Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Of the 74.9% Hagenbuch, N.,

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

PulmCCM

FEBRUARY 5, 2024

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).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

EM Literature of Note

OCTOBER 9, 2024

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. The “sepsis measure fallout gestapo” might disagree, however.

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. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

ACEP Now

OCTOBER 30, 2023

This makes documentation and communication of the utmost importance for these patients for their health and safety. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. This leads into the next part of the model—Assessment. One commonly used example is tachycardia.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Emergency Medicine Ireland

JULY 3, 2023

Type 5 is the big bucket where they put all the left over disease that cause both kidney and heart failure eg things like amyloid, or sepsis or cirrhosis. This segues relatively nicely into a section of the document on palliative care. Type 4 is again renocardiac with the kidneys causing the heart failure but on a chronic basis.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

RebelEM

JANUARY 29, 2024

What They Did: Single-center, pilot prospective observational cohort trial in Turkey Thrombolysis 25mg of alteplase without a bolus was administered over 6 hours by peripheral IV infusion If hemodynamic instability persisted despite first dose of thrombolysis, a second 6hr infusion of 25mg alteplase without bolus was administered (No patients in the (..)

Stroke 136

Stroke Outcomes Hospitals Administration 136

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

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.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. References British Society for Surgery of the Hand – Flexor Sheath Infection Document Pang H-N, Teoh L-C, Yam AK, et al. Blood tests: FBC (leukocytosis), CRP, serum urate if suspecting gout as differential.

Operations 52

Operations Sepsis Documentation/Coding 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. In both tracings — an exceedingly fast PMVT is documented. That said — there is no evidence on ECG of re-occlusion of the infarct artery.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

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). The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. C., & Solomon, T. van de Beek, D., Cabellos, C.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

RebelEM

AUGUST 12, 2024

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 (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

Mind The Bleep

FEBRUARY 27, 2024

“PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial”, Trials pp776, 2021 Written and edited by Dr Bex Evans, paediatric registrar

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

RebelEM

MARCH 27, 2023

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.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 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. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused by pneumonia.

Research 94

Research Outcomes Administration Shock 94

Dr. Smith's ECG Blog

APRIL 15, 2019

A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis. Although the quality is suboptimal, it appears to me to show a hyperdynamic heart and possibly and apical wall motion abnormality.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

ACEP Now

JULY 7, 2023

Patients with sepsis get antibiotics. Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level. This month, we are discussing the medical management of patients with mild to moderate agitation. Emergency departments (EDs) focus on rapid initiation of medical treatment.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Northwestern EM Blog

MAY 16, 2022

Please ensure that you document and discuss with the patient accordingly. were hospitalizations during f/u period; 26.4% Finally, a burden on us as EM clinicians is training in and awareness of clinical practice guidelines and recommendations from specialties outside of EM.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Emergency Medicine Ireland

AUGUST 1, 2022

The next job is to document clearance from the blood. There are some nuances once you get into the weeds (and beyond the scope of an ICU exam) about addition of aminoglycosides (not routinely recommended) or addition of rifampicin (generally only in the context of prosthetic joints or hardware). once on the bug juice repeat the cultures.

Sepsis 40

Sepsis Shock Documentation/Coding 40

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.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

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

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EM Updates

JUNE 15, 2021

After admission to the EDAT, documentation was performed on the inpatient electronic health record (EHR), which at MMC is a different platform than the ED EHR. Providers carried out their tasks using foreign ordering and documentation pathways within an EHR that had to be learned immediately and without training. N Engl J Med.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

See below how this has been documented. MAT almost always occurs in one of 2 common clinical scenarios : i ) Severe pulmonary disease ( ie, COPD, long-term asthma; pulmonary hypertension ) ; or , ii ) Acutely ill patients with multisystem disease ( ie, patients with sepsis; shock; electrolyte and/or acid-base disorders ).

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

EB Medicine

JUNE 6, 2019

However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. was sensitive for 28-day mortality in sepsis. Jeff: Speaking of HR, tachycardia can be a response to pain, anxiety, fever, blood loss, or sepsis. In one study, a SI > 0.7 Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

ACEP Now

JANUARY 5, 2025

1,2 This article reviews key statutes in the states with the strongest prohibitions against abortion and offers documentation principles for treating patients with ectopic pregnancies, spontaneous miscarriages, and other pregnancy-related emergencies. Suggestions: Document the threat to the mothers life or bodily function.

Documentation/Coding 98

Documentation/Coding Sepsis Emergency Department 98

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 113

Sepsis Outcomes Administration Shock 113

Emergency Medicine Ireland

OCTOBER 28, 2020

This has relevance to the ICU population in 2 major ares * Sepsis. * EF does not correlate with particularly well with mortality in sepsis though diastolic dysfunction does * It may be due to under filling and the reduced diastolic filling due to the ubiquitous tachycardia in sepsis. . *

Sepsis 40

Sepsis Documentation/Coding Ultrasounds Wellness 40

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane).

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

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.

Infectious Diseases 164

Infectious Diseases Pediatrics Sepsis Documentation/Coding 164

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

Don't Forget the Bubbles

JULY 5, 2023

Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Sickle cell patients also qualify to receive the annual influenza vaccine, since influenza virus infection predisposes to bacterial pneumonia and sepsis caused by S. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Dr. Smith's ECG Blog

DECEMBER 27, 2024

Documentation lists a diagnosis of "sinus tachycardia." This demands an explanation -- sepsis, hemorrhage, withdrawal, etc. Serial troponin was undetectable. As an aside, sinus tachycardia at a rate of 140 in an elderly man is seriously concerning and demands an explanation.

EKG/ECG 121

EKG/ECG Hospitals Sepsis Documentation/Coding 121

Mind The Bleep

JANUARY 24, 2025

Blood cultures in cases of suspected sepsis. Documentation and Communication Maintain meticulous records of assessments, interventions, and outcomes. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) to assess inflammation. Serum albumin and prealbumin levels to evaluate nutritional status.

Sepsis 52

Sepsis Documentation/Coding Outcomes Ultrasounds 52