We all know hypotension is bad. But should we fill with fluids or rev up the heart with pressors. This begs the question does early norepi help prevent hypotension and mortality? Today’s quick hit article: Permpikul C, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. 2019 Feb 1. doi: 10.1164/rccm.201806-1034OC. PMID 30704260. …
Infectious Diseases
Lactate for Safely Screening Sepsis?
Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition …
Antibiotic StewardSHIP…Moveover Titanic…there’s a new failure in town.
Tamma, et al. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2018 Dec 27. doi: 10.1001/jama.2018.19509. [Epub ahead of print] BOTTOM LINE: Providers should be asking themselves: “What is the likelihood my patient has an infection and that it requires antibiotic therapy?” Those who know …
Macrolide Resistance: Is Resistance Futile?
There hasn’t been an update to the IDSA/ATS guidelines for CAP (community acquired pneumonia) since 2007 (I keep hearing they will be out soon). These guidelines recommend a macrolide antibiotic as first-line therapy for previously healthy patients who have no risk factors for drug-resistant S. pneumonia (SPN) infection (strong recommendation) and a combination of a …
SO YOU THINK YOU KNOW CELLULITIS?
Sometimes things aren’t as they seem. As an attending I often hear from a resident “Hey got an easy one for ya, 50 y/o diabetic with bilateral cellulitis vanc given, I’ll get some admit labs” followed by a precipitous mic drop. I was told once that a good attending “makes a difficult case simple and …
Quick Hit Article #8: Say No To Flouro(Quinolone) in Pyelo
Quick Hit Article: Pyelonephritis treatment in the community emergency department: Cephalosporins vs. first-line agents. Vogler Am J Emerg Med. 2018 Aug 8. pii: S0735-6757(18)30652-1 The Bottom Line: In this retropsective chart review with moderate (not optimal) methods, patients placed on cephalosporins had significantly less treatment failure (0% vs 23%, p< 0.001) than when placed on either …
(Really) Quick Hit Article #7 – LR does not clinically increase serum lactate. If you believe in lactate…come along with me…
Source: J Emerg Med. 2018 Jul 20. pii: S0736-4679(18)30602-4 Today’s (really) quick hit is a neat little article trying to answer the question “Does Lactated Ringers increase your serum lactic acid. Given that sepsis seems to be the only diagnosis of anymore, can our friend lactic acid still help us if we are giving 30 ml/kg …
QUICK HIT #3: THE ED TEMPERATURE VITAL SIGN – Its HOT! But How Hot????
Yes, summer in Arizona is hot but we aren’t talking weather – hot. We are talking fever – hot, as in, is our ED temperature measurements correct? The scientist part of me wants accuracy, the caring part of me wants not to put things in peoples bum! So, is there a happy medium when it …
C. Diff-(iccile): Should the treatment B. Diff-(erent)? A 2018 Update
Table 1. Adult Treatment Strategies 1: Severity Severity Definition Treatment First time, non-severe WBC ≤15000 cells/mL and Cr <1.5 mg/dL • vancomycin PO 125 mg QID x 10 days, OR • fidoxamycin 200 mg BID x 10 days • Alternate: flagyl, 500 mg PO TIDx10 d First time, severe WBC ≥15000 cells/mL or Cr >1.5 …
QUICK HIT ARTICLE #1 : Should you be “PRO” PROcalcitonin? PRObably not.
Source: Huang DT et al. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med. 2018 May 20. Sepsis (well more correctly severe sepsis/shock) is as dangerous as fake news but so is ordering cr(a)p that wont help you in the management of your patients. The current darling of the useless …