New to Meducation?
Sign up
Already signed up? Log In

Category

Preview
0
14

JICS Cast: Daniels - UK Sepsis Trust - Intensive Care Network

Olusanya & Day interview Ron Daniels, head of the UK Sepsis Trust. Daniels discusses the worldwide effort for better recognition & treatment of sepsis.  
intensivecarenetwork.com
over 5 years ago
Sinaiem dark
0
23

a-tale-of-two-trachs

34 year old male with PMHx quadriplegia 2/2 GSW 8 years prior, with elective tracheostomy after his early disease course was complicated by frequent intubations for sepsis, presents to ED from NH with fever x1 day.  
sinaiem.org
over 5 years ago
Preview
0
2

miniRAGE: The ProCESS Trial - The RAGE Podcast

The RAGE Team discuss the ProCESS Trial and management of severe sepsis.  
ragepodcast.com
over 5 years ago
Preview
0
8

SGEM#113: EGDT – ProMISe(s) ProMISe(s)

Suneel is an Associate Clinical Professor Emergency Medicine at McMaster University and Associate Member of Clinical Epidemiology and Biostatistics. He is also the Chair CAEP standards committee and a sepsis researcher.  
thesgem.com
over 5 years ago
Preview
0
8

The Protocolised Management in Sepsis (ProMISe) Trial - R.E.B.E.L. EM - Emergency Medicine Blog

Part 3 of the sepsis trilogy has been published in the saga of EGDT vs "usual" care: The Protocolised Management in Sepsis (ProMISe) Trial  
rebelem.com
over 5 years ago
Preview
0
6

The New Age of Sepsis Management - R.E.B.E.L. EM - Emergency Medicine Blog

Physicians have become more aggressive in the management of sepsis which raises the question of whether all elements of EGDT protocol are still necessary.  
rebelem.com
over 5 years ago
Preview
0
8

A young woman with recurrent perianal sepsis

A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, and episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, and she was started on oral and topical mesalazine. In the following months she was admitted twice with acute perianal sepsis, which required examinations under anaesthesia and drainage of an intersphincteric abscess. She later presented after feeling generally unwell for four days with “flu-like” symptoms and perianal pain. On examination she had tenderness and fluctuance in the region of the right ischial tuberosity, with an external fistula opening visibly in the perineum. Her blood tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) and mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only.  
feeds.bmj.com
over 5 years ago
Preview
0
9

A young woman with recurrent perianal sepsis

A 23 year old woman had been experiencing cramping abdominal pain, alternating diarrhoea and constipation, and episodic blood per rectum for four months. An earlier colonoscopy showed proctitis, which was thought to be indicative of underlying inflammatory bowel disease, and she was started on oral and topical mesalazine. In the following months she was admitted twice with acute perianal sepsis, which required examinations under anaesthesia and drainage of an intersphincteric abscess. She later presented after feeling generally unwell for four days with “flu-like” symptoms and perianal pain. On examination she had tenderness and fluctuance in the region of the right ischial tuberosity, with an external fistula opening visibly in the perineum. Her blood tests show mild neutrophilia (9.40×109/L, reference range 2-7.5) and mildly raised C reactive protein (380.96 nmol/L (40 mg/L), 0-95.24 (0-10) only.  
feeds.bmj.com
over 5 years ago
Preview
0
17

Critical Care

Patients with severe sepsis often present with concurrent coagulopathy, microcirculatory failure and evidence of vascular endothelial activation and damage. Given the critical role of the endothelium in balancing hemostasis, we investigated single-point associations between whole blood coagulopathy by thrombelastography (TEG) and plasma/serum markers of endothelial activation and damage in patients with severe sepsis.  
ccforum.com
over 5 years ago
Preview
0
8

CAH with adrenal crisis

This case is written by Dr. Quang Ngo from McMaster University. Dr. Ngo is a pediatric emergency physician in Hamilton, ON and one of the advisory board members at EMSimCases. Why it Matters This cases highlights three crucial management steps for a toxic neonate: Maintaining a broad differential diagnosis (including hypoglycemia, sepsis, metabolic/cardiac conditions) Consideration of hypoglycemia as…  
emsimcases.com
over 5 years ago
Preview
0
2

Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
over 5 years ago
Preview
0
12

Critical Care

Neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (Cys-C), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) are novel diagnostic biomarkers of acute kidney injury (AKI). We aimed to determine the diagnostic properties of these biomarkers for detecting AKI in critically ill patients with sepsis.  
ccforum.com
over 5 years ago
Preview
0
5

REBELCast: Sepsis Care in 2015 - R.E.B.E.L. EM - Emergency Medicine Blog

This post is a summary of my lecture from the Texas College of Emergency Physicians meeting in Austin, TX (April 23rd - 26th, 2015) on sepsis, titled "Optimizing ED Management of Sepsis."  
rebelem.com
over 5 years ago
Preview
0
4

Critical Care

The Tie2/angiopoietin (Tie2/Ang) and vascular endothelial growth factor receptor-ligand systems (VEGFR/VEGF) are recognized to play important roles in the regulation of microvascular endothelial function. Downregulation of these genes during sepsis has been implicated in the pathogenesis of sepsis-related microvascular leak and multiple organ dysfunction syndrome. Mechanisms responsible for dysregulation of angiogenic genes in sepsis are poorly defined.  
ccforum.com
over 5 years ago
Preview
0
11

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 5 years ago
Preview
0
11

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 5 years ago