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Access to Care for Patients With Time-Sensitive Conditions in Pennsylvania
Conclusion: Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions.
Source: Annals of Emergency Medicine - December 23, 2013 Category: Emergency Medicine Authors: Rama A. Salhi, J. Matthew Edwards, David F. Gaieski, Roger A. Band, Benjamin S. Abella, Brendan G. Carr Tags: Health Policy Source Type: research

Approaches in Prehospital Sepsis Screening
Discussion In the United States, sepsis is one of the leading causes of death, which requires timely identification and proper treatment (CDC, 2019; Guerra et al., 2020; Polito et al., 2015). Based upon a review of literature conducted from 2014 to 2018, the primary investigators could locate five prehospital EMS screening tools to assist EMS providers in identifying at-risk sepsis patients. The researchers explored how the modified SIRS and qSOFA scoring systems were used in hospital settings in addition to these five prehospital EMS screening tools. The Bas 90-30-90, Guerra, PRESEP, PRESS, and Robson tools have ove...
Source: JEMS Patient Care - January 5, 2021 Category: Emergency Medicine Authors: JEMS Staff Tags: Exclusives Patient Care EMS EMT Paramedic Prehospital Sepsis Source Type: news

Endotoxin adsorption by polymyxin B column or intraaortic balloon pumping use for severe septic cardiomyopathy
Septic patients often have low cardiac output. Some of them present severe cardiac dysfunction such as septic cardiomyopathy. However, no well-known and effective treatment for septic cardiomyopathy exists. The effect of endotoxin adsorption by polymyxin B–immobilized fiber column–direct hemoperfusion (PMX-DHP) and intraaortic balloon pumping (IABP) for septic shock remains uncertain. We experienced 2 very contrastive case reports of severe septic cardiomyopathy. We experienced 2 cases of severe septic cardiomyopathy with refractory shock. Case 1 with colon perforation presented refractory shock 6 hours after PMX-DHP, ...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Kensuke Nakamura, Kent Doi, Ryota Inokuchi, Tatsuma Fukuda, Takahiro Hiruma, Takeshi Ishii, Susumu Nakajima, Eisei Noiri, Naoki Yahagi Tags: Case Reports Source Type: research

N-terminal prohormone of brain natriuretic peptide—how far can we extrapolate?
We read the article by Velibey et al with interest. Their result is consistent with various other studies done in the past, but long-term (4 years) survival prediction on hospital admission with a single plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level is a new and important finding. The mean value of NT-proBNP is significantly correlated with ejection fraction and the functional class (New York Heart Association Class) of heart failure . The author had neither commented on the functional status of the patients nor on the etiology of acute shortness of breath at the time of admission. Testing the...
Source: The American Journal of Emergency Medicine - December 23, 2013 Category: Emergency Medicine Authors: Nayer Jamshed, Fouzia F. Ozair, Meera Ekka, Praveen Aggarwal Tags: Correspondence Source Type: research

Optimizing Oxygen Delivery in the Critically Ill: Assessment of Volume Responsiveness in the Septic Patient
Assessing volume responsiveness, defined as an increase in cardiac index after infusion of fluids, is important when caring for critically ill patients in septic shock, as both under- and over-resuscitation can worsen outcomes. This review article describes the currently available methods of assessing volume responsiveness for critically ill patients in the emergency department, with a focus on patients in septic shock.The single-pump model of the circulation utilizing cardiac-filling pressures is reviewed in detail. Additionally, the dual-pump model evaluating cardiopulmonary interactions both invasively and noninvasively...
Source: The Journal of Emergency Medicine - July 31, 2014 Category: Emergency Medicine Authors: Benjamin de Witt, Raj Joshi, Harvey Meislin, Jarrod M. Mosier Source Type: research

Predictors of Patients Who Present to the Emergency Department With Sepsis and Progress to Septic Shock Between 4 and 48 Hours of Emergency Department Arrival*
Conclusion: Approximately 12% of septic emergency department patients develop shock within 48 hours of presentation, and more than half of these patients develop shock after the first 4 hours of emergency department arrival. Over a third of patients who have sepsis within 4 hours of emergency department arrival and develop septic shock between 4 and 48 hours of emergency department arrival are not admitted to an ICU.
Source: Critical Care Medicine - April 17, 2015 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Emergency Department Management of Sepsis Patients: A Randomized, Goal-Oriented, Noninvasive Sepsis Trial
Conclusion Protocol-based fluid resuscitation of patients with severe sepsis and septic shock with the noninvasive cardiac output monitor and passive leg-raising maneuver did not result in better outcomes compared with usual care. Future studies to demonstrate the use of the noninvasive protocol-based care in patients with preexisting fluid overload states may be warranted.
Source: Annals of Emergency Medicine - October 24, 2015 Category: Emergency Medicine Source Type: research

Muhammed Ali's Death Underscores Importance of Prehospital Sepsis Detection
Muhammad Ali, one of the greatest athletes of all times and a world-class treasure, passed away on Friday, June 3, 2016, as result of sepsis. Imagine if an EMS crew could have detected that he was becoming septic and was able to treat him in the field, helping the hospital attack this deadly condition before it attacked his vital organs? Soon, crews all over the world will be capable of doing so. Severe sepsis is caused by overwhelming infection, and is responsible for significant morbidity and mortality among hospitalized patients. Clinical identification of sepsis includes two or more of the systemic inflammatory respons...
Source: JEMS Patient Care - June 6, 2016 Category: Emergency Medicine Authors: A.J. Heightman, MPA, EMT-P Tags: Patient Care Source Type: news

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