The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. She is also an Assistant Professor, Department of Emergency Medicine Mayo […] The post SGEM#346: Sepsis – You Were Always on My Mind first appeared on The Skeptics Guide to Emergency Medicine. mg/dl or 107 umol/L).

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

EMDocs

AUGUST 24, 2023

Blood cultures were collected from patients before the admiration of antibiotics (gold standard), and then again 30 – 120 min following administration of antibiotics. Yields from the post-antibiotic set of blood cultures were then compared against the pre-antibiotics administration set. Difference of 12% (95% CI 5.4 Ann Intern Med.

Administration 67

Administration Sepsis Shock Outcomes 67

Emergency Medicine Cases

MAY 5, 2020

The post EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis Pediatrics EMS Fractures 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. Myth busting: Is peripheral administration safe?

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Core Ultrasound

MARCH 25, 2024

The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid. There is no one dichotomous test that will tell you whether to give fluid or not. That is a holy grail that we have to stop chasing.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

EM Literature of Note

AUGUST 1, 2023

have grown from 9% of GDP to 20% GDP, and administrative costs are estimated to comprise up to 30% of total national health care spending. suddenly we’re obviously talking about tens of billions of dollars of added administrative overhead. Health care expenditures in the U.S. Multiplied by the 4000+ hospitals in the U.S.,

Administration 69

Administration Sepsis Hospitals 69

JournalFeed

MARCH 4, 2023

Spoon Feed This unblinded superiority trial found no significant difference in mortality among patients who were randomized to a restrictive fluid strategy with earlier use of vasopressors or liberal fluid administration for treatment of sepsis-induced hypotension.

Sepsis 52

Sepsis Administration 52

EMDocs

SEPTEMBER 6, 2023

Learning points: Consider differential – sepsis, thyroid storm, thalamic stroke, exertional and classic heat stroke, serotonin syndrome, neuroleptic malignant syndrome, sympathomimetic toxicity, and anticholinergics. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Temperature starts to decrease.

Anaphylaxis 69

Anaphylaxis Shock Sepsis Stroke 69

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

RebelEM

APRIL 26, 2023

Remember to evaluate for concurrent medical illness: gastritis, pancreatitis, pyelonephritis, pneumonia, sepsis. Thiamine 100mg IV 4 Fix electrolyte abnormalities (Hypokalemia, Hypomagnesemia) Administration of bicarbonate is generally unnecessary. Treatment consists of thiamine, dextrose, and volume repletion. 1991 Aug;91(2):119-28.

Sepsis 112

Sepsis Administration EMS 112

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration.

Sepsis 104

Sepsis Fluid Resuscitation Resuscitation Administration 104

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. It’s clear that the features listed above are fairly non specific and like always it’s likely just sepsis.

Sepsis 52

Sepsis Resuscitation Wellness Administration 52

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane).

Sepsis 84

Sepsis Administration Documentation/Coding Fractures 84

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. Patients with sepsis and immunocompromise were not included. Open-label, non-inferiority RCT including patients with uncomplicated diverticulitis, no significant comorbidities, no immunosuppression, and no signs of sepsis.

Sepsis 86

Sepsis Best Practices Hospitals Outcomes 86

Emergency Medicine Ireland

APRIL 29, 2024

But as we all know patients often have multiple reasons to be obtunded including sepsis or intoxication or multiple other causes. I will say that once the hypertonic is in and you’re reaching for a 2nd or a 3rd you should probably be thinking about a CVC as the access for administration and indeed regular sampling is really helpful.

Seizures 75

Seizures Sepsis Stroke Administration 75

The Skeptics' Guide to EM

JUNE 6, 2020

Background: I think we have covered sepsis more often than any other topic on the SGEM. It was the landmark paper published 19 years ago by Dr. Emanuel Rivers on early goal directed therapy in the treatment of severe sepsis and septic shock that sensitized the medical community ( Rivers et al NEJM 2001).

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

PulmCCM

NOVEMBER 27, 2023

A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third. This comports with the earlier findings of lack of benefit and possible harm from high-dose vitamin C supplementation in sepsis.

Sepsis 52

Sepsis Shock Administration Outcomes 52

The Bottom Line

JANUARY 10, 2024

In acutely ill adults (ED / ICU) does the administration of cefipime or piperacillin-tazobactam (pip-taz) result in an increased incidence of AKI or death by day 14?

Administration 60

Administration Sepsis 60

PulmCCM

DECEMBER 10, 2023

Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin.

Seizures 52

Seizures Sepsis Academics Administration 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.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

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

PulmCCM

FEBRUARY 5, 2024

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). to enforce compliance with an administrative policy).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

PulmCCM

MARCH 11, 2024

Ascension and UPenn test automatic palliative care consults Palliative care programs are sometimes pitched to administrators on the basis of their potential to reduce costs, by shortening length-of-stay or intensity of expensive and unhelpful therapies at the end of life. The trial was funded by NIH and a philanthropic trust.

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. This post evaluates the recent “Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP)” trial.

Sepsis 89

Sepsis Outcomes Administration Research 89

ACEP Now

JULY 8, 2023

To better address this question, we begin with a prospective observational cohort study of 239 children that evaluated the diagnostic ability of clinical recognition signs (CRS) to identify sepsis. The authors mention that “CRS were not associated with intravenous antibiotics administration, SBI [ serious bacterial illness ], or admission.”

Pediatrics 52

Pediatrics Poisoning Emergency Department Sepsis 52

EMDocs

NOVEMBER 27, 2023

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. 2 DRESS Syndrome has a 10% mortality rate with the primary cause of mortality being hepatic necrosis.

EMS 70

EMS Sepsis Burns EKG/ECG 70

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). There have been at least two randomized control trials published that do not support the use of Vitamin C in sepsis. It was Dr. Paul Marik who has been a big advocate for Vitamin C sepsis. Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 40

PulmCCM

FEBRUARY 12, 2024

In mechanically ventilated patients with septic shock, randomized trials have not shown improved survival with steroid administration , even among those who were “cosyntropin responders” (although hemodynamics were improved with steroids ). Critically ill patients with low cortisol (e.g.,

Shock 52

Shock Administration Sepsis Fractures 52

Don't Forget the Bubbles

JANUARY 1, 2024

2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Late surfactant administration after 48 hours of age in preterm neonates with respiratory insufficiency: a systematic review and meta-analysis. Pawlowski TW, et al. Eur J Pediatr. Weiss SL, et al. Pediatrics. 2023 Dec 12:e2023062967. Hua LL, et al. Pediatrics.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. percent to 38.3 N Engl J Med.

Research 52

Research Airway Management Stroke Outcomes 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

Currently, the administration of water for the paediatric population is based on the Holliday-Segar formula (100ml/kg/day for the first 10kg of weight, 50ml/kg/day for the second 10kg of weight and 20ml/kg/day for weight over 20kg). Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

The Skeptics' Guide to EM

JANUARY 25, 2020

Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Clinical Question: Is bag-mask ventilation (BMV) performed during the apneic period of RSI (defined as the time between administration of RSI medications and intubation) in critically ill adults safe and effective? Reference: Casey et al.

Airway Management 40

Airway Management EMS Administration Resuscitation 40

PulmCCM

NOVEMBER 11, 2021

evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0 Accordingly, the baseline PPV was 20%, suggesting greater preload dependency prior to phenylephrine administration. A lesser-known investigation from nearly 40 years ago offers one explanatory model.

Stroke 40

Stroke Sepsis Administration Wellness 40

PulmCCM

OCTOBER 23, 2023

Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin.

Hospitals 98

Hospitals Emergency Department COPD CDC 98

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Their workup reveals a multifocal pneumonia with signs of sepsis. The SGEM Bottom Line was that the routine administration of supplemental oxygen in patients with suspected or confirmed acute myocardial infarction who are not hypoxic does not appear to provide a patient-oriented benefit. Reference: Chu DK et al.

Administration 52

Administration Poisoning Hospitals Outcomes 52