Archive for category: Infectious Disease

The HYPRESS Trial: Early Steroids to Prevent Septic Shock

31 Oct
October 31, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: The most recent surviving sepsis campaign recommends the use of hydrocortisone in patients with refractory septic shock (i.e. vasopressor dependent).  However, the use of hydrocortisone in severe sepsis without shock still remains a very controversial topic. Recommendations for hydrocortisone are mostly based on 2 randomized clinical trials (i.e. […]

October 2016 REBEL Cast: IDSA Pneumonia Update

10 Oct
October 10, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketEvery few years we get updates in the guidelines based on new evidence. Guidelines give us a framework to work with in the treatment of disease processes, such as pneumonia. The last Infectious Disease Society of America (IDSA) guidelines update on the treatment of pneumonia came from 2005, but […]

Macrolide Antibiotics, Prolonged QTc, and Ventricular Dysrhythmias

08 Aug
August 8, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: When it comes to treating community acquired respiratory tract infections, macrolide antibiotics (azithromycin, clarithromycin, and erythromycin) are a common choice of agent. In 2010, 57.4 million macrolide prescriptions were written in the U.S. with azithromycin being the most commonly prescribed individual antibiotic agent overall with ~51.5 million prescriptions (Hicks […]

Is It Necessary to Irrigate Abscesses After I&D?

11 Apr
April 11, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Irrigation after incision and drainage (I&D) of an abscess in the ED is considered by some sources to be standard care but local practice varies considerably. There are no randomized controlled trials to date that look at the potential benefits of this procedure. Irrigation increases the time required […]

Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses?

10 Mar
March 10, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: It is well documented that the number of visits to the ED for abscesses is on the rise in the US, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common cause of purulent skin and soft-tissue infections. The primary treatment for cutaneous abscesses is incision and drainage (I&D). […]

Sepsis 3.0

24 Feb
February 24, 2016

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Systemic Inflammatory Response Syndrome (SIRS) is something that has been beat into the heads of medical students, residents, fellows, and all physicians in general. However, the derivation of SIRS occurred in 1991, where the focus was on the then-prevailing inflammatory response of the host immune system. In 2001, […]

The HEAT Trial – Acetaminophen in ICU Patients with Fever

19 Oct
October 19, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Acetaminophen (paracetamol) is commonly used to lower the temperature of patients with fever suspected to be causeed by an infection in both homes across the world and the hospital. There are, however, opposing theories to the utility of decreasing fever in these situations. One side argues that fever […]

Time to Antibiotics in Sepsis: A Metric Not Supported by “High Quality” Evidence

21 Sep
September 21, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Some of the major take home points from the sepsis trilogy of studies recently published (ProCESS, ARISE, and ProMISe) was that early identification of patients with sepsis, early intravenous fluids, and timely, appropriate broad-spectrum antibiotics is key to decreasing morbidity and mortality. In 2006 a study by Kumar […]

REBELCast: Sepsis Care in 2015

04 May
May 4, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketSo I was recently invited to the Texas College of Emergency Physicians meeting in Austin, TX (April 23rd – 26th, 2015) and was asked to give a lecture on sepsis, titled “Optimizing ED Management of Sepsis.” I was able to record my audio from that lecture and will summarize […]

The Protocolised Management in Sepsis (ProMISe) Trial

17 Mar
March 17, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketSince 2002, the surviving sepsis campaign (SSC) has stated that best practice in sepsis care includes: early recognition, source control, appropriate/timely antibiotic therapy, resuscitation with intravenous fluids (IVF) and vasoactive medications. Resuscitation of the septic patient in the emergency department has been largely based off the 2001 Rivers trial. […]

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