Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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. It’s a wonderful contribution to the literature and well worth reading. Without valid diagnostic criteria, sepsis studies are prone to imprecise or biased findings.

Sepsis 45

Sepsis Shock Research Wellness 45

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. perforation).  Br J Surg.

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

Core Ultrasound

MARCH 25, 2024

If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. 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.

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 86

Operations Radiology Radiology Fluid Resuscitation 86

ACEP Now

MAY 10, 2024

Patients with flank pain (which would suggest pyelonephritis) as well as patients meeting two or more SIRS criteria (which would suggest sepsis) comprise a higher risk group. For simplicity, we will focus only on the patients with suspected lower urinary tract infection (UTI).

Infectious Diseases 98

Infectious Diseases Sepsis Emergency Department Administration 98

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

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

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

Emergency Medicine Ireland

APRIL 29, 2024

The sodium rises, the patient stops seizing everyone relaxes but then the Na continues to rise, well above the 5mmol we wanted and a panic ensues. But as we all know patients often have multiple reasons to be obtunded including sepsis or intoxication or multiple other causes. This bit is usually pretty straightforward. Christopher, K.,

Seizures 75

Seizures Sepsis Stroke Administration 75

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 91

EMS Sepsis Burns EKG/ECG 91

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. Got FDA exemption as well as went to the community and made sure their community was ok with the trial). Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2;

Outcomes 93

Outcomes Emergency Department Administration Resuscitation 93

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. There may well be some co existing sepsis so give some antibiotics. There is occasionally some coexisting adrenal insufficiency so you’ll treat that as well. Firstly do a bit of resuscitation.

Sepsis 52

Sepsis Resuscitation Wellness Administration 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. Background: There was a huge buzz in the media a few years ago about a vitamin C cocktail (vitamin C, hydrocortisone and thiamine) as a possible cure for sepsis. This was because of a well-known critical care physician Dr. Paul Marik.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

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. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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

EMDocs

OCTOBER 25, 2024

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

Sepsis 91

Sepsis Burns EKG/ECG EMS 91

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

Dr. Smith's ECG Blog

JULY 21, 2024

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. Administration of Procainamide is 10-17 mg/kg at 20 mg/min. The patient was already intubated and sedated. What About Procainamide?

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

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. This comports with the earlier findings of lack of benefit and possible harm from high-dose vitamin C supplementation in sepsis.

Sepsis 52

Sepsis Shock Administration Leadership 52

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.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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. It was Dr. Paul Marik who has been a big advocate for Vitamin C sepsis. Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 40

The Skeptics' Guide to EM

FEBRUARY 24, 2018

There is a certain subset of patients in septic shock whose adrenal axis functions well enough to support them in a state of health but are unable to support them in a state of unwell. This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock. Reference: Venkatesh S et al. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

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 84

EMS Infectious Diseases Pediatrics Research 84

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

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. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

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

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 ). Critically ill patients with low cortisol (e.g., 3 days).

Shock 52

Shock Administration Sepsis Fractures 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

PulmCCM

NOVEMBER 11, 2021

Notably, they observed that while phenylephrine rectified hypotension, it significantly reduced heart rate [HR], SV – and, therefore, total cardiac output [CO] – as well as cerebral oxygenation [SctO2]. evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0

Stroke 40

Stroke Sepsis Administration Wellness 40

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. First, oral administration is preferred, as this route can often be as effective as intramuscular administration.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

PulmCCM

SEPTEMBER 9, 2021

Arguably, this might be mitigated by slower volume administration. And so, Zampieri and colleagues recently released the Balanced Solutions in Intensive Care Study [BaSICS], comparing two types of crystalloid resuscitation fluid, discussed previously , as well as two infusions rates of these fluids , considered below. 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.

Wellness 40

Wellness Outcomes Sepsis Stroke 40

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. A greater number of patients randomized to “standard of care” attained modified Rankin scores of 0 to 3 than the Andexxa cohort, as well.

Research 49

Research Stroke Outcomes Sepsis 49

Pediatric Emergency Playbook

MAY 1, 2017

Also, newborns have a double-whammy administrative load. Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. Check the bilirubin in any neonate you are working up for sepsis.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 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

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. were hospitalizations during f/u period; 26.4%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52