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.

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Sepsis Fluid Resuscitation Shock Resuscitation 59

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

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Paper: Yerke JR et al. CHEST 2024.

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Administration Sepsis EMS Shock 137

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

Administration 96

Administration Sepsis Shock Emergency Department 96

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 97

Anaphylaxis Shock Sepsis Stroke 97

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 95

Sepsis Shock Resuscitation Fluid Resuscitation 95

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

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.

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Sepsis Shock Research Wellness 45

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.

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Sepsis Administration Shock 40

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

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

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

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. 2021, Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

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

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 95

Operations Radiology Radiology Fluid Resuscitation 95

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. You are ready to call the ICU and get her admitted. Reference: Putzu et al.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

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. About 25% of the excluded patients had septic shock, but the classification of hypotension as septic shock was at the discretion of the treating team.

Research 94

Research Outcomes Administration Shock 94

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

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

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

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Shock Administration Outcomes Sepsis 40

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. 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.

Sepsis 52

Sepsis Shock Administration Leadership 52

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. The 2017 SCCM/ESICM suggestion had been to use steroids for severe septic shock (requiring high-dose or multiple vasopressors). critical care professional societies agree.

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Shock Administration Sepsis Fractures 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy.

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EKG/ECG Shock Hospitals Sepsis 131

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. Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. . Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 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). Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis.

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Resuscitation Dehydration Administration Shock 80

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

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

EMDocs

JULY 1, 2023

This is the only situation in which aspirin is recommended for administration in children, as the benefits outweigh the risks of Reye syndrome. High-dose methylprednisolone (B) is not currently recommended, as steroids for Kawasaki disease are controversial. Rosh Review Website Link FOAMed: [link] [link] [link] References: Noorani, M.,

EMS 94

EMS Infectious Diseases Pediatrics Research 94

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. This can be the result of hypotension, tachycardia, sepsis, PE, etc. PCI) in STEMI Early administration of aspirin decreases mortality and complications of MI (all types). (19),

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Sepsis 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

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. Troponin I rose to 44.1

CPR 52

CPR EKG/ECG Shock Ultrasounds 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

SEPTEMBER 9, 2021

Arguably, this might be mitigated by slower volume administration. sepsis – defined as suspected or confirmed infection plus acute organ dysfunction; d.] Further, the Simplified Severe Sepsis Protocol [SSSP-2] , employed by Andrews and colleagues in Zambia called for an initial, therapeutic bolus at 33.3 hypotension; c.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

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. Indeed, a recent consensus statement suggested a fluid challenge be 500 mL infused in less than 30 minutes. ED50] and in 90% [i.e.,

Wellness 40

Wellness Outcomes Sepsis Stroke 40