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.

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Sepsis Research Academics Stroke 93

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension. This can manifest as hypotension.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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. The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats.

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Outcomes Research Sepsis Emergency Department 114

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. Thiruganasambandamoorthy V, Kwong K, Wells GA, et al.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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

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 Outcomes 52

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

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] 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Rev Infect Dis.

EMS 87

EMS Pediatrics Sepsis Airway Management 87

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. No difference in their primary outcome of complications and need for emergency surgery (1.9%

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. Sepsis-3!!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 96

EKG/ECG Shock Wellness EMS 96

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

Core Ultrasound

MARCH 25, 2024

If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. 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.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

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.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

PulmCCM

NOVEMBER 27, 2023

Authors wondered if chance resulted in more withdrawal-of-care decisions among the landiolol arm, making their outcomes look worse. Based on these findings, most intensivists will likely continue the well-established practice of not administering beta-blockers to patients with septic shock requiring vasopressors. That produced a 99.9%

Sepsis 52

Sepsis Shock Administration Leadership 52

EMDocs

JULY 13, 2024

Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Incidence, treatment and outcome of peripartum sepsis. Plasma cell endometritis is associated with Chlamydia trachomatis infection. Am J Clin Pathol.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

RebelEM

JULY 17, 2023

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 Range 5 to 9) Diff -0.2; 95% CI -1.4

Outcomes 98

Outcomes Administration Emergency Department Resuscitation 98

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

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

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). There have been at least two randomized control trials published that do not support the use of Vitamin C in sepsis. no statistical difference in primary outcome of SOFA scores at 72 hours or the secondary outcome of 30-day mortality.

Sepsis 40

Sepsis Shock Outcomes Research 40

PEMBlog

AUGUST 20, 2024

These could include severe sepsis. eCPR is typically performed in specialized centers with highly trained personnel in well coordinated teams. For instance, eCPR is well established as a bridge therapy in pediatric patients with congenital heart disease and increasingly used in in hospital cardiac arrests.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Don't Forget the Bubbles

JANUARY 1, 2024

While adenotonsillectomy may not directly impact cognitive functions, it can benefit other aspects of health and well-being in children with mild sleep-disordered breathing. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Outcomes From a Randomized Clinical Trial. Pawlowski TW, et al. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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. 4 Overall, good or excellent outcomes were seen in 79 percent of the reteplase cohort versus 70 percent of those receiving alteplase.

Research 64

Research Stroke Outcomes Sepsis 64

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. In 42 patients getting PET scans in a neuro-ICU over 10 years, four of the six with sepsis had infectious foci identified. °C oral measured multiple times).

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Best Practices Ultrasounds Infectious Diseases Sepsis 111

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at? Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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. Prescriptive birthweight charts can improve the prediction of adverse outcomes in very preterm infants who are small for gestational age. Eur J Pediatr 2016;175:1047-57.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Emergency Medicine Ireland

MARCH 7, 2022

They are also distinct in histology and outcomes from the solid organ malignancies. It clearly works really well as an educational aid in audio form… Myeloid cells differentiate into, well, most of blood cells that appear on your FBC, things like red cells, platelets, neutrophils, basophils.

Sepsis 52

Sepsis Outcomes Wellness 52

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. percent to 38.3

Research 52

Research Airway Management Stroke Outcomes 52

PEMBlog

JANUARY 17, 2024

Well when a break in the skin occurs, normal skin, flora, and bacteria can enter the subcutaneous tissue, where they do not belong, and they can also invade the lymphatic system. You can also see petechiae and hemorrhage, as well as superficial bulla, vesicles, or even echemosis. Full blown sepsis and toxic shock syndrome.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Don't Forget the Bubbles

NOVEMBER 6, 2024

Digital Detox and Well-Being. Update to the Neonatal Early-Onset Sepsis Calculator Utilizing a Contemporary Cohort. Trends in C-Reactive Protein Use in Early-onset Sepsis Evaluations and Associated Antibiotic Use. You will find the list is broken down into four sections: 1.Reviews Catassi G, et al. Eur J Pediatr. Pediatrics.

Pediatrics 59

Pediatrics Sepsis Fractures Hospitals 59

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. Groups were well matched at baseline. Was blinding achieved?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Dr. Smith's ECG Blog

MARCH 30, 2014

Case A female in her 60s presented with 3 days of nausea, vomiting, and diarrhea, and not feeling well. Then they were worried about sepsis as an etiology of hypotension. Then she had some RUQ tenderness which led to a long process of evaluation for an abdominal source of sepsis, which turned up negative. What was the diagnosis?

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. Well this is where the fun beings. Primary outcome here was kidney based rather than mortality. How does it work?

Shock 52

Shock Sepsis Wellness Outcomes 52