EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

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. Myth busting: Is peripheral administration safe?

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Critical Care Now

AUGUST 18, 2024

ClinicalTrials.gov: NCT025174897 Background: Community-acquired pneumonia (CAP) can lead to significant pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and increased mortality. The primary outcome showed a 28-day mortality of 6.2% in the hydrocortisone group compared to 11.9%

Outcomes 93

Outcomes Sepsis Administration EMS 93

University of Maryland CC Project

JANUARY 31, 2024

The topic of their lecture today is their recently published article in CHEST: “Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study”. Their article can be found here: [link]

Administration 40

Administration Sepsis Research Outcomes 40

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. Range 5 to 9) Etomidate: 7.0

Outcomes 97

Outcomes Emergency Department Administration Resuscitation 97

The Skeptics' Guide to EM

JUNE 6, 2020

Background: I think we have covered sepsis more often than any other topic on the SGEM. It was the landmark paper published 19 years ago by Dr. Emanuel Rivers on early goal directed therapy in the treatment of severe sepsis and septic shock that sensitized the medical community ( Rivers et al NEJM 2001). increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

Core Ultrasound

MARCH 25, 2024

The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. In 42 patients getting PET scans in a neuro-ICU over 10 years, four of the six with sepsis had infectious foci identified. to enforce compliance with an administrative policy).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Critical Care Now

AUGUST 18, 2024

ClinicalTrials.gov: NCT025174897 Background Community-acquired pneumonia (CAP) can lead to significant pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and increased mortality. The primary outcome showed a 28-day mortality of 6.2% in the hydrocortisone group compared to 11.9%

Outcomes 52

Outcomes Sepsis Administration EMS 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Their workup reveals a multifocal pneumonia with signs of sepsis. The SGEM Bottom Line was that the routine administration of supplemental oxygen in patients with suspected or confirmed acute myocardial infarction who are not hypoxic does not appear to provide a patient-oriented benefit. Reference: Chu DK et al.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

PulmCCM

NOVEMBER 27, 2023

A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third. Authors wondered if chance resulted in more withdrawal-of-care decisions among the landiolol arm, making their outcomes look worse.

Sepsis 52

Sepsis Shock Administration Leadership 52

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Diagnosis and Management of Pituitary Adenomas: A Review.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

JANUARY 25, 2020

Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Clinical Question: Is bag-mask ventilation (BMV) performed during the apneic period of RSI (defined as the time between administration of RSI medications and intubation) in critically ill adults safe and effective? Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. What do we need to give?

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Emergency Medicine Education

SEPTEMBER 29, 2024

A retrospective study published in the Critical Care journal investigated the impact of intravenous thiamine administration on clinical outcomes in septic patients. The study evaluated key parameters, including lactate clearance and overall mortality. Link to article

Shock 40

Shock Administration Outcomes Sepsis 40

RebelEM

FEBRUARY 2, 2023

Small sample size limits the power of the study and increases margin of error A patient-oriented outcome such as mortality was not included Follow-up beyond disposition to evaluate hospitalization recurrences related to atrial fibrillation was not included. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc).

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

RebelEM

JANUARY 25, 2023

Small bowel obstruction: Outcome and cost implications of admitting service. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Emery Med J 2014; 31(3): 248-9. 0.27 – 0.83

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. Am J Emerg Med.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

ACEP Now

SEPTEMBER 6, 2024

You may have mastered all the latest changes affecting management of sepsis, STEMI, and opiate-use disorder, but there’s no stopping the relentless revisions to our approach to neurologic emergencies. 4 Overall, good or excellent outcomes were seen in 79 percent of the reteplase cohort versus 70 percent of those receiving alteplase.

Research 49

Research Stroke Outcomes Sepsis 49

The Skeptics' Guide to EM

FEBRUARY 24, 2018

This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock. While the primary outcome showed no difference between glucocorticoid treatment and placebo, there was also no secondary mortality benefit observed. Reference: Venkatesh S et al. NEJM January 2018. Population: Adults,

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

PulmCCM

FEBRUARY 12, 2024

In mechanically ventilated patients with septic shock, randomized trials have not shown improved survival with steroid administration , even among those who were “cosyntropin responders” (although hemodynamics were improved with steroids ). The new evidence prompted all three societies to issue new guideline updates.

Shock 52

Shock Administration Sepsis Fractures 52

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. First, oral administration is preferred, as this route can often be as effective as intramuscular administration. Patients in DKA get insulin.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Plasma levels of lidocaine following nebulized aerosol administration. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Pediatrics.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

PulmCCM

JANUARY 4, 2022

” -Fran Lebowitz Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome. The primary outcome was identification of the optimal volume for assessing fluid responsiveness. If I get to the dry cleaners without having a huge fight, that’s challenging enough.”

Wellness 40

Wellness Outcomes Sepsis Stroke 40

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. Studies without a clear timeframe for fluid administration.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

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

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 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

RebelEM

MAY 18, 2023

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9%

Sepsis 103

Sepsis Shock Resuscitation Outcomes 103

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Don't Forget the Bubbles

MARCH 31, 2025

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. Reviewed by Dr Faye Leggott Article 2: Does fluid overload increase mortality in children with sepsis? Whats it about?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. No difference in their primary outcome of complications and need for emergency surgery (1.9% Patients with sepsis and immunocompromise were not included. 623 patients included. 528 patients included. 5.0%; p = 0.085).

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

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

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

MAY 15, 2024

Early administration of antibiotics is the only factor known to reduce this mortality. Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Early administration of antibiotics is the only factor known to reduce this mortality. Isolate, but do not wait to initiate treatment.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

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