Sepsis

  0 Introduction 0 Toxic shock syndrome (TSS) is critical to recognize because it can be rapidly lethal and yet is usually treatable.   TSS is a relatively  

0 Introduction 0 Over the last few years, I've gone through an almost 180-degree change in my conceptualization of septic shock.  In a perfect world, this  

Introduction 0 Traditionally it has been thought that during septic shock, renal blood flow decreases leading to pre-renal kidney injury.  This implied tha  

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.  

An overview of the latest update of the new care bundles published by the Surviving Sepsis Campaign in April 2015.  

Olusanya & Day interview Ron Daniels, head of the UK Sepsis Trust. Daniels discusses the worldwide effort for better recognition & treatment of sepsis.  

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.  

The RAGE Team discuss the ProCESS Trial and management of severe sepsis.  

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.  

 

 

 

Part 3 of the sepsis trilogy has been published in the saga of EGDT vs "usual" care: The Protocolised Management in Sepsis (ProMISe) Trial  

Physicians have become more aggressive in the management of sepsis which raises the question of whether all elements of EGDT protocol are still necessary.  

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.  

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.  

An overview of the latest update of the new care bundles published by the Surviving Sepsis Campaign in April 2015.  

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.  

Based on surviving sepsis campaign and sepsis kills programme.  

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…