 ARDS guideline update.

Shock 52

Shock Administration Sepsis Fractures 52