PHEM Cast

APRIL 10, 2016

[link] We hope you enjoyed our sepsis podcast. St Emlyns Induction podcast on Sepsis. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. March 2016.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EMDocs

AUGUST 24, 2023

PICO Population Inclusion criteria Age ≥ 18 years old Patients with septic shock Must have 2/4 SIRS criteria plus Confirmed or suspected source plus Lactate ≥ 4mmo/L or systolic blood pressure ≤ 90 mmHg Had blood cultures completed before antibiotics and were available for collection of an additional set of antibiotics following antibiotics.

Administration 97

Administration Sepsis Shock Emergency Department 97

RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. References: Yerke JR et al. CHEST 2024.

Administration 137

Administration Sepsis EMS Shock 137

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

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Critical Care Now

JUNE 30, 2024

The latest Surviving Sepsis Campaign (SSC 2021) guidelines say the following about albumin in in sepsis: The lack of proven benefit and higher cost of albumin compared to crystalloids contributed to our strong recommendation for the use of crystalloids as first-line fluid for resuscitation in sepsis and septic shock.

Sepsis 52

Sepsis Fluid Resuscitation Shock Resuscitation 52

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Reviewed by: John Coveney Article 2: How do we define sepsis in children? International Consensus Criteria for Pediatric Sepsis and Septic Shock. doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Taming the SRU

APRIL 17, 2024

The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.

Sepsis 95

Sepsis Research Stroke Academics 95

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Background: I think we have covered sepsis more often than any other topic on the SGEM. Date: June 2nd, 2020 Reference: Permpikul et al. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e.

Resuscitation 123

Resuscitation Outcomes EMS Sepsis 123

Dr. Smith's ECG Blog

MARCH 30, 2014

Then they were worried about sepsis as an etiology of hypotension. Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Then she had some RUQ tenderness which led to a long process of evaluation for an abdominal source of sepsis, which turned up negative.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

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 Resuscitation Shock Outcomes 52

Taming the SRU

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 98

EKG/ECG Shock Wellness EMS 98

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. 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.

Sepsis 52

Sepsis Shock Administration Leadership 52

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. We should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Emergency Medicine Education

SEPTEMBER 29, 2024

A retrospective study published in the Critical Care journal investigated the impact of intravenous thiamine administration on clinical outcomes in septic patients. The study evaluated key parameters, including lactate clearance and overall mortality. Link to article

Shock 40

Shock Administration Outcomes Sepsis 40

The Skeptics' Guide to EM

JANUARY 15, 2022

Case: You respond to a rapid response on the floor for a 58-year-old woman in septic shock who is requiring emergent rapid sequence intubation (RSI). Both agents are considered hemodynamically stable, but any induction agent may precipitate shock in the critically ill.

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia. critical care professional societies agree.

Shock 52

Shock Administration Sepsis Fractures 52

RebelEM

JANUARY 25, 2023

Small bowel obstruction: Outcome and cost implications of admitting service. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Emery Med J 2014; 31(3): 248-9. 0.27 – 0.83

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 9, 2012

Maybe the patient has dehydration, sepsis, hemorrhage, or PE. If you were to give verapamil to someone with sinus tach secondary to underlying pathology, you would harm them and perhaps provoke hypotension and shock. Outcome: The etiology of the patient's sinus tachycardia was not discovered.

EKG/ECG 52

EKG/ECG Dehydration Sepsis Shock 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. Primary outcome here was kidney based rather than mortality. Vasopressin versus norepinephrine infusion in patients with septic shock. This was closer to home in the UK, with 18 ICUs. Gordon, A.

Shock 52

Shock Sepsis Wellness Outcomes 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Jasmine, a hypothetical case Jasmine is a 5-year-old girl weighing 18kg admitted to PICU with suspected sepsis. Remember, we can add more if needed, but taking it away is much harder.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock/profound hypotension; GI bleeding; anemia; "sick patient"; etc. ). 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

Exclusions: Oxygen saturations <92% on room air; silent chest; shock or sepsis; previous PICU admission with wheeze; prematurity; other cardiac or respiratory disease; likely alternative diagnosis for the wheeze; or steroid treatment within the preceding 14 days.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

RebelEM

NOVEMBER 3, 2022

Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion. Articles removed were duplicates, contained irrelevant outcomes, or had a significant risk for bias.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. REFERENCES: Acute Respiratory Distress Syndrome Network et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. BMJ 2012; 345:e5521.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

PulmCCM

JANUARY 4, 2022

” -Fran Lebowitz Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome. The primary outcome was identification of the optimal volume for assessing fluid responsiveness. If I get to the dry cleaners without having a huge fight, that’s challenging enough.”

Wellness 40

Wellness Outcomes Sepsis Stroke 40

EB Medicine

JULY 8, 2019

Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. vs. 0.91), positive predictive value (0.27

Sepsis 94

Sepsis Fluid Resuscitation Resuscitation Shock 94