Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

PulmCCM

NOVEMBER 1, 2024

Neither of two large randomized trials in the 2000s showed a benefit from albumin solutions as a resuscitation fluid for patients with septic shock. Significant uncertainty remained, though, as we discussed further here: Another randomized trial was therefore performed, dubbed ABC-SEPSIS.

Sepsis 40

Sepsis Shock Resuscitation 40

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

Emergency Medicine Cases

MARCH 26, 2019

Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? Which fluid and how much fluid is best for resuscitation of the septic shock patients? What are the goals of resuscitation in the patient with sepsis or septic shock?

Sepsis 40

Sepsis Shock EMS Resuscitation 40

Don't Forget the Bubbles

JUNE 30, 2023

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Identify the percentage of children whose heart or respiratory rate would exceed the “severe” cut-off from the UK Sepsis Trust and NICE guidelines.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

RebelEM

FEBRUARY 8, 2024

were they in the resuscitative phase? were they in the resuscitative phase? This study does not address the utility of arterial lines vs NIBP in the acute resuscitative phase Author Conclusion: “There was broad agreement between IABP and NIBP in critically ill patients over a range of BPs and severity of illness. to 2.47; p – 0.04

Resuscitation 120

Resuscitation Outcomes EMS Sepsis 120

University of Maryland CC Project

JANUARY 31, 2024

Her current research focuses on improving the quality and timeliness of early sepsis care. She is interested in the organization of healthcare delivery and in optimizing the delivery of evidence-based interventions for critically ill patients.

Sepsis 45

Sepsis Hospitals Research Resuscitation 45

EMDocs

AUGUST 17, 2023

Additionally, 80% of patients in the control group required open label NE use indicating that NE was going to be needed in most of these patients regardless of initial resuscitation method. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 67

Sepsis Shock Resuscitation Fluid Resuscitation 67

Taming the SRU

JUNE 26, 2024

TEE can be helpful in guiding resuscitation if available. Patients with AML and sepsis have a higher mortality than their otherwise healthy counterparts. Patients with AML and sepsis have a higher mortality than their otherwise healthy counterparts. Gut translocation is a common etiology of sepsis in patients with AML.

Blood Transfusions 85

Blood Transfusions Sepsis CPR EKG/ECG 85

Emergency Medicine Cases

MARCH 1, 2022

The post EM Quick Hits 36 – Surviving Sepsis, Angle Closure Glaucoma, Bougies, Frostbite, Hot/Altered Patient, Central Cord Syndrome appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis EMS Fluid Resuscitation Hyperthermia / Hypothermia 52

EMDocs

SEPTEMBER 6, 2023

Learning points: Consider differential – sepsis, thyroid storm, thalamic stroke, exertional and classic heat stroke, serotonin syndrome, neuroleptic malignant syndrome, sympathomimetic toxicity, and anticholinergics. Resuscitate and administer antibiotics. Start resuscitation early with vasopressors, antibiotics.

Anaphylaxis 71

Anaphylaxis Shock Sepsis Stroke 71

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Don't Forget the Bubbles

MAY 6, 2024

Reviewed by: Tasnim Ransome and Spyridon Karageorgos Article 3: Which Sepsis Scoring Tools Perform Best? Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Each patient was scored using the four sepsis tools. Schlapbach, L.J., Hagenbuch, N.,

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

EMDocs

JUNE 22, 2024

“Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” “Amniotic fluid embolism: diagnosis and management.” ” Am J Obstet Gynecol 215(2): B16-24. link] j.ajog.2016.03.012 2016.03.012 Patel, P., ” Clin Appl Thromb Hemost 25: 1076029619843338.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

Critical Care Now

JULY 14, 2024

This week’s article, by Heuts et al, titled “Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis” is a fresh take on the issue. Now, before we dive into the weeds, we need to establish what exactly a Bayesian meta-analysis is.

Resuscitation 98

Resuscitation CPR Outcomes Sepsis 98

University of Maryland CC Project

SEPTEMBER 17, 2021

Mallia, Assistant Professor of Emergency Medicine and Associate Program Director of the Pulmonary and Emergency Medicine-Critical Care Fellowship at MedStar Washington Hospital presents on critical care ultrasound and the volume resuscitation dilemma as part of the DC5 lecture series.

Resuscitation 40

Resuscitation Ultrasounds Hospitals Sepsis 40

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Background: I think we have covered sepsis more often than any other topic on the SGEM. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

University of Maryland CC Project

MAY 25, 2023

Stephanie Taylor, MD, Associate Professor of Internal Medicine at Carolinas Medical Center presents at Critical Care Grand Rounds, a lecture entitled, "Clinical Subtypes of Sepsis Survivors Predicts Readmission and Mortality After Hospital Discharge.”

Sepsis 40

Sepsis Hospitals Resuscitation 40

University of Maryland Department of Emergency Med

NOVEMBER 27, 2023

Background: -Initial lactate clearance over 2 hours has been used to measure pt response to resuscitation in sepsis. However, data. Click to view the rest

Sepsis 54

Sepsis Resuscitation 54

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

Documentation/Coding 92

Documentation/Coding CPR EKG/ECG Sepsis 92

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

Taming the SRU

MARCH 30, 2023

Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2).

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Emergency Medicine Journal

MAY 23, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension by Shapiro et al Topic: sepsis Outcome rating: head turner Several studies (FEAST, CLASSIC) have challenged the benefit of large volumes of fluid for septic shock.

Sepsis 52

Sepsis Resuscitation Shock Outcomes 52

Thinking Critical Care

MAY 20, 2023

With help from the usual suspects (Rory Spiegel, Andre Denault, Korbin Haycock) we are focusing on some core areas in acute and critical care – sepsis, arrest and respiratory failure are perennials, but this year we are also adding neurocrit as a core component, which I think is a bit underserved and certainly deserving of more.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

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

PulmCCM

FEBRUARY 28, 2022

Further, the treating clinician must have deemed either normal saline or balanced crystalloid as appropriate resuscitation options; the patient’s expected-admission to the ICU must have been at least 3 days. saline crystalloid resuscitation, the inter-trial evaluations become murkier, though seemingly less tendentious.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EMDocs

OCTOBER 28, 2023

Spoon Feed Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: 1: How Useful Is Lactate Clearance Anyway?

Emergency Department 66

Emergency Department Pediatrics Sepsis Resuscitation 66

JournalFeed

OCTOBER 21, 2023

Friday Spoon Feed: Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course. However, they were also associated with a higher rate of adverse outcomes.

Sepsis 52

Sepsis Resuscitation Outcomes 52

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. ETCO 2 correlates with blood pressure, lactate, and base excess in critically ill patients. Further Reading : [link] [link] References: Long B, Koyfman A, Vivirito MA. Circulation.

Emergency Department 68

Emergency Department Blood Transfusions Resuscitation Sepsis 68

EMergucate

APRIL 29, 2014

Issues: shock – bleeding (haematemesis), vomiting, sepsis jaundice – liver failure, cholangitis Sepsis Requires immediate concurrent resuscitation and investigation pH … Continue reading →

Sepsis 40

Sepsis Resuscitation Shock EMS 40

Dr. Smith's ECG Blog

OCTOBER 26, 2010

More often, tachycardia with ST segment abnormalities (elevation or depression) is due to an underlying illness (PE, sepsis, hemorrhage, dehydration, hypoxia, respiratory failure, etc.). Large volume fluid resuscitation was undertaken. The patient was suffering from severe dehydration, possibly with sepsis. The K returned at 6.9

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Thinking Critical Care

NOVEMBER 30, 2024

Recently I’ve heard of a few discussions around sepsis and shock resuscitation that took place at pretty respectable and large conferences, and, to be frank, I was fairly aghast at what was being taught, especially to the young trainees. So I hope this starts to spark some interest.

Shock 51

Shock Sepsis Resuscitation 51

ACEP Now

OCTOBER 29, 2024

Caring for critically ill patients with limited information requires snap assessments and judgements for timely resuscitation and efficient emergency department throughput. In this study, clinical gestalt is not only fast, but accurate for the benefit of timely resuscitation and intervention. New York: Penguin Books. Ann Emerg Med.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

PulmCCM

MAY 22, 2023

Read in NEJM Fluid resuscitation and vasopressors are both usually needed in septic shock , but the ideal volume of fluid to infuse before starting vasopressors has been unclear. centers, patients with sepsis and systolic blood pressure <100 mm Hg all received at least 1000 mL of crystalloid.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

RebelEM

JULY 17, 2023

Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4

Outcomes 95

Outcomes Administration Emergency Department Resuscitation 95