The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Background: I think we have covered sepsis more often than any other topic on the SGEM. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

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 92

Operations Radiology Radiology Fluid Resuscitation 92

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 Resuscitation Administration 97

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

Don't Forget the Bubbles

NOVEMBER 15, 2023

Currently, the administration of water for the paediatric population is based on the Holliday-Segar formula (100ml/kg/day for the first 10kg of weight, 50ml/kg/day for the second 10kg of weight and 20ml/kg/day for weight over 20kg). As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

RebelEM

JANUARY 25, 2023

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. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

RebelEM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). Unfortunately, the exact dose and time of administration of first line medications was not reported before a second line medication was given. Lastly, there is a substantial amount of data missing, specifically the underlying cause of the Atrial Fibrillation with RVR (ie.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Plasma levels of lidocaine following nebulized aerosol administration. A randomized, double-blind, placebo-controlled trial. Pediatrics. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Chest 1977;71(3):346-8. Cullen L et al. Nebulized lidocaine decreases the discomfort of nasogastric tube insertion: a randomized, double-blind trial.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

PulmCCM

JANUARY 4, 2022

As well, the volume of administration might be much lower than 500 mL, with previous research indicating that 4 mL/kg of crystalloid was an optimal volume needed to increase mean systemic filling pressure. Thoughts Barthelemy and colleagues report an inventive and necessary study for those interested in resuscitation physiology.

Wellness 40

Wellness Outcomes Sepsis Stroke 40

Dr. Smith's ECG Blog

MAY 19, 2020

pulmonary embolism, sepsis, etc.), The gold standard technique for diagnosing coronary spasm is administration of high-dose intracoronary acetylcholine boluses with the response evaluated by invasive contrast angiography. The diagnosis of MINOCA should exclude: 1) other overt causes for elevated troponin (e.g., myocarditis).

CPR 52

CPR EKG/ECG Shock Ultrasounds 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. Studies without a clear timeframe for fluid administration.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

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

Northwestern EM Blog

JULY 15, 2024

Indeed, there are many inciting sources that can be divided into direct—pneumonia, aspiration, intrathoracic procedures—and indirect—non-pulmonary sepsis, pancreatitis, trauma/burns, blood product transfusion (“TRALI”)—lung injury. Initial Resuscitation in ARDS [NUEM Blog. 2024, Jul 15). Expert Commentary by Esposito, AJ.

Resuscitation 98

Resuscitation Burns Emergency Department Sepsis 98

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

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

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Don't Forget the Bubbles

NOVEMBER 1, 2023

This is not always feasible in an acute resuscitation scenario. This retrospective observational cohort study looked at whether lactate can be used to predict the need for acute resuscitation in paediatric emergency department (PED) patients. In children who did not need acute resuscitation, the 95th percentile of lactate was 3.2

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

SEPTEMBER 6, 2023

Learning points: Consider differential – sepsis, thyroid storm, thalamic stroke, exertional and classic heat stroke, serotonin syndrome, neuroleptic malignant syndrome, sympathomimetic toxicity, and anticholinergics. Resuscitate and administer antibiotics. IV fluids administrated, IV vancomycin and piperacillin-tazobactam.

Anaphylaxis 95

Anaphylaxis Shock Sepsis Stroke 95

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

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

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Emergency Medicine Ireland

JANUARY 22, 2024

It’s clear that the features listed above are fairly non specific and like always it’s likely just sepsis. Firstly do a bit of resuscitation. There may well be some co existing sepsis so give some antibiotics. Our first relevant condition is the wonderfully named thyroid storm.

Sepsis 52

Sepsis Resuscitation Wellness Administration 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

The Skeptics' Guide to EM

OCTOBER 3, 2021

Many critically ill patients receive intravenous crystalloids for volume expansion as part of their resuscitation. Clinical Question: Does administration of a balanced solution (Plasma-Lyte 148) during intensive care unit (ICU) stay, compared with saline solution, result in improved 90-day survival in critically ill patients?

Outcomes 52

Outcomes Sepsis Resuscitation Administration 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 N Engl J Med.

Research 52

Research Airway Management Stroke Outcomes 52

Mind The Bleep

MAY 12, 2023

Administration of human albumin solution (HAS) in SBP reduces the incidence of renal failure by 72% and mortality by 47%. In those who are grossly obese, it may be better to employ a more cautious approach with regard to albumin administration. The number needed to treat to prevent one death is around 5 in SBP. On Day 3 (i.e.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

PulmCCM

SEPTEMBER 9, 2021

Sylvia Plath Background Implicit in resuscitation is speed. Septic sheep randomized to early, rapid volume resuscitation had greater vasopressor requirements 12 hours after initial fluid bolus. Arguably, this might be mitigated by slower volume administration. Jon-Emile S. needed at least 1 fluid expansion, 2.] hypotension; c.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Don't Forget the Bubbles

JUNE 10, 2024

Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation. Differential diagnoses include septic ileus, and infection causes such as sepsis, meningitis and pneumonia. How do we diagnose necrotising enterocolitis?

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Thinking Critical Care

MAY 18, 2023

To everybody outside Glasgow glucocorticoids seemed to be the answer and Chicago surgeon William Schumer was their chief flag waver, claiming in 1976 that steroid therapy reduced the mortality of saline-treated sepsis in his service from 33% to around 10%. [5] I do not recall one experiment getting as far as the resuscitation stage.

Shock 40

Shock Research Sepsis Resuscitation 40

EM Updates

JUNE 15, 2021

Administrative logistics demanded that patients receiving ongoing care in the emergency department be formally admitted to the hospital; we were therefore enjoined to admit these patients to ourselves and therefore formed the Emergency Department Admitting Team. and Emergency Medicine residents, in 12 hour shifts. N Engl J Med. Crit Care Med.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases. It’s an easy number to remember. 1-800-222-1222.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Dr. Smith's ECG Blog

APRIL 6, 2025

His heart rate had improved to the 80s after epinephrine administration. He was given vancomycin and cefepime empirically, though we overall had low concern for sepsis as the etiology of his presentation. Cardiology was consulted. Subsequently, he became increasingly bradycardic and was noted to have myoclonic movements.

EKG/ECG 110

EKG/ECG CPR Shock Sepsis 110

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. In lower-resource settings, the evidence is stronger against a liberal approach to volume resuscitation.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75