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

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41.

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Shock Outcomes Sepsis Resuscitation 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.

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Airway Management Resuscitation EKG/ECG CPR 95

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. PCP Pneumonia, Sepsis) can be discharged with initiation of Antiretroviral Therapy in consultation with Infectious Disease (ID) physician with full ID evaluation outpatient. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Medications: 25.6%

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EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

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!!

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Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. May still be passing small amounts of stool and flatus.

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EMS Sepsis Shock Fluid Resuscitation 88

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. Furthermore, notice the well-formed Q-waves in inferior leads. Large volume fluid resuscitation was undertaken. The K returned at 6.9

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EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

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Operations Radiology Radiology Fluid Resuscitation 78

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.

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Fluid Resuscitation Resuscitation Outcomes Sepsis 40

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] Evaluation Labwork CBC: A white blood cell count is variable and nonspecific.

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EMS Pediatrics Sepsis Airway Management 99

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. There is occasionally some coexisting adrenal insufficiency so you’ll treat that as well.

Sepsis 52

Sepsis Resuscitation Wellness Administration 52

PEMBlog

AUGUST 20, 2024

This episode of PEM Currents discusses ECPR (Extracorporeal Cardiopulmonary Resuscitation), an advanced procedure used in cases of cardiac arrest when traditional CPR fails. Extracorporeal Cardiopulmonary Resuscitation. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.

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CPR Resuscitation Pediatrics Hospitals 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. Tachycardia may be present both from many medications or drugs, as well as withdrawal. The Mental Model: A mental model for sinus tachycardia can assist.

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Shock Emergency Department Pediatrics EKG/ECG 103

Taming the SRU

JANUARY 12, 2024

Often AE-ILD is idiopathic, but treatable causes must be excluded (PNA, PE, volume overload) Treatment for AE-ILD should include antibiotics for CAP coverage (specifically including azithromycin), steroids, and respiratory support; consider opportunistic infection if immunosuppressed as well as diuresis as needed for euvolemia HFNC should be favored (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

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

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Outcomes Administration Emergency Department Resuscitation 90

The Skeptics' Guide to EM

NOVEMBER 18, 2017

Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Following the triage sepsis pathway, recently amended to use qSOFA. and the other 35.5C.

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Sepsis Emergency Department Seizures Pediatrics 52

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

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Ultrasounds Sepsis Radiology Radiology 78

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Most drugs are chosen to be dissolved in 0.9%

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Resuscitation Dehydration Administration Shock 80

EM Curious

JULY 8, 2015

LACTATE KNOWLEDGE BOMB UNDERSTANDING LACTATE IN SEPSIS [BLOG]: Raise your hand if you think elevated lactic acid in sepsis is from anaerobic metabolism? Well, this may not be completely true. Check out the case here and be sure to watch the video tutorial from 5minsono.

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Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Thinking Critical Care

NOVEMBER 28, 2021

Essentially the F2F conference will be 100% interactive, as the long conversations are meant to address the topics that don’t lend themselves well to, or require hands-on workshops (eg sepsis and complex hemodynamics). If all goes well the remainder of the live registration cost will be required 4 weeks prior to the event.

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Sepsis Airway Management Wellness Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. This looked at hydrocortisone to prevent patients with severe sepsis in developing septic shock. NEJM January 2018.

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Shock Sepsis Emergency Department Resuscitation 40

Mind The Bleep

SEPTEMBER 12, 2023

Were there any risk factors for sepsis? Did the baby need resuscitating? Increased work of breathing with grunting and tachypnoea could be due to sepsis, hypoglycaemia or acidosis due to an inborn error of metabolism. Birth History How long was the labour? What were the APGAR signs? Were they cooled? Were the cord gases poor?

Sepsis 52

Sepsis Seizures Poisoning Wellness 52

PulmCCM

SEPTEMBER 9, 2021

Sylvia Plath Background Implicit in resuscitation is speed. Septic sheep randomized to early, rapid volume resuscitation had greater vasopressor requirements 12 hours after initial fluid bolus. sepsis – defined as suspected or confirmed infection plus acute organ dysfunction; d.] Jon-Emile S. older than 65 years; b.]

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Resuscitation Fluid Resuscitation Sepsis Outcomes 40

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. Lactate A sick child with sepsis syndrome? In the adult literature, we know that a lactate level above 4 mmol/L in patients with severe sepsis was associated with the need for critical care.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Their workup reveals a multifocal pneumonia with signs of sepsis. This study expands upon that investigation to patients with other conditions as well. Case: You’re working a shift in a rural emergency department when a 68-year-old man presents with a two-day course of worsening cough, shortness of breath, and fever.

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Poisoning Administration Hospitals Outcomes 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 75

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Case 1: Sepsis Laura is a 2-month-old baby girl born at 32 weeks gestational age who today has been “breathing fast” per mother. She is in respiratory failure from bronchiolitis and likely viral sepsis. We have a few minutes to optimize, to resuscitate before we intubate. She needs her airway taken over.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

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?* Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines.

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Seizures Sepsis Pediatrics Shock 40

PulmCCM

JANUARY 4, 2022

As well, the volume of administration might be much lower than 500 mL, with previous research indicating that 4 mL/kg of crystalloid was an optimal volume needed to increase mean systemic filling pressure. Thoughts Barthelemy and colleagues report an inventive and necessary study for those interested in resuscitation physiology.

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Wellness Outcomes Sepsis Stroke 40

RCEM Learning

NOVEMBER 28, 2022

It is important to closely monitor the patient’s haemodynamic status and repeat the pelvic x-ray post binder removal because a well-applied pelvic binder can mask fracture. REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used as a non-invasive clamp of the aorta. From the case rID 52597 Fig.

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Fractures Blood Transfusions Sepsis Operations 40

Mind The Bleep

FEBRUARY 9, 2024

48 hours) to help her through the initial period of sepsis while her antibiotics take time to work. She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. The patient and team agree to instate a u-DNACPR.

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Hospitals Resuscitation Fluid Resuscitation Shock 52

ACEP Now

MARCH 6, 2024

Many clinicians staffing emergency departments intubate infrequently, as well, and these results are likely applicable to a wide scope of practice. 10 The trial was stopped due to superiority due to both its overall mortality benefit, as well as a reduction in the need for mechanical ventilation. percent to 38.3 2023;330(23):2267.

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Research Airway Management Stroke Outcomes 52

Mind The Bleep

DECEMBER 31, 2023

Damaged kidneys don’t handle drugs well Or fluids! Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. If the patient is an outpatient, they should be called to check they are well. Be gentle with both. In certain circumstances (e.g.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

PulmCCM

FEBRUARY 19, 2024

Well … no. Panelists called this “low certainty evidence from five before-after studies that this intervention may be associated with lower mortality and fewer unsuccessful resuscitation events.” ” But even that watered-down statement is unjustified. Let’s take a closer look.

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

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Emergency Department Operations Academics Documentation/Coding 52

Don't Forget the Bubbles

OCTOBER 2, 2024

This referral procedure is only possible with a well-structured system and may not be feasible in all settings. Impact of in situ simulation training on quality of postnatal stabilization and resuscitation-a before-and-after, non-controlled quality improvement study. De la Cruz-Mena JE, et al. Pediatrics. 2024 Oct 1;154(4):e2023065390.

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Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52