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.

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Emergency Medicine Ireland

JANUARY 22, 2024

It’s clear that the features listed above are fairly non specific and like always it’s likely just sepsis. Firstly do a bit of resuscitation. There may well be some co existing sepsis so give some antibiotics. Our first relevant condition is the wonderfully named thyroid storm.

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Sepsis Resuscitation Wellness Administration 52

Critical Care Now

APRIL 26, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. They quickly recognized the underlying condition and began resuscitation and stabilization before transport. Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director.

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Resuscitation Fluid Resuscitation EMS Sepsis 52

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. Urology took him for orchiopexy.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pedaitr Surg. 2007; 16:27-33. Dias SC et al. Insights Imaging. 2012; 3:247-250. Kawahara H et al. J Pediatr Surg. 2005; 40:1848-1851.

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Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

JULY 13, 2024

Incidence, treatment and outcome of peripartum sepsis. Evaluate for retained products of conception as etiology Diagnosis Diagnosis of endometritis with at least two of the following: 8 Fever >100.4F Am J Obstet Gynecol. 1985 Dec 1;153(7):737-9. doi: 10.1016/0002-9378(85)90335-7. PMID: 4073137. Acta Obstet Gynecol Scand. doi: 10.1034/j.1600-0412.2003.00265.x.

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OB/GYN EMS Sepsis Fluid Resuscitation 64

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 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

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Operations Sepsis Resuscitation Ultrasounds 52

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Axilla, Sacral, GU Overall Volume Status?

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Shock Emergency Department Pediatrics EKG/ECG 95

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.

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EMS Airway Management Administration Resuscitation 40

Northwestern EM Blog

FEBRUARY 14, 2022

Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. Two classes of vasopressors have been used in the past for hypotension. They are catecholamines and vasopressin-like peptides.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 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.)

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Seizures Fractures EKG/ECG Resuscitation 74

Pediatric Emergency Playbook

JUNE 1, 2016

Cardiogenic Shock: Act Use point-of-care cardiac ultrasound : Good Squeeze? It’s seen easily enough on point of care ultrasound. Tamponade: if any sign of shock, pericardiocentesis, preferentially ultrasound-guided. Children with sepsis come in two varieties: warm shock and cold shock. Pericardial Effusion?

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Shock Sepsis Pediatrics Ultrasounds 40

Don't Forget the Bubbles

MAY 8, 2024

Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research. 2024 Apr 3:114037 Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm. Shah M, et al. 2024 Apr 12:114054. Alonso-Ojembarrena A, et al. Marinelli T, et al.

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Pediatrics Emergency Department Outcomes Research 69

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Was there any prenatal care or ultrasound done? Check a glucose ad drug screen Sepsis - Saved for last - You'll almost always treat the sick neonate empirically for sepsis - think of congenital and acquired etiologies. Before you decide on sepsis, ask yourself, could this be a cardiac problem?* ACEP/McGraw-Hill, 2013.

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Seizures Sepsis Pediatrics Shock 40

Don't Forget the Bubbles

FEBRUARY 5, 2024

Role of diagnostic tests for sepsis in children: a review. Sustained inflation and chest compression versus 3:1 chest compression to ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns (SURV1VE): A cluster randomised controlled trial. Anagnostou A, et al. Arch Dis Child. 2024 Jan 12:archdischild-2023-326225.

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Pediatrics Research Resuscitation Psychiatric 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!

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Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

MAY 19, 2020

The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. pulmonary embolism, sepsis, etc.), The diagnosis of MINOCA should exclude: 1) other overt causes for elevated troponin (e.g., myocarditis).

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CPR EKG/ECG Shock Ultrasounds 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.

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Emergency Department Sepsis Operations Dehydration 40

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. 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.

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Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Mind The Bleep

DECEMBER 31, 2023

Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. These require swabs, antibiotics, potentially a sepsis screen and bleeping your registrar / consultant for further advice. Always run renal drug dosing by a pharmacist if you are unsure.

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Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., This finding does not alter the need to pursue emergent reperfusion, although it might suggest a poorer prognosis.”[3] Knotts RJ, Wilson JM, Kim E, Huang HD, Birnbaum Y.

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EKG/ECG Shock Sepsis Emergency Department 52

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

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Sepsis Fluid Resuscitation Resuscitation Shock 65

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Jeff: I feel like we should get some entry music for every ultrasound reference because it seems to make its way into just about every episode. It’s an easy number to remember. 1-800-222-1222. Lavonas EJ, Ruha AM, Banner W, et al.

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Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

NOVEMBER 1, 2023

This is not always feasible in an acute resuscitation scenario. This retrospective observational cohort study looked at whether lactate can be used to predict the need for acute resuscitation in paediatric emergency department (PED) patients. In children who did not need acute resuscitation, the 95th percentile of lactate was 3.2

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Emergency Department Hospitals Resuscitation Administration 140

PulmCCM

MARCH 1, 2022

The core of the conference is, no doubt, ultrasound, especially because Philippe has been at the forefront of point of care ultrasound in the intensive care unit. Therefore, there will be much ultrasound learning during hands-on workshops, in addition to the large library of digital offerings to supplement the face-to-face component.

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Ultrasounds Resuscitation Sepsis 40

Dr. Smith's ECG Blog

DECEMBER 23, 2024

She was resuscitated and admitted to ICU for presumed sepsis. If you do not have an arterial line, use bedside ultrasound to verify myocardial contractility corresponds to pacing. If you don't have ultrasound (but you should), then palpate a pulse! Her family had not heard from her and called EMS.

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EKG/ECG Shock Ultrasounds Sepsis 107

EMDocs

OCTOBER 29, 2024

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report. J Thorac Dis.

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Shock EMS Sepsis Resuscitation 87