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

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 93

Documentation/Coding CPR EKG/ECG Sepsis 93

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

Taming the SRU

FEBRUARY 5, 2024

It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. This resource offers additional information on ultrasound assisted LP’s. WHY - Why Not? REFERENCES 1. Zambito Marsala, S., Gioulis, M., & Pistacchi, M. Cabellos, C.,

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

EMDocs

MARCH 4, 2024

12 Ultrasound and computed tomography (CT) can both identify CBD and are available in most emergency departments. Ultrasound is cost-effective and radiation-sparing. Ultrasound has approximately 90% sensitivity for detecting common bile duct dilation. 13 CT is also superior to ultrasound in its ability to detect malignancy.

Emergency Department 88

Emergency Department Ultrasounds EMS Radiology 88

EM Curious

JULY 29, 2015

NO RESPECT FOR THE RIGHT VENTRICLE [PODCAST]: The boys from Ultrasound Podcast sit down with critical care guru, Dr. Haney Mallemat, to discuss the assessment of the right ventricle with ultrasound. S-E-P-S-I-S A SEPSIS SMACC-BACK [PODCAST]: If you were at SMACC 2015 you may have been confused after the sepsis expert panel discussion.

Sepsis 52

Sepsis EMS Emergency Department Ultrasounds 52

Core Ultrasound

MARCH 25, 2024

For example a pt in the ED with sepsis, and a collapsible IVC, dry lungs and no peripheral edema is more likely to benefit from fluid than be harmed Take that same pt, with the same US and physical exam findings and make it 72-hrs later in the ICU after 6-10 L. For this we use clinical judgement, US findings, PE findings.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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.). The patient was suffering from severe dehydration, possibly with sepsis. Furthermore, notice the well-formed Q-waves in inferior leads. Cr was 13.4.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Diagnosis and Management of Pituitary Adenomas: A Review.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Taming the SRU

AUGUST 30, 2023

Notably, lung ultrasound for the diagnosis of bacterial CAP demonstrated exceptional stand-alone diagnostic accuracy in 33 studies including 4,901 adults and children in the emergency department, with a pooled sensitivity of 92% and specificity of 90%. High serum procalcitonin concentrations in patients with sepsis and infection.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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. There may well be some co existing sepsis so give some antibiotics. The key is to do an assessment, this likely includes having a sneaky peak at the heart and the lungs with ultrasound.

Sepsis 52

Sepsis Resuscitation Wellness Administration 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

Don't Forget the Bubbles

JULY 5, 2023

Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Sickle cell patients also qualify to receive the annual influenza vaccine, since influenza virus infection predisposes to bacterial pneumonia and sepsis caused by S. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Pediatric Education

FEBRUARY 4, 2024

A right-sided suprarenal mass had been identified on routine ultrasound during the third trimester that was thought to likely be an adrenal hemorrhage. The radiologic evaluation of an ultrasound examination showed a small hypoechoic mass in the area of right adrenal gland that was smaller than previously recorded prenatally.

Ultrasounds 52

Ultrasounds Radiology Radiology Pediatrics 52

EMDocs

JULY 13, 2024

Incidence, treatment and outcome of peripartum sepsis. Am J Obstet Gynecol. 1985 Dec 1;153(7):737-9. doi: 10.1016/0002-9378(85)90335-7. PMID: 4073137. Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Acta Obstet Gynecol Scand. 2003 Aug;82(8):730-5. doi: 10.1034/j.1600-0412.2003.00265.x. 1600-0412.2003.00265.x. PMID: 12848644. Moldenhauer, Julie S.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

Emergency Medicine Journal

JULY 24, 2023

An intern says he wants to complete sepsis bundles; a second-year is shooting for more bedside ultrasounds. Beyond them, in the collective treatment area, is a flood. My attending likes to start shifts by asking about our daily goals. As the senior resident, I say I’m working on "volume", but what I really mean is flow.

Sepsis 40

Sepsis Ultrasounds Hospitals 40

ACEP Now

MAY 4, 2023

Diagnosis: Complex Hydrocele (Pyocele) The testicular ultrasound revealed a small left complex hydrocele suspicious for pyocele. Early treatment with broad-spectrum antibiotics is essential to prevent sepsis and preserve testicular function. There were no rashes, discharge, or palpable inguinal hernias. Click to enlarge.)

Urgent Care 52

Urgent Care Ultrasounds Sepsis Emergency Department 52

ACEP Now

OCTOBER 29, 2024

For example, experienced emergency physicians have great clinical gestalt and accuracy to predict sepsis in critically ill patients at just 15 minutes from patient arrival—more so than scoring tools like the qSOFA, MEWs, and even machine-learning trained artificial intelligence models. A testicular ultrasound confirmed restored blood flow.

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. J Ultrasound. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. Semin Pedaitr Surg. Dias SC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Mind The Bleep

AUGUST 5, 2023

Common signs and symptoms include: Abdominal distention with prominent veins and discolouration Umbilical flaring Poor feeding Bilious vomiting Abdominal tenderness Bowel changes, including diarrhoea, blood and mucus Lethargy, apnoea, bradycardia Sepsis Risk factors of low birth rate, prematurity and formula feeding. (1, Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun;182(6):2735-2757 Point-of-care ultrasound to assess degree of dehydration in children: a systematic review with meta-analysis. Sethi SK, et al. Pediatr Nephrol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PulmCCM

JULY 10, 2023

Continuous meropenem infusion for critically ill patients with sepsis Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

EM Curious

JULY 15, 2015

Onto the Foamed AIRWAY MANAGEMENT IN THE CRITICALLY ILL [PAPER]: If you intubate patients this is a must read for management of the airway of sick patients. Check it out here at Critical Care Horizons, a relatively new free online peer reviewed journal.

Airway Management 52

Airway Management EMS Poisoning Emergency Department 52

EMDocs

JULY 29, 2023

Transoral Ultrasound in the Diagnosis of Obstructive Salivary Gland Pathologies. Ultrasound Med Biol. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Acute bacterial sialadenitis: a study of 29 cases and review. Rev Infect Dis.

EMS 72

EMS Dehydration Ultrasounds Emergency Department 72

The Skeptics' Guide to EM

OCTOBER 23, 2021

The patient is neurovascularly intact and there is no evidence of deep vein thrombosis (DVT) on ultrasound. Case: A 46-year-old male with a history of diabetes controlled on metformin presents with erythema and warmth to his right lower leg measuring 27 cm by 10 cm for the past four days. Excluded: Unstable comorbidity (e.g.

Emergency Department 52

Emergency Department Sepsis Hospitals Research 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. Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). Axilla, Sacral, GU Overall Volume Status? Do they have edema?

Shock 96

Shock Emergency Department Pediatrics EKG/ECG 96

ACEP Now

MAY 9, 2024

6 The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

University of Maryland CC Project

OCTOBER 5, 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 for the assessment of the LV and RV as part of the DC5 lecture series. Dr. Anantha K.

Ultrasounds 40

Ultrasounds Hospitals Sepsis 40

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.

EMS 40

EMS Airway Management Administration Resuscitation 40

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? Pediatrics.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Critical Care Now

APRIL 26, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director. A reduced supply of cortisol will decrease vascular tone, causing systemic vasodilation, shock, and hemodynamic collapse.

Resuscitation 52

Resuscitation Fluid Resuscitation EMS Sepsis 52

EMDocs

MAY 11, 2024

Cavernous sinus syndrome (B) usually presents with cranial nerve deficits, diplopia, periorbital cellulitis, and facial swelling that may progress to meningitis or sepsis. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. anatomic region). Brainstem stroke: anatomy, clinical and radiological findings. doi: 10.1053/j.sult.2013.01.004.

Stroke 90

Stroke EMS EKG/ECG Radiology 90