ACEP Now

JANUARY 5, 2025

Sepsis Robots or Sepsis Humans The proliferation of sepsis alerts in the ED has reached levels best described as obscene. The common refrain from trained clinicians: We are smarter than any computer or simple scoring system, and we can rapidly and accurately identify sepsis by ourselves, thank you very much. N Engl J Med.

Sepsis 40

Sepsis Research Airway Management Outcomes 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 134

Stroke Outcomes Hospitals Administration 134

Taming the SRU

APRIL 17, 2024

The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med.

Sepsis 92

Sepsis Research Stroke Academics 92

PulmCCM

DECEMBER 11, 2024

An excellent review article titled “Sepsis and Septic Shock” was published 4 December 2024 in the New England Journal of Medicine. health system require us to enter a diagnosis to generate payment by a health insurer, it’s worth emphasizing that sepsis is a syndrome, not a disease.

Sepsis 45

Sepsis Shock Research Wellness 45

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. 2015) reported a sensitivity of 98.9%

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

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

PulmCCM

MAY 22, 2023

In the TEAM trial conducted by the ANZICS group, 750 ICU patients in 49 hospitals in 6 countries were randomized to either early mobilization or usual care (which usually included in-bed physical therapy). centers, patients with sepsis and systolic blood pressure <100 mm Hg all received at least 1000 mL of crystalloid.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

Emergency Medicine Ireland

APRIL 29, 2024

Last time i was butchering my way through a diagnostic approach to hyponatraemia, particularly the forms likely to end up in the critical care end of the hospital. Hopefully what follows will provide enough broad brush strokes to get you through a night on call or even worse a viva. We’ll start with truly emergent situations.

Seizures 75

Seizures Sepsis Stroke Administration 75

ACEP Now

SEPTEMBER 6, 2024

You may have mastered all the latest changes affecting management of sepsis, STEMI, and opiate-use disorder, but there’s no stopping the relentless revisions to our approach to neurologic emergencies. This comes out of INTERACT-4, a trial testing the efficacy of blood pressure reduction in undifferentiated acute stroke syndromes.

Research 49

Research Stroke Outcomes Sepsis 49

PulmCCM

APRIL 8, 2024

Read in Journal of Palliative Medicine New-onset atrial fibrillation provoked by sepsis: anticoagulate or not? Your elderly patient with sepsis develops new-onset atrial fibrillation that spontaneously converts to normal sinus rhythm. The rate is 10-15% in most acute care hospitals.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

ACEP Now

MARCH 6, 2024

What’s New in Stroke Care? The simplicity of tenecteplase administration makes its use likely the preferred agent for treating acute ischemic stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke.

Research 52

Research Airway Management Stroke Outcomes 52

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 72

EMS Sepsis Shock Fluid Resuscitation 72

Don't Forget the Bubbles

NOVEMBER 18, 2024

Epidemiology in Australia In Australia, the reported prevalence of neonatal hypotension in preterm infants is like that in the UK, with around 20-30% of very low birth weight infants experiencing significant hypotension during their initial hospital stay. CO = SV x HR SV is Stroke Volume (the amount of blood ejected with each heartbeat).

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Sepsis Shock Hyperthermia / Hypothermia Administration 59

ACEP Now

OCTOBER 29, 2024

For example, experienced emergency physicians have great clinical gestalt and accuracy to predict sepsis in critically ill patients at just 15 minutes from patient arrival—more so than scoring tools like the qSOFA, MEWs, and even machine-learning trained artificial intelligence models. Mary’s Hospital in Leonardtown, Maryland.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. Cleland DA, Eranki AP.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Taming the SRU

FEBRUARY 5, 2024

2018) Epidemiology of lumbar punctures in hospitalized patients in the United States. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Journal of the history of the neurosciences, 6(2), 147–153. PLOS ONE 13(12): e0208622. van de Beek, D.,

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

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

All Ohio EM

OCTOBER 26, 2018

Among patients who survive one day on ECMO, 2/3 walk out of the hospital neurologically intact. Coiling decreases lifespan by 2 years due to stroke and aneurysm rupture, while the lifetime rupture rate is 0.23% if the aneurysm is under 3 mm. no terminal conditions or DNR. beat you up and asked you the tough questions) in private.

CPR 52

CPR Sepsis Stroke EMS 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. 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 short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock 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. Dr. Pyle is an attending physician and ultrasound director at Jackson Memorial Hospital with an interest in medical education, ultrasound and critical care.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Northwestern EM Blog

JUNE 16, 2024

The most common symptoms include: Lightheadedness Syncope Chest pain Exercise intolerance Fatigue **Important note: The heart rate at which patients experience symptoms may vary based on their ability to increase stroke volume. 2024, Jun 17). Symptomatic Bradycardia: Considering the Differential Diagnosis. Expert Commentary by Trueger, S].

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9% Do not transport to an alternative location.

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Northwestern EM Blog

MAY 16, 2022

were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% There also were no significant differences in pain scores, hospitalizations, ED readmissions among the groups. He endorses nausea without vomiting and denies fever. vs. US 31.2%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

JUNE 1, 2016

Distributive Shock The most common cause of distributive shock is sepsis, followed by anaphylactic, toxicologic, adrenal, and neurogenic causes. Children with sepsis come in two varieties: warm shock and cold shock. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Taming the SRU

MAY 1, 2023

Trauma/Pre-Hosp Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension Link: [link] Bottom Line: Think about maintaining normotension rather than simply avoiding hypotension in isolated TBI. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

ACEP Now

JULY 7, 2024

Patients with status epilepticus require hospital admission, often to an intensive care setting. These seizures are detectable only with EEG monitoring and, similar to convulsive seizures, nonconvulsive seizures that are prolonged or repetitive can present a neurological emergency termed nonconvulsive status epilepticus.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

EB Medicine

NOVEMBER 1, 2018

It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

SEPTEMBER 1, 2018

Nachi: Right, but in Australia, not only are the snakes more venomous but the hospital transport distances are much longer, so, basically they sacrifice the limb to potentially save a life. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition.” Symptoms began just prior to presentation. Her blood pressure (BP) is 195/104 mmHg.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Taming the SRU

JUNE 6, 2023

Allows for the patient to be held for a psychiatric evaluation Varies greatly based on state laws In OH, this means patient can be held for 24h prior to being evaluation by a psychiatrist & may be held for additional 72h after that initial evaluation is performed In OH, can be signed by physician, psychologist, mental health NP, mental health clinical (..)

Documentation/Coding 63

Documentation/Coding Seizures Psychiatric Wellness 63

ACEP Now

JANUARY 2, 2025

20 million ED visits per year 1,000-plus individual ED locations 250-plus emergency medicine practice groups E-QUAL Enrolled emergency physicians gain access to webinars, podcasts, and toolkits, plus publications and posters with a focus on stroke, opioid and alcohol use disorder, and venous thromboembolism.

Best Practices 52

Best Practices Stroke Emergency Department Research 52

Mind The Bleep

NOVEMBER 2, 2024

Every baby has a NIPE performed, either in hospital before discharge or at home by a community midwife. Swab any discharge and discuss with a senior about starting antibiotics as infection in a baby can quickly lead to sepsis. Whilst this is a top-to-toe examination, it focuses on the eyes, heart, hips and testicles.

Documentation/Coding 52

Documentation/Coding Dislocations Ultrasounds Wellness 52