RebelEM

FEBRUARY 19, 2024

Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Paper: Yerke JR et al.

Administration 134

Administration Sepsis EMS Shock 134

EMDocs

AUGUST 24, 2023

Blood cultures were collected from patients before the admiration of antibiotics (gold standard), and then again 30 – 120 min following administration of antibiotics. Yields from the post-antibiotic set of blood cultures were then compared against the pre-antibiotics administration set. Difference of 12% (95% CI 5.4 Ann Intern Med.

Administration 89

Administration Sepsis Shock Emergency Department 89

PHEM Cast

APRIL 10, 2016

[link] We hope you enjoyed our sepsis podcast. St Emlyns Induction podcast on Sepsis. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. March 2016.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

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

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 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

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

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 108

Sepsis Best Practices Hospitals Outcomes 108

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 133

Stroke Outcomes Hospitals Administration 133

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

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. She is also an Assistant Professor, Department of Emergency Medicine Mayo […] The post SGEM#346: Sepsis – You Were Always on My Mind first appeared on The Skeptics Guide to Emergency Medicine. mg/dl or 107 umol/L).

Sepsis 40

Sepsis Emergency Department COPD Hospitals 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 93

Outcomes Emergency Department Administration Resuscitation 93

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

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

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

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

EMDocs

OCTOBER 10, 2024

Sepsis is diagnosed and antibiotics started for the first time. High level amputation is considered, but she dies of sepsis and multiorgan failure on hospital day 7. Delay in administration of antibiotics. Takeaways : There are more questions than answers in this case, but: This is a common outcome. It reveals a 7.5

Documentation/Coding 93

Documentation/Coding Hospitals Sepsis Infectious Diseases 93

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. Secondary Outcome By day 90, mortality was 9.3% 5148 excluded 800 enrolled and randomized in the trial. in the hydrocortisone group vs. 11.9%

Research 94

Research Outcomes Administration Shock 94

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo? The PROTECTION trial. Contemp Clin Trials. Epub 2022 Aug 28.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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

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

PulmCCM

JULY 10, 2023

Continuous meropenem infusion for critically ill patients with sepsis Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

The Skeptics' Guide to EM

OCTOBER 3, 2021

In the two large trials, this benefit was seen as a reduction in a composite outcome of major adverse kidney events within 30 days (MAKE-30). The SALT-ED trial was also a single-centre unblinded trial, but the primary outcome was hospital free days. Lactated Ringer’s or Plasmalyte 148) over 0.9%

Outcomes 52

Outcomes Sepsis Administration Resuscitation 52

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). There have been at least two randomized control trials published that do not support the use of Vitamin C in sepsis. no statistical difference in primary outcome of SOFA scores at 72 hours or the secondary outcome of 30-day mortality.

Sepsis 40

Sepsis Shock Outcomes Academics 40

Northwestern EM Blog

JANUARY 24, 2022

Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. At those levels, bicarbonate administration has not been shown to improve cardiac output, MAP or pressor response. Alternate Shock Not all shock is declared equal.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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 Dehydration EMS 52

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 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