Emergency Medicine Journal

MARCH 25, 2025

Association between time to antibiotic and mortality in patients with suspected sepsis in the emergency department: post hoc analysis of the 1-BED randomised clinical trial by Philippon et al 1 Topic: Sepsis Outcome rating: Game changer The importance of early antibiotic administration in sepsis is well recognised, yet the necessity of strict 1-hour (..)

Sepsis 52

Sepsis Emergency Department Administration Outcomes 52

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

RebelEM

MAY 18, 2023

REBEL Cast Ep116: The CLOVERS Trial – Restrictive vs Liberal Fluids in Sepsis-Induced Hypotension Click here for Direct Download of the Podcast Paper: The National Heart, Lung and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network. Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

EMDocs

JANUARY 11, 2025

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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. CHEST 2024.

Administration 137

Administration Sepsis EMS Shock 137

Board Bombs

SEPTEMBER 10, 2023

Hospital administrators take note. We're covering what's important in sepsis care. Sepsis: burn the stopwatches. Hospital administrators take note. We're covering what's important in sepsis care. Sepsis: burn the stopwatches. We promise this isn't clickbait. Take a guess what we won't be covering.

Burns 52

Burns Sepsis Administration Hospitals 52

Board Bombs

SEPTEMBER 10, 2023

Hospital administrators take note. We're covering what's important in sepsis care. Sepsis: burn the stopwatches. Hospital administrators take note. We're covering what's important in sepsis care. Sepsis: burn the stopwatches. We promise this isn't clickbait. Take a guess what we won't be covering.

Burns 52

Burns Sepsis Administration Hospitals 52

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

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

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 95

Administration Sepsis Shock Emergency Department 95

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

RebelEM

APRIL 26, 2023

Remember to evaluate for concurrent medical illness: gastritis, pancreatitis, pyelonephritis, pneumonia, sepsis. Thiamine 100mg IV 4 Fix electrolyte abnormalities (Hypokalemia, Hypomagnesemia) Administration of bicarbonate is generally unnecessary. Treatment consists of thiamine, dextrose, and volume repletion. 1991 Aug;91(2):119-28.

Sepsis 130

Sepsis Administration EMS 130

PulmCCM

DECEMBER 11, 2024

An excellent review article titled “Sepsis and Septic Shock” was published 4 December 2024 in the New England Journal of Medicine. health system require us to enter a diagnosis to generate payment by a health insurer, it’s worth emphasizing that sepsis is a syndrome, not a disease.

Sepsis 45

Sepsis Shock Research Wellness 45

Emergency Medicine Cases

MAY 5, 2020

The post EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis Pediatrics EMS Fractures 52

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. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Temperature starts to decrease.

Anaphylaxis 96

Anaphylaxis Shock Sepsis Stroke 96

EMDocs

AUGUST 17, 2023

The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 93

Sepsis Shock Resuscitation Fluid Resuscitation 93

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In 2021, the Surviving Sepsis Campaign International Guidelines advised clinicians to administer antimicrobials within 1h and 3h to sepsis patients with and without shock respectively. We aim to evaluate whether the timing of antibiotic administration in admitted sepsis patients affects mortality.

Sepsis 40

Sepsis Administration Shock 40

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. Contrary to the recency bias of many, ARDS is not just a phenomenon associated with COVID-19.

Resuscitation 98

Resuscitation Burns Emergency Department Sepsis 98

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. Open-label, non-inferiority RCT including patients with uncomplicated diverticulitis, no significant comorbidities, no immunosuppression, and no signs of sepsis.

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

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

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

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.

Outcomes 93

Outcomes Sepsis Administration EMS 93

PulmCCM

APRIL 29, 2024

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). The stakes are going up. That was the pregame.

Infectious Diseases 52

Infectious Diseases Sepsis Administration Shock 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

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

EM Literature of Note

AUGUST 1, 2023

have grown from 9% of GDP to 20% GDP, and administrative costs are estimated to comprise up to 30% of total national health care spending. suddenly we’re obviously talking about tens of billions of dollars of added administrative overhead. Health care expenditures in the U.S. Multiplied by the 4000+ hospitals in the U.S.,

Administration 65

Administration Sepsis Hospitals 65

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

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).

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. There is no one dichotomous test that will tell you whether to give fluid or not. That is a holy grail that we have to stop chasing.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

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

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. It reveals a 7.5 cm abscess in the R thigh and retro-cecal appendicitis with retro-peritoneal perforation.

Documentation/Coding 97

Documentation/Coding Hospitals Sepsis Infectious Diseases 97

Emergency Medicine Journal

OCTOBER 23, 2024

The administration of dilute solutions of noradrenaline via peripheral venous catheters (PVCs) has gained increasing acceptance in recent years. Large studies have provided reassuring safety data, 1 and guidelines recognise this therapy as a short-term measure for blood pressure support, 2 particularly in septic shock.

Sepsis 52

Sepsis Administration Shock Hospitals 52

JournalFeed

MARCH 4, 2023

Spoon Feed This unblinded superiority trial found no significant difference in mortality among patients who were randomized to a restrictive fluid strategy with earlier use of vasopressors or liberal fluid administration for treatment of sepsis-induced hypotension.

Sepsis 52

Sepsis Administration 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. 2 DRESS Syndrome has a 10% mortality rate with the primary cause of mortality being hepatic necrosis.

EMS 96

EMS Sepsis Burns EKG/ECG 96

PulmCCM

FEBRUARY 5, 2024

In 18 severe sepsis patients in 3 years at one center who underwent PET scanning (apparently done ad hoc), 14 of the 18 had positive tests, and 11 were true positives, leading to surgery in 2 and pacemaker removal in 2 (and longer / new antibiotics in 2). to enforce compliance with an administrative policy).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

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