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 93

Sepsis Research Academics Stroke 93

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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 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).

Stroke 137

Stroke Outcomes Hospitals Administration 137

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. What’s New in Stroke Care?

Research 52

Research Airway Management Stroke Outcomes 52

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 126

Resuscitation Outcomes EMS Sepsis 126

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

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. Gut feelings: the intelligence of the unconscious.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

PulmCCM

MAY 22, 2023

Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). centers, patients with sepsis and systolic blood pressure <100 mm Hg all received at least 1000 mL of crystalloid.

Fluid Resuscitation 68

Fluid Resuscitation Resuscitation Hospitals Sepsis 68

ACEP Now

JULY 7, 2024

Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings. Early and established status epilepticus: the impact of timing of intervention, treatment escalation and dosing on outcome.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. He endorses nausea without vomiting and denies fever.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism. 10 It is difficult to say exactly how many of the 163 patients at JHS suffered a PFE without autopsy reports.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

PulmCCM

JANUARY 4, 2022

” -Fran Lebowitz Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome. The primary outcome was identification of the optimal volume for assessing fluid responsiveness. If I get to the dry cleaners without having a huge fight, that’s challenging enough.”

Wellness 40

Wellness Outcomes Sepsis Stroke 40

All Ohio EM

OCTOBER 26, 2018

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. In the 25 years since CTPA became readily available to us in the ED, we’ve increased the diagnosis of PE 10-fold without decreasing the number of bad outcomes at all. IT’S NOT A TIME BOMB.

CPR 52

CPR Sepsis Stroke EMS 52

Dr. Smith's ECG Blog

AUGUST 23, 2017

Slow atrial flutter (flutter rate 240, ventricular rate 120) Misdiagnosed as sinus tach Here is the case: Sepsis with Pulmonary Edema and Elevated Right Sided Pressures Atrial Flutter rate: Atrial flutter is usually at a rate of 300, but can be anywhere between 240 and 360. Same stroke precautions as atrial fib

Stroke 52

Stroke Sepsis Emergency Department 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

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. October 8th, 2009.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Taming the SRU

AUGUST 25, 2023

bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Don't Forget the Bubbles

AUGUST 21, 2023

Infection/sepsis? Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are the long-term outcomes for children with dilated cardiomyopathy? Female sex and younger age favour better outcomes. Bad bronchiolitis ?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

EB Medicine

SEPTEMBER 1, 2018

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64