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. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Core Ultrasound

MARCH 25, 2024

The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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

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

EMDocs

MAY 11, 2024

Cavernous sinus syndrome (B) usually presents with cranial nerve deficits, diplopia, periorbital cellulitis, and facial swelling that may progress to meningitis or sepsis. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion.

Stroke 111

Stroke EMS EKG/ECG Radiology 111

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]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. Procalcitonin.

Infectious Diseases 89

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

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

Pediatric Education

FEBRUARY 4, 2024

A right-sided suprarenal mass had been identified on routine ultrasound during the third trimester that was thought to likely be an adrenal hemorrhage. The radiologic evaluation of an ultrasound examination showed a small hypoechoic mass in the area of right adrenal gland that was smaller than previously recorded prenatally.

Ultrasounds 52

Ultrasounds Radiology Radiology Pediatrics 52

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 Small bowel obstruction: Outcome and cost implications of admitting service. Am Surg 2010; 76:687-691.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. J Med Genet 2008; 45:1. 2007; 16:27-33.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Case: A 60-year-old male is in your emergency department with sepsis from pneumonia.

EMS 40

EMS Airway Management Administration Resuscitation 40

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. was sensitive for 28-day mortality in sepsis. Jeff: Indeed. Sounds familiar. Jeff: We sure did!

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Don't Forget the Bubbles

MAY 28, 2024

Hence, PPHN can be idiopathic or secondary to a variety of conditions such as meconium aspiration syndrome , respiratory distress syndrome, sepsis, asphyxia and congenital diaphragmatic hernia. Were there any abnormalities on ultrasounds? Imagine being a few hours old and dealing with this). Does the baby look septic?

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

MAY 1, 2023

Midline Ludwig’s angina Dermoid cyst Thyroglossal duct cyst Thyroid mass Thyroid goiter Lateral Sialadenitis Branchial cleft cyst Kawasaki’s Lymphoma Diagnosis: Thyroglossal Duct cyst with a superimposed strep throat infection without typical symptoms of pharyngitis Test of choice: Ultrasound Thyroglossal Duct cyst Most common pediatric cervical congenital (..)

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

As a result — cardiac cath was not performed — since results of a cath would not have altered the unfortunate outcome. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., BOTTOM Line from Today’s Case: As per Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

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

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 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

EMDocs

OCTOBER 23, 2023

Diagnosis can be confirmed with ultrasound (for deep vein thrombosis) or CT angiography (CTA) chest (for pulmonary embolism) and patients treated with anticoagulants. This may also predispose a patient to sepsis, peritonitis, or bowel infarction, which need to be recognized quickly. 2020 Sep;127(10):1269-1279. BJOG 2008; 115:1473.

OB/GYN 95

OB/GYN Operations EMS Ultrasounds 95

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. You will find the list is broken down into four sections: 1.Reviews

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

Don't Forget the Bubbles

FEBRUARY 5, 2024

Their main outcome measure was the proportion of pictures inconsistent with current safety recommendations. Role of diagnostic tests for sepsis in children: a review. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? Half showed a picture of a sleeping baby. Arch Dis Child.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

PEMBlog

JANUARY 17, 2024

Full blown sepsis and toxic shock syndrome. If you think that there’s an abscess, you can diagnose it clinically by a localized area of induration or fluctuance or use an ultrasound. You’re concerned about SIRS or sepsis. Bilateral red limbs? That’s probably something different. Fortunately, those are rare.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Don't Forget the Bubbles

JANUARY 1, 2024

Lung ultrasound for the sick child: less harm and more information than a radiograph. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Musolino AM, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

PulmCCM

MARCH 31, 2025

critical care society issued a guideline update authored by a cadre of those experts, recommending bedside ultrasound should be used to help manage the vast majority of critically ill patients. What drove the society to make this significant change to its 2016 ultrasound guidelines? In February 2025, the major U.S.

Ultrasounds 72

Ultrasounds Shock Sepsis Outcomes 72

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. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. pneumoniae and S.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? 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

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. 9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al. Andrews et al. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Before considering a further fluid bolus, you do a point-of-care ultrasound (POCUS). As the PICU Registrar, you are called to review him. How Do We Measure Venous Congestion?

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

The Skeptics' Guide to EM

NOVEMBER 23, 2024

Ultrasound is commonly used due to its non-invasive nature, while computed tomography (CT) scans, although more definitive, are often avoided in children due to radiation concerns [3]. Outcomes of appendicitis largely depend on early recognition and treatment. Outcomes of appendicitis largely depend on early recognition and treatment.

Pediatrics 79

Pediatrics Sepsis Academics Emergency Department 79

Broome Docs

JANUARY 27, 2025

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia: A Systematic Review and Meta-Analysis. Diagnosis of acute aortic syndromes with ultrasound and D-dimer: the PROFUNDUS study. (I would be worried if people were using this as a data point to make medical decisions.) JAMA Intern Med. 2024 Dec 9.

Sepsis 101

Sepsis Anaphylaxis Hospitals Ultrasounds 101