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 Outcomes Pediatrics Documentation/Coding 75

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Adjust all tubing and reassess connections.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

EM Guide Wire

SEPTEMBER 9, 2020

0.5 – 1 mg q5min, max dose 3 mg peds = 0.02 Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01 Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 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

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. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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

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. What About Procainamide?

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. 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.

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). The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). (And C., & Solomon, T. The Journal of infection , 72 (4), 405–438.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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

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. 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.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

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

PulmCCM

FEBRUARY 19, 2024

Well … no. At Shands (the level 1 trauma center admitting adults), the panel relates the impressive results that mortality fell by 58%, and unplanned codes by 47% “after the widespread implementation of patient/ family activated RRT/MET.” Family-Activated METs in Adults Halves Mortality?

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. The history of necrotising enterocolitis The earliest documented cases resembling Necrotising enterocolitis (NEC) date back to the late 19th and early 20th centuries.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 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. Hot” and “cold” zones were set up, as well as detached screening/testing locations, and many ambulatory patients were assessed and released without ever entering the ED.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. Look at the aortic outflow tract.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

JANUARY 5, 2020

See below how this has been documented. Thus, both overdiagnosis and underdiagnosis of AF are well-recognized problems in computer interpreted electrocardiograms, and they adversely affect patient management with either inappropriate anticoagulation and/or antidysrhythmics or undertreatment [ 1 , 14 ]. Poon et al. sensitivity and 98.9%

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. In one study, a SI > 0.7 Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

Mind The Bleep

FEBRUARY 27, 2024

1] It is worth mentioning this formula was designed for well, euvolaemic children, which does not represent the popluation of children who require IV fluids. The curve on this graph can be split into 3 linear sections corresponding to the following weight categories: 0-10kg, 10-20kg, and 20-70kg. [1]

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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

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 101

Sepsis Outcomes Administration Shock 101

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. While not IQ tests per se , the tests (branded as Cognitron ) purport to correlate well with, and to be indexed to, formal IQ tests. Thanks to the large data set, however, other demographics were well-represented and analyzable. standard deviation).

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Pawlowski TW, et al. Eur J Pediatr. Weiss SL, et al. Pediatrics. 2023 Dec 12:e2023062967.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. This sort of sepsis would produce many of the common autopsy findings. What do we know about SIDS and how effective back sleep is at reducing it?

CDC 87

CDC Sepsis Research Pediatrics 87

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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. Calling sinus tachycardia raises more questions than answers.

EKG/ECG 121

EKG/ECG Hospitals Sepsis Documentation/Coding 121

Mind The Bleep

SEPTEMBER 17, 2024

Document clearly: The location of all wounds Medical photography or drawn labelled diagrams can aid in explaining the exact location. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. Always consider an ATLS approach to the assessment. Feel for any swelling/collection/abscess.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

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 ). It is well-recognised that the environment in the PICU can negatively affect children and their parents/caregivers, increasing the probability of delirium.

Pediatrics 59

Pediatrics Hospitals Sepsis Administration 59

Mind The Bleep

NOVEMBER 2, 2024

Babies in the neonatal unit will typically wait until they are well enough for the examination e.g. NIPE is not performed for baby’s who are ventilated, on CPAP or have lots of different lines inserted. Other important questions to ask: Have they been feeding well? Was the baby head down presentation from 36 weeks onwards?

Documentation/Coding 52

Documentation/Coding Dislocations Ultrasounds Wellness 52