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

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

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 Wellness 60

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

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

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

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

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 Administration Emergency Department 98

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 15.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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 88

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

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 96

EMS Resuscitation Blood Transfusions Seizures 96

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

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

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

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

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 87

EMS Pediatrics Sepsis Airway Management 87

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.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

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

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

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

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 125

EKG/ECG Shock Emergency Department Ambulance Services 125

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 78

Ultrasounds Sepsis Radiology Radiology 78

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

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 71

EMS Sepsis Burns EKG/ECG 71

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 Administration Emergency Department 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 97

Airway Management Resuscitation EKG/ECG CPR 97

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 Outcomes Dehydration 98

Don't Forget the Bubbles

OCTOBER 2, 2024

This referral procedure is only possible with a well-structured system and may not be feasible in all settings. 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. Mohamud H, et al. Pediatrics.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

Taming the SRU

JULY 21, 2023

Accessed June 11, 2023. In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. licensed under a Creative Commons Attribution 3.0 licensed under a Creative Commons Attribution 3.0

Emergency Department 87

Emergency Department EMS Burns Wellness 87

Mind The Bleep

SEPTEMBER 17, 2024

Management The management is guided by the examination findings which are covered in the respective chapter, this section will delve into the importance of a number of those steps, as well as further long-term care. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. UK Health Security Agency. link] Chu, D.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

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

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 87

Hospitals Emergency Department EMS Outcomes 87

Pediatric Education

SEPTEMBER 10, 2023

The patient had a sepsis evaluation and was started on empiric antibiotics. Surgical treatment may include ligation as well as vascular re-implantation. These patients may have tracheal stenosis as well as ~75% may have complete cartilaginous tracheal rings. Surgical correction may also include tracheal correction as well.

Pediatrics 40

Pediatrics Radiology Radiology Wellness 40

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. C or 100.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

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 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. 2023 Dec;78(12):1175–80. 2023 Sep 9 [cited 2024 Jan 30];62(suppl 67). Cochrane; 2023 [cited 2024 Apr 15]. N Engl J Med.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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