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EM Nerd-The Case of the Hurried Objective
In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]
IBCC chapter & cast – Asthma
Severe asthma is a challenging topic, because this spans a lot of different patient phenotypes with varying severity and physiology. This chapter attempts to outline some general principles to guide management, but ultimately clinical judgement and serial evaluation at the bedside will trump all of this. The rarity, acuity, and heterogeneity of severe asthma make […]
Tox and Hound – Don’t Wernicke’s, B(1) Happy
by Meghan Spyres You take the perilous sign out of a 55-year-old patient with alcohol use disorder (AUD) who came to the ED intoxicated. “He’s just metabolizing” your colleague tells you. A few hours go by and he is now awake and asking to leave. The nurse road tests him and he can walk, but […]
EM Nerd-The Case of the Sour Remedy
In 2017 Marik et al (1) published an observational before and after study examining the initiation of the sepsis cocktail for ICU patients admitted with sepsis. The authors noted, following the introduction of this cocktail, which included IV vitamin C, thiamine and hydrocortisone, ICU mortality dropped by an extraordinary 31.9% (40.4% to 8.5%). Since this […]
PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this
background Fever is harmful in post-arrest patients. This creates confusion in studies of hypothermia in post-arrest patients: is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both? Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]
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