Emergency Medicine Journal

OCTOBER 26, 2023

Background Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment. No other score provided clearly superior accuracy to NEWS2.

Sepsis 52

Sepsis Ambulance Services Operations Hospitals 52

Taming the SRU

AUGUST 11, 2024

ABEM updates - R4 Capstone - Sepsis Operations update - R3 taming the sru - traveler’s diarrhea abem updates WITH dr. melissa platt, abem board of directors Beginning 2026, ABEM will be requiring a new certifying exam to replace the previous oral boards.

Sepsis 89

Sepsis Burns Shock Operations 89

Pediatric EM Morsels

NOVEMBER 17, 2023

0.41), p < 0.001. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. 2022 Apr;29(4):406-414. doi: 10.1111/acem.14431.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

Don't Forget the Bubbles

JUNE 30, 2023

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. These procedures require an experienced operator. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis requiring urgent treatment. No other score provided clearly superior accuracy to NEWS2.

Sepsis 40

Sepsis Ambulance Services Operations Hospitals 40

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. 1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability.

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

PulmCCM

FEBRUARY 5, 2024

In 18 severe sepsis patients in 3 years at one center who underwent PET scanning (apparently done ad hoc), 14 of the 18 had positive tests, and 11 were true positives, leading to surgery in 2 and pacemaker removal in 2 (and longer / new antibiotics in 2). Ultrasound can quickly and more accurately identify significant biliary disease (e.g.,

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Sensible Medicine

OCTOBER 20, 2023

i] My third year of medical school began with a night in the operating room with a man with an aorto-enteric fistula. 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.

Hospice 98

Hospice Operations Hospitals Sepsis 98

Don't Forget the Bubbles

APRIL 22, 2024

Occasionally, lacrimal probing does not work, and an operation is needed. Sepsis: The spread of infection through the bloodstream, known as sepsis, is a critical condition that can lead to organ failure and death if not promptly treated. This might be balloon dacryoplasty, stenting, or dacryocystorhinostomy (DCR).

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Mind The Bleep

SEPTEMBER 14, 2024

Management Immediate management: Consider ABCDE approach and Sepsis 6 pathway including early empirical IV antibiotics. Operative management: Surgical washout of the flexor sheath within 24 hours of the decision to operate. Consider tetanus booster if applicable. Remove all rings! Urgent referral to the hand surgery department.

Operations 52

Operations Sepsis Documentation/Coding 52

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

Taming the SRU

AUGUST 30, 2023

This finding was not significantly different among operators with different levels of experience, or between adults and children. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. High serum procalcitonin concentrations in patients with sepsis and infection.

Infectious Diseases 89

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

ALiEM

SEPTEMBER 9, 2024

Patients are at high risk of bacterial spread to the abdomen or retrograde spread up the ventriculoperitoneal shunt leading to peritonitis, peritoneal abscess, ventriculitis, meningitis, or sepsis. General surgery and neurosurgery should be consulted emergently for further operative interventions.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

Dr. Smith's ECG Blog

JUNE 26, 2023

Most occurrences are associated with events such as sepsis, shock, recent infarction, post-operative state, electrolyte disturbance — or "sick patient". PEARL # 5: Accelerated junctional rhythms are not common in adults. This led me to wonder what the clinical situation in today's case might be!

EKG/ECG 97

EKG/ECG Seizures Sepsis Operations 97

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

Taming the SRU

JULY 31, 2024

morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. 1 The Rise of the Miami BBL An entire industry has emerged around gluteal AFTs in Miami.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Sensible Medicine

OCTOBER 20, 2023

i] My third year of medical school began with a night in the operating room with a man with an aorto-enteric fistula. 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.

Hospice 52

Hospice Operations Hospitals Sepsis 52

Intensive Blog

MARCH 11, 2024

multi organ dysfunction, severe sepsis, age, frailty, co-morbidities) What investigations and treatment has the patient had to date? They are staffed by Ambulance attendants to help operate specialized bariatric equipment. What information are you going to relay? Are there any contraindications?

Hospitals 69

Hospitals Radiology Radiology Sepsis 69

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” were hospitalizations during f/u period; 26.4% vs. In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. J Urol 2019.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. Comparing quick sequential organ failure assessment scores to end-tidal carbon dioxide as mor- tality predictors in prehospital patients with suspected sepsis.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. More pertinent and relevant takeaway messages have to do with staffing and operations. Prior studies have used annual census or shift level crowding.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Northwestern EM Blog

JUNE 16, 2024

For example, hypothyroidism, adrenal insufficiency, sepsis, neuromuscular disease, malnutrition, thiamine deficiency, hypoglycemia can all lead to hypothermia [11-13]. Operational definition of normal sinus heart rate. Bishop, R. L., & Rifkin, R. The American Journal of Cardiology , 69 (14), 1245–1246. link] UpToDate.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

ACEP Now

JULY 7, 2024

For example, other modes of EEG monitoring may be used in the operative setting, including bispectral index monitoring (BIS) and SEDline device, to monitor depth of sedation. Some institutions have the capability to perform real-time EEG monitoring and interpretation by a neurologist in the ED.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

PulmCCM

JANUARY 4, 2022

.’ What they found 45 critically-ill patients were included with a 28-day mortality rate of 29%; distributive shock was the most common cause of circulatory failure with sepsis being the most common cause of distributive physiology. All patients were invasively-ventilated at the time of study and 69% were receiving norepinephrine.

Wellness 40

Wellness Outcomes Sepsis Stroke 40

Northwestern EM Blog

APRIL 25, 2022

Violation of the joint capsule exposes the sterile intra-articular space to the environment which can result in a deep infection and sepsis. Definitive treatment is joint wash out in the Operating Room. The knee joint is the most common joint to be affected, followed by the ankle.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

RebelEM

NOVEMBER 3, 2022

The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. The groups were unbalanced, with more patients with sepsis and more patients with difficult airway characteristics in the ketamine group. Granular details of the dosing of induction agents were not given.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

ACEP Now

MARCH 6, 2024

7 The operators involved in the trial were mostly emergency medicine residents or critical care fellows, but this fact does not diminish the generalizability of these observations. The Right Way to Airway Video largyngoscopy (VL) is simply, in most situations, the better tool for the job. percent to 38.3

Research 52

Research Airway Management Stroke Administration 52

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. Operational criteria for the classification of chronic alcoholics: identification of Wernicke’s encephalopathy. Alcohol Alcohol. 2017 Jul 1;52(4):466-471.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

PulmCCM

FEBRUARY 28, 2022

45% of patients were admitted to the ICU directly from operating or recovery rooms, 79% were mechanically-ventilated and 42% had sepsis. What they found 5037 patients were randomized – 2522 to saline and 2515 to balanced crystalloid; approximately 96% of the randomized patients had data available for analysis.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EB Medicine

JUNE 6, 2019

However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. was sensitive for 28-day mortality in sepsis. Jeff: Speaking of HR, tachycardia can be a response to pain, anxiety, fever, blood loss, or sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

DECEMBER 18, 2023

Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. vs. 0.91), positive predictive value (0.27

Sepsis 83

Sepsis Fluid Resuscitation Shock Resuscitation 83

Don't Forget the Bubbles

MARCH 4, 2024

Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. It doesn’t help to diagnose or exclude sepsis. doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Don't Forget the Bubbles

NOVEMBER 1, 2023

Reviewed by: Leanne Lindenstruth, ENP Article 4: Can we treat appendicitis non-operatively? Non-operative treatment of acute appendicitis in children: clinical efficacy of amoxicillin-clavulanic acid in a retrospective single-centre study. Picard C, Abbo O, Munzer C, et al. BMJ Paediatrics Open 2023; 7: e001855.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 86

OB/GYN Operations EMS Ultrasounds 86