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Sepsis alerts work! Just not in the patients who fire the alerts

PulmCCM

In the past decade, so-called “sepsis alerts” came out of nowhere to become a ubiquitous and resource-intensive component of inpatient medical care. “Sepsis alerts” are automated notifications that flag patients who meet certain criteria compatible with severe infection discernible from the electronic medical record.

Sepsis 45
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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

You can read the document here. Read the original document here. 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).

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Infective Flexor Tensosynovitis (Flexor Sheath Infection)

Mind The Bleep

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. Operative management: Surgical washout of the flexor sheath within 24 hours of the decision to operate. Consider tetanus booster if applicable. Remove all rings! Urgent referral to the hand surgery department.

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The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection

RebelEM

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

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Impact of Emergency Department Crowding on Lung Protective Ventilation

RebelEM

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. Prior studies have used annual census or shift level crowding.

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Nephrolithiasis: Ultrasonography versus Computed Tomography

Northwestern EM Blog

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” Please ensure that you document and discuss with the patient accordingly. were hospitalizations during f/u period; 26.4% vs. In this study, 40.7% J Urol 2019. 202(3):475-483.

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Managing the Patient with Alcohol Intoxication

RebelEM

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. Alcohol Alcohol. PMID: 28340112.