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

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. It’s a wonderful contribution to the literature and well worth reading. Without valid diagnostic criteria, sepsis studies are prone to imprecise or biased findings.

Sepsis 45

Sepsis Shock Research Wellness 45

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. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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

Taming the SRU

DECEMBER 17, 2024

There is substantial evidence that IV fluids can be beneficial in patients with sepsis complicated by hypotension and labor. compared the effects of these two among the acute gastroenteritis children and reported that the use of ORT was associated with shorter hospital stay and increased patient satisfaction. AtherlyJohn et al.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. Type 5: MI associated with coronary bypass surgery. Who should have troponins sent?

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

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 94

Sepsis Fractures Documentation/Coding Administration 94

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

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. The recurrence rate and length of hospital stay were the same. perforation).  Br J Surg.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

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. We like it that way.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

PulmCCM

FEBRUARY 5, 2024

Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. In 42 patients getting PET scans in a neuro-ICU over 10 years, four of the six with sepsis had infectious foci identified. You can read the document here. What’s a Fever?

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

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

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. Drugs, devices and treatment strategies often face the challenge of randomized trials. Yet policies mostly escape this challenge. The study carried on for 3 years (not 9 months).

Outcomes 106

Outcomes Research Sepsis Emergency Department 106

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. GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. pneumoniae and S. He is apyrexial.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JANUARY 1, 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). 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Can’t get enough of Bubble Wrap? Pawlowski TW, et al. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Don't Forget the Bubbles

JUNE 19, 2023

Fetal Growth Restriction (FGR) and dysmaturity are common in neonatology and are a leading cause of morbidity during the neonatal period, as well as later in life. The centile used to define “small” may differ both by scientific study and by hospital. According to the Obstetric resident, the placenta looked a little small.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

PulmCCM

MARCH 4, 2024

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. Selection bias is baked into any self-selected survey sample such as this.

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

Thinking Critical Care

MAY 20, 2023

With help from the usual suspects (Rory Spiegel, Andre Denault, Korbin Haycock) we are focusing on some core areas in acute and critical care – sepsis, arrest and respiratory failure are perennials, but this year we are also adding neurocrit as a core component, which I think is a bit underserved and certainly deserving of more.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

EMDocs

DECEMBER 18, 2024

This series provides evidence-based updates to previous posts so you can stay current with what you need to know. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 88

Seizures Hyperthermia / Hypothermia Emergency Department EMS 88

RebelEM

JULY 17, 2023

PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? 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

Outcomes 95

Outcomes Administration Emergency Department Resuscitation 95

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. 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. May still be passing small amounts of stool and flatus.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

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

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

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

ALiEM

FEBRUARY 9, 2024

Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here. as seen in heart failure, arrhythmias, or sepsis). She has no other recent illnesses or travel history.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

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. The sodium rises, the patient stops seizing everyone relaxes but then the Na continues to rise, well above the 5mmol we wanted and a panic ensues.

Seizures 75

Seizures Sepsis Stroke Administration 75

Dr. Smith's ECG Blog

OCTOBER 12, 2023

She was admitted to the hospital with clinical signs of infection. The patient was admitted with a suspicion of sepsis. The ECG could as well fit with acute myopericarditis. ECG#4 (below) was recorded about one year after the hospital stay described above. She was febrile and hypotensive at presentation.

EKG/ECG 100

EKG/ECG Hospitals Sepsis Wellness 100

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

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

OCTOBER 19, 2024

Leukocytosis, as well as mild leukopenia, are common. Blood cultures: Blood cultures are rarely positive; however, should be obtained if suspicion for sepsis is present or if the patient is immunocompromised. [2][3] Care Variations and Outcomes for Children Hospitalized With Bacterial Tracheostomy-Associated Respiratory Infections.

EMS 87

EMS Pediatrics Sepsis Airway Management 87

ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing.

Sepsis 60

Sepsis Academics Operations Wellness 60

Sensible Medicine

OCTOBER 20, 2023

She came to the hospital with three days of weakness, fever, chills, and anorexia. That night introduced me to the smell of melena — a smell that I now can recognize even rooms away on a hospital floor, and which also takes me back to that New York Hospital operating room in 1991. ” Back to where I began with LT.

Hospice 70

Hospice Hospitals Operations Sepsis 70

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. 2018, Kuttab, Lykins et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., He was later transferred back to his local hospital neurologically intact and without serious sequela. See this case and this case for more examples of ACS involving the LMCA Learning points: LMCA occlusion carries a poor prognosis, most patients do not make it to the hospital.

EKG/ECG 125

EKG/ECG Shock Emergency Department Ambulance Services 125

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

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