Sensible Medicine

APRIL 15, 2024

A common cause of cardiogenic shock occurs when a blocked coronary artery (myocardial infarction or MI) causes the heart to fail. Cardiogenic shock from MI has a death rate of about 50%. This is why the DanGer-Shock trial had to be done in Denmark, a place where doctors are perhaps a little less sure of themselves. It did not.

Shock 76

Shock Sepsis Hospitals 76

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. 2021, Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

MAY 6, 2024

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. Each patient was scored using the four sepsis tools. Schlapbach, L.J., Hagenbuch, N.,

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Background: I think we have covered sepsis more often than any other topic on the SGEM. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 93

Sepsis Administration Fractures Documentation/Coding 93

PEMBlog

OCTOBER 18, 2023

rectally, prompting a sepsis workup given his age. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). link] Takahashi, N.,

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Outcomes 52

PulmCCM

MARCH 4, 2024

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. A score of 2 or higher on the Phoenix-4 in a child with suspected or confirmed infection would diagnose sepsis. vs 11.4%, confidence interval 0.33 favoring benefit).

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

Pediatric EM Morsels

MARCH 29, 2024

Then please put IEM on your differential for critically ill newborns and infants Kids should be Sweet!

Dehydration 289

Dehydration Pediatrics Sepsis EMS 289

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Taming the SRU

MARCH 10, 2024

There are also many costs to hypoglycemia, both in terms of financial burdens on hospitals/caretakers/patients, and in terms of morbidity and mortality. critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex.

EKG/ECG 95

EKG/ECG Shock Wellness EMS 95

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med.

Sepsis 113

Sepsis Fluid Resuscitation Resuscitation Administration 113

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. The 2017 SCCM/ESICM suggestion had been to use steroids for severe septic shock (requiring high-dose or multiple vasopressors). critical care professional societies agree.

Shock 52

Shock Administration Sepsis Fractures 52

ACEP Now

MAY 4, 2023

Early treatment with broad-spectrum antibiotics is essential to prevent sepsis and preserve testicular function. Dr. Rader works at Ascension Macomb-Oakland Hospital. Dr. Fishman is an associate program director at Ascension Macomb-Oakland Hospital. Fishman is an associate program director at Ascension Macomb-Oakland Hospital.

Urgent Care 52

Urgent Care Ultrasounds Sepsis Emergency Department 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52

PulmCCM

JULY 10, 2023

Continuous meropenem infusion for critically ill patients with sepsis Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

ACEP Now

MAY 9, 2024

Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital Emergency Department. This should be suspected in patients with intraoperative cardiac arrest or shock. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Sepsis Resuscitation 40

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. This sort of sepsis would produce many of the common autopsy findings.

CDC 79

CDC Sepsis Research Pediatrics 79

Don't Forget the Bubbles

JULY 3, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Trends in C-Reactive Protein Use in Early-Onset Sepsis Evaluations and Associated Antibiotic Use. Can’t get enough of Bubble Wrap? Pediatrics.

Pediatrics 105

Pediatrics Fluid Resuscitation Hospitals Research 105

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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. Following the triage sepsis pathway, recently amended to use qSOFA.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

Mind The Bleep

FEBRUARY 9, 2024

Intensive care units provide the highest-level care for patients within the hospital. At most hospitals, the CCOT service is run by nurses and other advanced healthcare professionals who are very experienced in assessing and looking after unwell patients. Some respiratory wards offer NIV – some renal units offer dialysis.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker.

EKG/ECG 116

EKG/ECG Shock Hospitals Sepsis 116

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. This post evaluates the recent “Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP)” trial.

Sepsis 98

Sepsis Outcomes Administration EMS 98

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. In-hospital mortality rates are about the same for STEMI and NSTEMI, about 10%. This can be the result of hypotension, tachycardia, sepsis, PE, etc. Part 2 : Why do we care?

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Population 6171 children from three hospitals in Uganda and one in Malawi were assessed for eligibility. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EMDocs

JUNE 27, 2024

This series provides evidence-based updates to previous posts so you can stay current with what you need to know. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The hospital is the Paediatric Major Trauma Centre for the South-West. Reviewed by: John Coveney Article 2: How do we define sepsis in children? doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

PEMBlog

JANUARY 17, 2024

Full blown sepsis and toxic shock syndrome. Well, you definitely shouldn’t be sending a blood culture because if you’re worried about bacteremia and sepsis, that kid needs to stay in the hospital. So when do you want to think about admission to the hospital or short stay unit versus discharge?

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

ACEP Now

OCTOBER 10, 2023

Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition.” Results A total of 7,036 patients were recruited from 121 hospitals that could be included in the modified intention-to-treat analysis. Goal-directed resuscitation for patients with early septic shock.

Outcomes 52

Outcomes Stroke Hospitals Emergency Department 52

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) 3] The type of IV fluid you use will vary depending on which hospital you are working in and what is available. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. How much fluid?

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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. Very high TSH levels (17-100 mIU/L) and very low FT3 (0-2.2)

Infectious Diseases 52

Infectious Diseases Outcomes Hyperthermia / Hypothermia Sepsis 52