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Ultrasound of the Month: Gallbladder Perforation

Taming the SRU

A bedside right upper quadrant ultrasound was performed, and the images are below. Complications of acute gallbladder perforation include localized peritonitis, hepatic, subhepatic, or pelvic abscess formation, pneumonia, pancreatitis, acute renal failure, and sepsis (7). The remainder of his exam was unremarkable.

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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

In 18 severe sepsis patients in 3 years at one center who underwent PET scanning (apparently done ad hoc), 14 of the 18 had positive tests, and 11 were true positives, leading to surgery in 2 and pacemaker removal in 2 (and longer / new antibiotics in 2). Ultrasound can quickly and more accurately identify significant biliary disease (e.g.,

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Another Study on Peripheral Vasopressors

RebelEM

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. of cases) Catheter ultrasound confirmation: 49.8% (i.e. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Not met in 16.7%

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Fetal Growth Restriction and Small for Gestational Age Babies

Don't Forget the Bubbles

There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant. Differential diagnosis of small babies The differential diagnosis for SGA and growth-restricted babies is extensive: The diagnosis of growth restriction in utero has improved because of the better use of ultrasound but still remains challenging.

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Grand Rounds Recap 6.19.2024

Taming the SRU

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. Gram positive sepsis is more common, but gram negative sepsis carries higher morbidity/mortality.

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Ultrasound of the Month - Not all veggies are good for your health

Downeast Emergency Medicine

C, RR 17, O2 sat 96% on RA In addition to having the standard sepsis workup with three blood cultures ordered upon primary evaluation, she was started on Ampicillin-Sulbactam and a bedside echo was performed. Her laboratory workup at urgent care was reviewed included the following labs (pertinent positives in parenthesis): CBC (WBC 12.6)

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emDOCs Podcast – Episode 98: Post ROSC Mental Model

EMDocs

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.,