Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Identify the percentage of children whose heart or respiratory rate would exceed the “severe” cut-off from the UK Sepsis Trust and NICE guidelines.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

ACEP Now

JULY 7, 2023

Emergency departments (EDs) focus on rapid initiation of medical treatment. Patients with sepsis get antibiotics. However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. Ann Emerg Med. West J Emerg Med. Am J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient. Plast Reconstr Surg.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. We have been reading online about something called sepsis that can be deadly. Does he have sepsis?” Specifically, heart rate and respiratory rates are used in early attempts to detect sepsis.

Pediatrics 90

Pediatrics Sepsis Urgent Care Emergency Department 90

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. Emerg Med Pract. Acad Emerg Med. 2015; 17(6): 1-19. Borgundvaag B, Bellolio F, Miles I, et al.

Seizures 99

Seizures Hyperthermia / Hypothermia Emergency Department EMS 99

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Sensible Medicine

JULY 29, 2024

Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good. The background for cash giveaways stem from the association of low income and worse health outcomes. Their primary endpoint was emergency department visits.

Outcomes 110

Outcomes Research Sepsis Emergency Department 110

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Background: We have covered sepsis many times on the SGEM since 2012.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

EMDocs

AUGUST 24, 2023

Study design Multicenter prospective observational cohort study across seven urban emergency departments. Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. Exclusion criteria: Severe coagulopathy A platelet count below 20, 000 INR > 6.0

Administration 81

Administration Sepsis Shock Outcomes 81

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

Critical Care Now

JULY 14, 2024

For example, let’s say I want to examine the efficacy of using lemonade to treat sepsis (an absurd, clinically improbable example made to illustrate the principles discussed here – although the LOVIT trial did happen… ). Three studies were included – ARREST, Prague OHCA and INCEPTION.

Resuscitation 98

Resuscitation CPR Outcomes Sepsis 98

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. first appeared on The Skeptics Guide to Emergency Medicine. The Lancet Nov 2017. The Lancet Nov 2017.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

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. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. Range 5 to 9) Diff -0.2;

Outcomes 90

Outcomes Administration Emergency Department Resuscitation 90

EMDocs

JANUARY 11, 2025

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

The Skeptics' Guide to EM

JUNE 6, 2020

Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED). Background: I think we have covered sepsis more often than any other topic on the SGEM. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Guest Skeptics: Dr. Erin Willard is a PGY-3 Emergency Medicine Resident, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 The primary outcome was in-hospital mortality. The secondary outcome focused on ICU admissions.

Hospitals 87

Hospitals Emergency Department EMS Outcomes 87

EM Curious

JULY 8, 2015

LACTATE KNOWLEDGE BOMB UNDERSTANDING LACTATE IN SEPSIS [BLOG]: Raise your hand if you think elevated lactic acid in sepsis is from anaerobic metabolism? BENIGN EARLY REPOLARIZATION [BLOG]: Have a quick skill brush-up on this common ECG finding that could be looking quite concerning if you are not familiar with it.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Trial: Prospective, randomized, parallel-assignment, open-label, single-center trial ( NCT02643381 )

Sepsis 42

Sepsis Shock Emergency Department Outcomes 42

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Diagnosis and Management of Pituitary Adenomas: A Review.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

JULY 16, 2022

Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University. Date: July 16th, 2022 Reference: Lamontagne F et al.

Sepsis 40

Sepsis Shock Outcomes EMS 40

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Case: You’re working a shift in a rural emergency department when a 68-year-old man presents with a two-day course of worsening cough, shortness of breath, and fever. Their workup reveals a multifocal pneumonia with signs of sepsis.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. Was blinding achieved?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EMDocs

JANUARY 25, 2025

PCP Pneumonia, Sepsis) can be discharged with initiation of Antiretroviral Therapy in consultation with Infectious Disease (ID) physician with full ID evaluation outpatient. A 45-year-old outdoor enthusiast presents to the emergency department with fever, headache, myalgias, and malaise. No rash is identified. 2017;24(1):46-53.

EMS 80

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

Pediatric Emergency Playbook

APRIL 1, 2016

used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. Lactate A sick child with sepsis syndrome? The acute recognition and treatment of sepsis is first and foremost, clinical. Later, Maher et al.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Don't Forget the Bubbles

AUGUST 4, 2024

They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. Neonatal bacterial sepsis. The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care. More studies on this topic will surely follow. Beaulieu E, Beno S. JAMA Pediatr.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. Case: Tom is a 4-year-old boy who comes into the emergency department with a wheeze following a viral illness. Meredith is also the director of a tertiary hospital paediatric emergency department.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. Over the course of his emergency department stay he has escalating vasopressor requirements. He writes an excellent blog called EM Nerd , which he describes as nihilistic ramblings.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. That was in NEJM Aug 18 2022. and FT4 (0-7.8

Infectious Diseases 52

Infectious Diseases Hyperthermia / Hypothermia Outcomes Sepsis 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? 1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergency departments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Am J Emerg Med. 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.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Skeptics' Guide to EM

JANUARY 25, 2020

Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Outcome: * Primary Outcome: The lowest oxygen saturation observed during the interval between induction and two minutes after tracheal intubation. He has worsening work of breathing and a decreasing level of consciousness.

EMS 40

EMS Airway Management Administration Resuscitation 40