Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and identified pediatric septic shock far sooner into a patient's course.
Read MoreJoin us for another week of Grand Rounds! We had a visit from Dr. Melissa Platt of the ABEM Board of Directors discussing the upcoming changes to the ABEM certification exam. Dr. Lawton presented to us about frequent fliers in the Emergency Department. Dr. Shewakramani spoke to us about sepsis metrics and operational changes that have been made in our department, and we closed with an exciting R3 Taming the SRU lecture with Dr. Artiga discussing difficult intubations.
Read MoreSepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world. Sepsis as a disease process has been difficult to both clearly define and quickly recognize. Many metrics for recognition and management of sepsis are dependent upon various scoring systems, including SIRS, SOFA, qSOFA, and MEWS, none of which were designed for the acute detection of sepsis within the emergency department. This journal club recap will look at an article by Knack et al looking at physician gestalt vs scoring systems for the detection of sepsis.
Read MoreJoin us to summarize another fantastic series of Grand Rounds lectures. We start off with in-flight emergencies, including changes to physiology and what equipment is available to you on most commercial flights, with Dr. Urbanowicz. Followed by a literature-filled debate between Drs. Lane and McDonough on the utility of CT pan-scans in trauma patients. With the help of Dr. Shewakramani, we all learn how to better recognize and care for patients with sepsis. Meanwhile, Dr. Roche teaches us about all various bites/stings- including marine species, scorpions, and mosquitos! Lastly, Dr. Wright introduces us to the science of reliability and how to design processes in healthcare to be more reliable, with the ultimate goal of improving our care of patients.
Read MoreSepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. One of the primary pathophysiologic mechanisms involves complex cascade of host dysregulation in response to an infectious stimulus (Evans, Rhodes et al. 2021, Jarczak, Kluge et al. 2021). Recent meta-analyses and systematic reviews evaluating mortality in patients with septic shock reported mortality as high as 35% and 38% at 30 and 90 days, respectively (Vincent, Jones et al. 2019, Bauer, Gerlach et al. 2020). Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. 2021). Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al. 2022).
Read MoreEarly recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. 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. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.
Read MoreThis week in Grand rounds, we had some case reflection from R4 Dr.Zalesky reminding us to avoid anchoring, be aware of our biases for or against patients, and avoid creating a rude work environment. Dr. Moulds and Dr. Goel had a CPC showdown with a case of Cecal Diverticulitis, while Dr. Artiga gave us the low down on Lung Ultrasound in the ED. We wrapped up the day with an R4 lead simulation on a case of Thyrotoxicosis.
Read MoreThis week we had a tour de force of education goodness. We started off with Dr. Mullen presenting Morbidity and Mortality Conference. This was followed with an updated DKA QI/KT protocol developed by Dr. Shaw and Dr. Glenn. More great faculty Core Content was brought by Dr. Irankunda elucidating high pressure injection injuries. We wrapped up the day with some research nuggets with Dr. Freiermuth.
Read MoreIn this week’s Grand Rounds, Dr. Laurence led us through an incredible and education Morbidity and Mortality Conference, Drs. Gillespie and Continenza worked through a dramatic case combining vision changes and rash, Dr. Wright reminded us to not forget the esophagus in our patients with chest pain and Dr. Connelly gave a fantastic overview of EMS provider education and systems structure in her R4 Capstone. Finally, our incredible visiting professor, Dr. Megan Rybarcyzk gave us insight into building an emergency medicine education program in the midst of a pandemic and provides tips and tricks for those seeking a career in global health.
Read MoreThis week Dr. Laurence provides great case-based learning in our monthly morbidity and mortality conference, Dr. Roblee walks us through aortic dissection management, Drs. Kletsel and Ferreri evaluate fluid resuscitation of ESRD patients, and Dr. Davis covers fungal skin infections.
Read MoreWe had a fantastic Grand Rounds this week!! Dr. Li kicked us off with our monthly Morbidity and Mortality conference, covering cases ranging from methamphetamine intoxication to the evidence behind the medical pan scan. Dr. Harty then led us through several cases where ultrasound made critical diagnoses that completely altered patients’ clinical courses #SonoWavesFTW. Dr. Modi passionately educated us on the importance of an individual’s name, in both identity and cultural significance, and how crucial it is to respect and pronounce names correctly. Lastly. Drs. Berger, Irankunda, and Urbanowicz expertly discussed pediatric orthopedic injuries.
Read MoreThis week Dr. Klaszky presented cases to help us improve our clinical care in the ED with our monthly Morbidity and Mortality conference. Drs. Hall, Modi, and Shaw taught us about marine, reptile, and arthropod envenomations with their R3 small group session. Finally, we were honored to (remotely) host the nationally renowned Dr. Megan Ranney, who gave us an eye-opening presentation on the overlap between gun violence, public health, and the role of emergency medicine.
Read MoreIn our first ever teleconferenced Grand Rounds - this week Dr. Kathryn Banning presented us with opportunities to improve the care we deliver in our monthly morbidity and mortality conference. Then, our panel of expert clinicians and self-aware humans engaged us all in a discussion of wellness and longevity that was at times vulnerable and candid, but also enlightening from start to finish. Finally, we learned more about radio operations and reflected on both failures and victories in HEMS CQI cases with our Air Care leadership team.
Read MoreNormal saline has taken hold as the de facto resuscitative fluid in the majority of health care institutions in the developed world. Walk through the recent data with Dr. Christopher Shaw which suggests that balanced fluids may provide benefit to patients suffering from a wide array of critical illnesses.
Read MoreWe had another great week in Grand Rounds, starting with a QI/KT presentation from Drs. Hunt and Pulvino about Tumor Lysis Syndrome. Next, Dr. Meigh gave a great presentation about TORCH infections and Dr. Spigner gave his R4 Capstone lecture on pre-hospital sepsis care. We welcomed a guest speaker, Dr. Henning, from podiatry who discussed a number podiatry emergencies. Finally, the week wrapped up with a simulation of an inferior STEMI in trauma.
Read MoreSRU (pronounced "shrew") = Shock Resuscitation Unit
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.
