American Medical Compliance

APRIL 16, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. Furthermore, prompt antibiotic treatment of illnesses, such as sepsis, decreases morbidity and saves lives.

Leadership 97

Leadership Sepsis Outcomes Hospitals 97

Emergency Medicine Cases

MARCH 26, 2019

In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? and many more.

Sepsis 40

Sepsis Shock EMS Resuscitation 40

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

Emergency Medicine Journal

MAY 23, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension by Shapiro et al Topic: sepsis Outcome rating: head turner Several studies (FEAST, CLASSIC) have challenged the benefit of large volumes of fluid for septic shock.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

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

EMDocs

NOVEMBER 25, 2023

Spoon Feed In this multicenter, randomized controlled trial comparing suturing the fingernail back onto the nail bed versus simply covering the nail bed with a non-adherent dressing after repair of a nail bed injury, there was no statistically significant difference in infection rate or cosmetic outcome. 3: High or Low Fluid Volume in Sepsis?

Sepsis 55

Sepsis Emergency Department Pediatrics Academics 55

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. After 40ml/kg of IV 0.9% The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

JournalFeed

OCTOBER 21, 2023

However, they were also associated with a higher rate of adverse outcomes. Friday Spoon Feed: Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.

Sepsis 52

Sepsis Resuscitation Outcomes 52

University of Maryland CC Project

JANUARY 31, 2024

The topic of their lecture today is their recently published article in CHEST: “Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study”. Their article can be found here: [link]

Administration 40

Administration Sepsis Research Outcomes 40

The Skeptics' Guide to EM

OCTOBER 14, 2023

We have been reading online about something called sepsis that can be deadly. Does he have sepsis?” Specifically, heart rate and respiratory rates are used in early attempts to detect sepsis. His parents look at the monitor and ask you, “Is that heart rate normal for him? It seems awfully high.

Pediatrics 98

Pediatrics Sepsis Urgent Care Emergency Department 98

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

EMDocs

AUGUST 24, 2023

Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. Exclusion criteria: Severe coagulopathy A platelet count below 20, 000 INR > 6.0 Difference of 10.6% (95% CI 3.3 – 17.9%) 30-240 min (entire study population): 31.4% Difference of 12% (95% CI 5.4

Administration 68

Administration Sepsis Shock Outcomes 68

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 84

Sepsis Administration Documentation/Coding Fractures 84

EMDocs

NOVEMBER 7, 2023

Included patients had confirmed uncomplicated diverticulitis but no immunosuppression, peritonitis, sepsis. No difference in their primary outcome of complications and need for emergency surgery (1.9% Patients with sepsis and immunocompromise were not included. 623 patients included. 528 patients included. 5.0%; p = 0.085).

Sepsis 87

Sepsis Best Practices Hospitals Outcomes 87

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. Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med.

Sepsis 104

Sepsis Fluid Resuscitation Resuscitation Administration 104

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). increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

The Trauma Pro

AUGUST 25, 2023

They tried to perform a systematic review and meta-analysis of studies that compared outcomes in splenectomy vs. angioembolization patients. We have no idea if the numbers of T- and B-cells seen and the antibody titers are actually enough to avoid overwhelming post-splenectomy sepsis. Not very precise, I know. But what would EAST say?

Sepsis 243

Sepsis Research Outcomes Hospitals 243

PulmCCM

NOVEMBER 27, 2023

Authors wondered if chance resulted in more withdrawal-of-care decisions among the landiolol arm, making their outcomes look worse. Powered by his enthusiasm and reputation, vitamin C caught on widely as a therapy for sepsis for several years—even generating an eponymously-named “protocol.” for benefit of vitamin C.

Sepsis 52

Sepsis Shock Administration Outcomes 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

JournalFeed

AUGUST 1, 2020

We cover pros and cons of antibiotics for dog bites, risk of delayed antibiotics in severe infection, immediate (<1h) vs early (<3h) antibiotic outcomes, and the largest meta-analysis to date on POCUS for cellulitis vs abscess. Here is the JournalFeed Podcast for the week of July 27-31, 2020.

Sepsis 52

Sepsis Outcomes 52

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3.

Administration 98

Administration Sepsis Ultrasounds Outcomes 98

Don't Forget the Bubbles

JANUARY 1, 2024

2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Outcomes From a Randomized Clinical Trial. Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants. Cannabis Exposure and Adverse Pregnancy Outcomes Related to Placental Function. Pawlowski TW, et al. Eur J Pediatr.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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. no statistical difference in primary outcome of SOFA scores at 72 hours or the secondary outcome of 30-day mortality.

Sepsis 40

Sepsis Shock Outcomes Research 40

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

RebelEM

SEPTEMBER 21, 2023

Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ).

EKG/ECG 139

EKG/ECG Sepsis EMS Outcomes 139

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis.

Sexual Assault 98

Sexual Assault Teamwork Outcomes Dehydration 98

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. In 42 patients getting PET scans in a neuro-ICU over 10 years, four of the six with sepsis had infectious foci identified. °C oral measured multiple times).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

PHEM Cast

SEPTEMBER 25, 2019

Sepsis Click for UK Sepsis Trust guidance for different clinical settings. Sörensen HT, Nielsen GL, Schönheyder HC, Steffensen FH, Hansen I, Sabroe S, Dahlerup JF, Hamburger H, Olsen J: Outcome of pre-hospital antibiotic treatment of meningococcal disease. References regarding IM benzylpenicillin that Tim mentions: Harnden A.

Ambulance Services 52

Ambulance Services Sepsis Burns Hospitals 52

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. That was in NEJM Aug 18 2022. Very high TSH levels (17-100 mIU/L) and very low FT3 (0-2.2)

Infectious Diseases 52

Infectious Diseases Outcomes Hyperthermia / Hypothermia Sepsis 52

PulmCCM

OCTOBER 23, 2023

Cefepime crosses the blood-brain barrier, and dozens of case reports have associated the drug with seizures, encephalopathy, delirium, and coma, with a possibly increased incidence of neurologic adverse effects among patients with renal failure or sepsis. Read in JAMA Does Paxlovid Improve Covid-19 Outcomes in the Omicron Era?

Hospitals 98

Hospitals Emergency Department COPD CDC 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

Research 52

Research Airway Management Stroke Outcomes 52

Don't Forget the Bubbles

JUNE 19, 2023

It is useful to know that there are two kinds of weight curves: Descriptive , in which nearly all mothers and their children are included with few exclusion criteria, and Prescriptive , in which groups of women with pathologies that affect neonatal morbidity and mortality outcomes have been excluded. Eur J Pediatr 2016;175:1047-57.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Outcomes 143

Dr. Smith's ECG Blog

MARCH 30, 2014

Then they were worried about sepsis as an etiology of hypotension. Then she had some RUQ tenderness which led to a long process of evaluation for an abdominal source of sepsis, which turned up negative. Outcome and Analysis: ECG 1 is diagnostic of inferior and right ventricular MI. Was there pulmonary edema?

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52