Don't Forget the Bubbles

MARCH 31, 2025

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study Archives of Disease in Childhood 2025;110:191196. Reviewed by Dr Faye Leggott Article 2: Does fluid overload increase mortality in children with sepsis?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. PCP Pneumonia, Sepsis) can be discharged with initiation of Antiretroviral Therapy in consultation with Infectious Disease (ID) physician with full ID evaluation outpatient. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Medications: 25.6%

EMS 96

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 96

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. 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. Ann Emerg Med. West J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

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. What are the contraindications to proning?

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations. J Emerg Med. Ann Emerg Med. West J Emerg Med. BMC Emerg Med.

Emergency Department 95

Emergency Department Blood Transfusions Resuscitation Sepsis 95

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Paper: Owyang CG, et al. J Crit Care. N Engl J Med. 2000 May 4; PMID: 10793162 Harvey CE, et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

EMDocs

MARCH 9, 2025

Well keep it short, while you keep that EM brain sharp. Other children at risk for osteomyelitis include those with sickle cell disease , sepsis , an indwelling catheter , and immunodeficiency (e.g., Infectious disease expertise is useful as the optimum duration of treatment is not well established. Pediatr Emerg Care.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

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. Their primary endpoint was emergency department visits. Yet policies mostly escape this challenge. It seems all a policy needs is a strong champion and plausibility.

Outcomes 118

Outcomes Research Sepsis Emergency Department 118

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Tachycardia may be present both from many medications or drugs, as well as withdrawal. Ann Emerg Med. Acad Emerg Med. Ann Emerg Med.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

Don't Forget the Bubbles

MAY 6, 2024

For a deep dive into intubation, see Intubation of the critically unwell Child in the emergency department – Don’t Forget the Bubbles (dontforgetthebubbles.com) For all things neonatal (lines and tubes), see Neonatal lines and tubes – Don’t Forget the Bubbles (dontforgetthebubbles.com) Why does it matter?

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

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. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. What can you do from the Emergency Department if suspected? What can you do from the Emergency Department if suspected?

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. The patient was given aspirin and heparin. While preparing for transport the patient became ashen and confused with cool and clammy skin and a very weak pulse.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the Emergency Department at Redcliffe Hospital in Australia. Case: You are working night shift in the emergency department.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

ACEP Now

MAY 10, 2024

Patients with flank pain (which would suggest pyelonephritis) as well as patients meeting two or more SIRS criteria (which would suggest sepsis) comprise a higher risk group. For simplicity, we will focus only on the patients with suspected lower urinary tract infection (UTI).

Infectious Diseases 98

Infectious Diseases Sepsis Emergency Department Administration 98

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. The trauma call goes out.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ALiEM

FEBRUARY 9, 2024

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. Pulses are well felt in all four limbs. as seen in heart failure, arrhythmias, or sepsis). J Am Coll Cardiol.

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EKG/ECG Emergency Department Burns Wellness 110

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. He had this ECG recorded. The HCO3 was 8.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

EMDocs

NOVEMBER 27, 2023

A 55-year-old male, with a previous medical history of hypertension, hyperlipidemia, and gout, presents to the emergency department for four days of fever and progressive rash. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

EMS 97

EMS Sepsis Burns EKG/ECG 97

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. 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.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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. Got FDA exemption as well as went to the community and made sure their community was ok with the trial). Range 5 to 9) Etomidate: 7.0 95% CI -1.4

Outcomes 97

Outcomes Emergency Department Administration Resuscitation 97

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. ng/mL, 0.25-0.5

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. Jeff: You’re right.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

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? Well, this may not be completely true.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Taming the SRU

JANUARY 12, 2024

r4 case follow up - r1 clinical knowledge: interstitial lung disease - halo - pediatric simulation - pediatric small groups r4 case follow up WITH dr. yates Psychiatric emergency department visits are on the rise in the United States, with roughly 15-19% of all ED visits associated with mental health diagnoses Roughly twenty percent of patients presenting (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

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

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Carly Eastin is an Associate Professor, Division of Research and Evidence Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI).

Sepsis 52

Sepsis Shock Outcomes Stroke 52

Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

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 West J Emerg Med. Am J Emerg Med. Acad Emerg Med. Ladde JG, Miller S, Chin K, et al.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

EMDocs

JULY 29, 2023

A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. We’ll keep it short, while you keep that EM brain sharp. He is also complaining of pain and subjective fevers. Initial vital signs include BP of 150/85, HR 103, T 100.8, RR 18, SpO2 97% on RA.

EMS 97

EMS Dehydration Ultrasounds Emergency Department 97

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. rectally, prompting a sepsis workup given his age. This patient was hospitalized for 4 days where he remained well-appearing.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Case: You are working the afternoon shift in the paediatric emergency department. Your shift is almost over and the department finally seems to be under control. However, if the child is looks well, but the clinician determines that the febrile infant is not in the low risk group for a UTI, the AAP recommends two options.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

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Anaphylaxis Shock Sepsis Resuscitation 52