Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. Document thorough skin assessment every nursing shift, and inspect weight-bearing ventral surfaces. Reattach EKG leads to back. Tilt patient into reverse Trendelenburg. Obstetrics & Gynecology. 136(2): 259-261.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) 3] The type of IV fluid you use will vary depending on which hospital you are working in and what is available. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. How much fluid?

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Pediatric Emergency Playbook

APRIL 1, 2016

Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care. The acute recognition and treatment of sepsis is first and foremost, clinical. The short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

FEBRUARY 5, 2024

1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2). 2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. Journal of the history of the neurosciences, 6(2), 147–153. Vickers A, Donnelly JP, Moore JX, Barnum SR, Schein TN, et al.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately. Annals of Emergency Medicine.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Northwestern EM Blog

APRIL 25, 2022

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Ideally your exploration should be in a bloodless, painless field and documented as such. The knee joint is the most common joint to be affected, followed by the ankle. Herndon, A. 2022, Apr 25).

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 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. Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

EMDocs

OCTOBER 10, 2024

Exam is normal except for tenderness as documented in the diagram. Hospital Inpatient : R thigh is indurated and blistered but abdomen is all but ignored. On the 2nd hospital day, she becomes obtunded and is intubated. Sepsis is diagnosed and antibiotics started for the first time. I just failed to document it.

Documentation/Coding 97

Documentation/Coding Hospitals Sepsis Infectious Diseases 97

EM Literature of Note

OCTOBER 9, 2024

and GPT-4T – is asked: Should this patient be admitted to the hospital? while also relying upon finished human documentation for its “decision-support” The prompts – “should”/”does” – replicate the intent of the decision-support concept of the exploration, but not the retrospective nature of the content.

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

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. We like it that way.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Dr. Smith's ECG Blog

JULY 21, 2024

The patient was extubated on Day-3 of the hospital stay. 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. In both tracings — an exceedingly fast PMVT is documented.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. vs. US 31.2%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial.

Research 94

Research Outcomes Administration Shock 94

Don't Forget the Bubbles

JUNE 10, 2024

The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries. Systemic Infections : Sepsis and other systemic infections can predispose infants to NEC by compromising the gut barrier and promoting inflammation.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. Treatment protocols changed rapidly and were devised by departmental and hospital consensus.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. was sensitive for 28-day mortality in sepsis. So fairly sensitive, but not too specific.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

RebelEM

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. address in the article discussed below. JAMA Intern Med.

Sepsis 108

Sepsis Outcomes Administration Shock 108

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Pediatr Emerg Care.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

Dr. Smith's ECG Blog

DECEMBER 27, 2024

Documentation lists a diagnosis of "sinus tachycardia." This demands an explanation -- sepsis, hemorrhage, withdrawal, etc. I'm also aware a number of cases ( including one at my former hospital ) where the patient was awake and alert in sustained VT for several days. Serial troponin was undetectable.

EKG/ECG 121

EKG/ECG Hospitals Sepsis Documentation/Coding 121

PulmCCM

MARCH 4, 2024

About half of participants had had documented prior Covid infection. New criteria for diagnosis of pediatric sepsis The diagnosis of pediatric sepsis will abandon the so-called SIRS criteria in favor of a simple organ-failure score. standard deviation). The model was validated using electronic medical record data including 3.6

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Don't Forget the Bubbles

DECEMBER 9, 2024

Clinical recommendations for pain, sedation, withdrawal, and delirium assessment in critically ill infants and children Pediatric Acute Lung Injury and Sepsis Investigators ( PALISI ). Georges hospital , London in pictorial format: What is the role of Alpha2-agonists in sedation, and how to wean them? Am J Respir Crit Care Med.

Pediatrics 59

Pediatrics Sepsis Hospitals Administration 59

Taming the SRU

FEBRUARY 3, 2025

Patients with TLS should be admitted to the hospital with concurrent management from the oncology and renal teams. original document created by author of post. paclitaxel, doxorubicin, cisplatin) high-risk monoclonal antibody treatments (i.e. Loop diuretics are preferred since they promote potassium secretion (5,7).

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Taming the SRU

JUNE 6, 2023

Allows for the patient to be held for a psychiatric evaluation Varies greatly based on state laws In OH, this means patient can be held for 24h prior to being evaluation by a psychiatrist & may be held for additional 72h after that initial evaluation is performed In OH, can be signed by physician, psychologist, mental health NP, mental health clinical (..)

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Mind The Bleep

SEPTEMBER 17, 2024

Epidemiology The number of animal bites presented to A&E is largely underestimated, as many who are bit don’t present to receive medical care 1 or won’t receive treatment in a hospital setting so they are not counted in the statistics for bites 2. Always consider management as per ATLS protocol and SEPSIS 6 if relevant.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Don't Forget the Bubbles

JULY 5, 2023

GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. What medications would you give to control pain in hospital?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Mind The Bleep

NOVEMBER 2, 2024

Every baby has a NIPE performed, either in hospital before discharge or at home by a community midwife. Bruising- this can be common after a vaginal or instrumental birth or in babies who are large for gestational age, and should be documented carefully. Head When looking at the baby’s head, does the size look too large or too small?

Dislocations 52

Dislocations Documentation/Coding Ultrasounds Wellness 52

EMDocs

DECEMBER 9, 2024

2 Beginning in January 2023, the DRC documented a record number of annual suspected cases of clade 1 mpox, specifically classified as Clade 1b. By 2024, over 17,000 suspected cases (2,863 confirmed) were documented across Africa, with the majority in the DRC. encephalitis, sepsis, or conditions requiring hospitalization).

CDC 75

CDC Documentation/Coding Infectious Diseases Dehydration 75