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

FEBRUARY 17, 2024

2016) compares vital sign abnormalities and symptom duration between available case reports. 2016) compares vital sign abnormalities and symptom duration between available case reports. Source: Zerr et al 2016) BP, blood pressure; F, female; HR, heart rate; IV, intravenous; M, male; NA, not available; WBC, white blood cell.

EMS 83

EMS Sepsis Hospitals Wellness 83

Don't Forget the Bubbles

MARCH 4, 2024

This study retrospectively identified 1,414 children, presenting to 15 UK EDs (2016 -2017), who had been screened for malaria. Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Pediatric EM Morsels

APRIL 7, 2023

Unfortunately, it can cause so many other complications – Sepsis , acute chest syndrome , and hepatopathy. Epub 2016 Oct 17. 2016 Dec 2;2016(1):625-631. If Sickle Cell Disease only ever caused Vaso-Occlusive crises, it would be considered one of the most challenging conditions for patients and families to deal with.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

RebelEM

MAY 15, 2024

Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. Epub 2016 Dec 29. Neutropenic Fever: Fever (one reading of 38.3C Support Care Cancer. 2018 May;26(5):1465-1470. Epub 2017 Nov 22.

Infectious Diseases 78

Infectious Diseases Administration Sepsis Anaphylaxis 78

Pediatric EM Morsels

NOVEMBER 17, 2023

2016 Feb;30(1):3-11. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. 2022 Apr;29(4):406-414. doi: 10.1111/acem.14431. Anaesthesia. 2019 Sep;74(9):1186-1190. doi: 10.1111/anae.14787. Epub 2019 Jul 16. PMID: 31313280.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

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

Taming the SRU

MARCH 30, 2023

Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. decreased DSI values). References Vincent JL, De Backer D.

Shock 52

Shock Outcomes Sepsis Resuscitation 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. 2016, Andrews, Semler et al. N Engl J Med. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., Published February 15, 2016. The key is a patient who is on an AV nodal blocker and who has some sort of risk factor for renal insufficiency.

Shock 86

Shock Dehydration Sepsis EKG/ECG 86

Mind The Bleep

JUNE 27, 2023

Wang X, 2016 ) Kidneys Around 30-50% of patients have evidence of renal involvement with HSP. Joint involvement includes arthritis and arthralgia and most of those with joint involvement have swelling. Pain can be migratory and recurrent. Joints involved can be unilateral or bilateral and are commonly the knees, ankles, hands and feet.

Sepsis 52

Sepsis 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. Date: February 22nd, 2019 Reference: Lane et al. Reference: Lane et al.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

Don't Forget the Bubbles

AUGUST 21, 2023

Infection/sepsis? European Journal of Pediatrics; 2016: 175; 1461-1462 Cox, GF. The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. What are your differentials? Bad bronchiolitis ? Congenital cardiac disease – maybe a duct-dependent lesion? A metabolic issue?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

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. Published 2016 Jan 29. ETCO 2 correlates with blood pressure, lactate, and base excess in critically ill patients. Further Reading : [link] [link] References: Long B, Koyfman A, Vivirito MA.

Emergency Department 67

Emergency Department Blood Transfusions Resuscitation Sepsis 67

Emergency Medicine Ireland

OCTOBER 16, 2023

We’ll start with sepsis. Sepsis is a state of low systemic vascular resistance leading to reduced preload and afterload in the heart. Current Opinion in Critical Care 22 , 260–266 (2016). We’ll start with sepsis. Let’s say you’ve even managed to diagnose it using echo. Tribouilloy, C. &

Sepsis 52

Sepsis Shock Wellness 52

Taming the SRU

AUGUST 30, 2023

Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear. A 2013 meta-analysis of 30 studies including 3,244 patients published in The Lancet found PCT to have a pooled sensitivity of 77% and specificity of 79% for sepsis in critically ill patients [52]. 2016 Dec;115(6):317-21.

Infectious Diseases 78

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 78

PulmCCM

MARCH 11, 2024

Each hospital’s Medical Executive Committee approved the protocol, and data was collected 2016-2018. The trial was funded by NIH and a philanthropic trust. Out of the total sample of 34,239 patients, 44% received palliative care in the automatic group, vs. 16% in the usual care group.

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

Emergency Medicine Ireland

OCTOBER 30, 2023

As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Jama 316 , 509–518 (2016). Vasopressin is an ADH analogue, very simillar in structure with very similar effects.

Shock 52

Shock Sepsis Wellness Outcomes 52

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This is true in life-threatening conditions such as sepsis. However, when children do not have features of sepsis, oral antibiotics are equally effective. The take home is that although IV antibiotics are key in sepsis management, oral antibiotics are equally as effective as IV antibiotics for children without critical illness.

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

Emergency Medicine Ireland

OCTOBER 28, 2020

This has relevance to the ICU population in 2 major ares * Sepsis. * EF does not correlate with particularly well with mortality in sepsis though diastolic dysfunction does * It may be due to under filling and the reduced diastolic filling due to the ubiquitous tachycardia in sepsis. . *

Sepsis 40

Sepsis Documentation/Coding Ultrasounds Wellness 40

Taming the SRU

FEBRUARY 5, 2024

The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. C., & ESCMID Study Group for Infections of the Brain (ESGIB) (2016). Glennie, L., Gaillemin, O., Wyncoll, D., Kaczmarski, E., Thwaites, G., Davies, N. C., & Solomon, T. Cabellos, C.,

Infectious Diseases 86

Infectious Diseases Seizures Ultrasounds Sepsis 86

Don't Forget the Bubbles

JUNE 30, 2023

Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Northwestern EM Blog

JANUARY 24, 2022

Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. Hypothyroidism and Adrenal Insufficiency in Sepsis and Hemorrhagic Shock. Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

PulmCCM

SEPTEMBER 23, 2021

Critical care 2016, 20(1):270. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock. Marik P, Bellomo R: A rational approach to fluid therapy in sepsis. BJA: British Journal of Anaesthesia 2016, 116(3):339-349.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

In 2016, the American Academy of Pediatrics (AAP) reaffirmed their clinical practice guidelines for the diagnosis and management of UTIs. This two-step process can decrease the rate of catheterization by over 30% without missing UTIs or increasing length of stay in the pediatric emergency department (Lavelle et al Pediatrics 2016 ).

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

EB Medicine

JANUARY 10, 2020

This can be the result of hypotension, tachycardia, sepsis, PE, etc. This can be the result of hypotension, tachycardia, sepsis, PE, etc. In-hospital mortality rates are about the same for STEMI and NSTEMI, about 10%. Type 2 MI is the "mismatch" due to an imbalance in myocardial oxygen supply and demand.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

RebelEM

JANUARY 29, 2024

Thrombolysis Compared with Heparin for the Initial Treatment of Pulmonary Embolism: A Meta-Analysis of the Randomized Controlled Trials. PMID: 15262836 Sharifi M et al. Pulseless Electrical Activity in Pulmonary Embolism Treated with Thrombolysis (from the “PEAPETT” Study). PMID: 27422214 Wang C et al.

Outcomes 121

Outcomes Stroke Hospitals Administration 121

RebelEM

MARCH 9, 2023

Pain / Additional Complaints : Alcohol can weaken the immune system with only moderate use, predisposing individuals to pneumonia, soft tissue infections, and sepsis. 2016 Feb 4;65:242-51. Any report of trauma should prompt evaluation with imaging. Osteopathic Family Physician. 2014 Mar;6(2). Barr T, Helms C, Grant K, Messaoudi I.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

EB Medicine

MARCH 4, 2020

No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. Specifically, Salmonella, shigella, Campylobacter, and Yersinia 2016 ACG guidelines recommend them for patients with watery diarrhea and moderate to severe illness with fever for at least 72 hours.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 Yamazaki T, Shimada Y, Taenaka N, Oshumi H, Takezawa J, Yoshiya I: Circulatory responses to afterloading with phenylephrine in hyperdynamic sepsis. Yamazaki et al.

Stroke 40

Stroke Sepsis Administration Wellness 40

PEMBlog

MARCH 27, 2024

2016 Jan;37(1):3-15; quiz 16-7, 47. However, sometimes you might hear of siblings or other relatives who had early onset neurologic or GI dysfunction or died early in life, and this can often be attributed to sepsis or sudden infant death syndrome because the symptoms of these overlap with IEMs. In: StatPearls [Internet]. Pediatr Rev.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019. Screen time and preschool children: Promoting health and development in a digital world. Paediatr Child Health.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

RebelEM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). PMID: 36115743 Clinical Question: What is the effectiveness of IV amiodarone vs IV digoxin used as second line therapy in critically ill emergency department patients with atrial fibrillation/flutter where first-line BB use has failed?

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Sepsis indicators and malaria positivity did not modify the risk. 2016 Jan 7;4(1).

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Don't Forget the Bubbles

NOVEMBER 1, 2023

This retrospective study, conducted between 2016 and 2018, looked at paediatric patients aged between 2 and 17 years presenting with severe exacerbation of asthma to a single tertiary paediatric Emergency Department in Memphis, Tennessee. Pediatric Emergency Care 39(7):p 524-529, July 2023. DOI: 10.1097/PEC.0000000000002890

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Pediatric Emergency Playbook

APRIL 1, 2016

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. The acute recognition and treatment of sepsis is first and foremost, clinical. The short answer – yes.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. 2016; 5(1):5-12. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52