The Skeptics' Guide to EM

SEPTEMBER 28, 2019

But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. Background: There was a huge buzz in the media a few years ago about a vitamin C cocktail (vitamin C, hydrocortisone and thiamine) as a possible cure for sepsis. You wonder if giving vitamin C will affect her outcome?

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EM Literature of Note

OCTOBER 20, 2022

How FAST Can You Spot a Pneumothorax? Thin Evidence Supporting Thrombolysis of Those on Blood Thinners Epinephrine Norepinephrine, That Is the Question Ill PREPAREd-II Intubate the Critically Ill Enjoy!

Stroke 40

Stroke Sepsis Pediatrics Resuscitation 40

Taming the SRU

JULY 31, 2024

Barometric pressure, humidity, and temperature changes may influence stroke and fall incidence (especially in elderly patients with cardiovascular risk factors). Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

ACEP Now

MARCH 6, 2024

What’s New in Stroke Care? The simplicity of tenecteplase administration makes its use likely the preferred agent for treating acute ischemic stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke. the “ARAMIS” trial throws up another red flag for patients suffering mild stroke.

Research 52

Research Airway Management Stroke Outcomes 52

Pediatric Emergency Playbook

MAY 1, 2016

For altered adults, use AEIOU TIPS (Alcohol-Epilepsy-Insulin-Overdose-Uremia-Trauma-Infection-Psychosis-Stroke). meningoencephalitis, overwhelming alternate source of sepsis) T – Toxins (e.g. sludge phenomenon, secondary sepsis, hypoglycemia from supply-demand mismatch) S – Seizure (e.g. Pediatrics International.

Seizures 40

Seizures Sepsis Stroke Pediatrics 40

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. Cleland DA, Eranki AP.

Infectious Diseases 89

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

Pediatric Emergency Playbook

JUNE 1, 2016

Hypovolemic Shock The most common presentation of pediatric shock; look for decreased activity, decreased urine output, absence of tears, dry mucous membranes, sunken fontanelle. Distributive Shock The most common cause of distributive shock is sepsis, followed by anaphylactic, toxicologic, adrenal, and neurogenic causes. Pediatrics.

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Shock Sepsis Pediatrics Ultrasounds 40

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Pediatric airway management is a skill that integrates the three types of knowledge as described by the ancient Greeks: episteme , or theoretical knowledge, techne , or technical knowledge, and phronesis , or practical wisdom, also called prudence. She is in respiratory failure from bronchiolitis and likely viral sepsis.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

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. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Northwestern EM Blog

MAY 16, 2022

pediatrics, pregnancy, solitary kidney, fever, unstable/critically ill, unrelenting pain, atypical features, etc). He endorses nausea without vomiting and denies fever. were hospitalizations during f/u period; 26.4% Now, of course, this is exclusive of those patients with high-risk or complicating features (e.g.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

JULY 1, 2016

Children with limb-length discrepancy only need a non-urgent referral to pediatric orthopedics to look for congenital dysplasia of the hip, or other growth abnormalities. N – Neurologic Not to scare you, but children do have strokes; unlike adults, half are hemorrhagic, half are thromboembolic. Some are treated with orthotics.

Fractures 52

Fractures Poisoning Wellness Sepsis 52

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

ACEP Now

JULY 7, 2024

Utility of electroencephalogram in the pediatric emergency department. These seizures are detectable only with EEG monitoring and, similar to convulsive seizures, nonconvulsive seizures that are prolonged or repetitive can present a neurological emergency termed nonconvulsive status epilepticus. Ann Emerg Med. 2014;63(4):437-447.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

EB Medicine

NOVEMBER 1, 2018

Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. CNS dysfunction may be immediate or delayed and can range from strokes to spinal cord injuries. In total, they pulled references from 1966 until 2018.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

SEPTEMBER 1, 2018

Jeff: And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported. Jeff: Continuing right along, the next special population to discuss are pediatric patients. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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). Outcomes in Pediatric Hypertrophic Cardiomyopathy Patients with Reduced Systolic Ventricular Function. Progress in Pediatric Cardiology.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

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 Fractures Documentation/Coding Administration 95

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

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

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Advanced Emergency Nursing from AENJ

FEBRUARY 27, 2015

Woodrow Wilson Wilson suffered several strokes, and was isolated in the White House by his second wife, Edith, who allowed only herself and his physician to see him. died of sepsis from an infected blister on his foot resulting from a tennis game at the White House. He succeeded to the Presidency upon Harding’s death by heart attack.

Stroke 40

Stroke COPD Emergency Nursing Sepsis 40