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

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. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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. In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause. Other organ system involvement & hypotension/low perfusion affect EtCO 2. Circulation. 2019;140(24):e881-e894.

Emergency Department 95

Emergency Department Blood Transfusions Resuscitation Sepsis 95

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The trauma call goes out.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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.

Operations 95

Operations Radiology Radiology Fluid Resuscitation 95

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 Pediatrics Outcomes 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.

Shock 52

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.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

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

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.

OB/GYN 91

OB/GYN EMS Sepsis Fluid Resuscitation 91

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.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

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

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 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

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

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Adjust all tubing and reassess connections.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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 97

Outcomes Emergency Department Administration Resuscitation 97

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. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. Curr Opin Crit Care.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

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.

CPR 52

CPR Resuscitation Pediatrics Hospitals 52

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

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.

Sepsis 52

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).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

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%

Resuscitation 80

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.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 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.

Shock 40

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

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

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.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

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.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

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

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

Pediatric Emergency Playbook

AUGUST 1, 2017

Essentials: Typically presents in 1st week of life (case reports to 6 months in chronically ill children) Extend suspicion longer in NICU graduates Up to 10% of all cases of necrotizing enterocolitis are in full-term children Pathophysiology is unknown, but likely a translocation of bacteria Diagnosis: Feeding intolerance, abdominal distention Abdominal (..)

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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.

Seizures 40

Seizures Sepsis Pediatrics Shock 40