2012

2012

SAEM(Society of Academic Emergency Medicine)

SAEMDr. Deb Houry
traumatic brain injury, pulmonary embolism, sepsis, cardiac arrest, and injury prevention

Hopkins

entitled: Normal Initial Blood Sugar Level and History

of Diabetes Might Reduce in-hospital Mortality of Septic Patients Visited the Emergency
Department Comparison of a Novel Clinical Prediction Rule, MEDS, SIRS, and
CURB-65 in the Prediction of Hospital Mortality for Septic Patients Visited the
Emergency Department
retrospectivecohort study

counter-intuitiveHyperlactatemia
HyperglycemiaNon-Diabetic Septic Adults

presentderiveclinical prediction rule

studyHarvard DerivevalidateMortality in Emergency
Department Sepsis (MEDS) score HarvardMEDS
Richard Wolfe,
prediction rule/modelpopulationvalidation
population
Nathan Shapiro

Clinical prediction rules (CPRs), critical care medicine (CCM), toxicology, emergency
medical service (EMS), emergency ultrasound (EUS)
1


2012

Clinical prediction rules (CPRs):

derivedCPRsvalidation, north America chest pain rulelow

riskCPRsone size fits
allCPRsdisease severity
CPRs
CPRsrisk stratification
severity
Mortality in Emergency
Department Sepsis (MEDS) scoreEarly Goal Directed Therapy (EGDT) Protocol
efficacyEGDT
controlMEDSEGDT0.52RR
mortality

Clinical Decision Support System

(CDSS)CDSSD-dimerCTPulmonary Embolism
Before-and-afterpresenter

practice
CDSS

CPRsimpact analysisCPR
impact analysisderivation
interventional studies
effectiveness research
Pediatric Early Warning System

study population & target populationimpact

analysisvalidation study

Critical care medicine (CCM)

Sepsis

Hyperlactatemiahyperglycemia
lactateLactateclearance
lactate
lactateAUClactate
Odds Ratiolactate(normalization, defined as


2012

<2.0 mmol/L)OR, 2 or 4 mmol/L, 10%

LactateRiversSevere SepsisEarly goal directed
therapylactate
biomarkers/clinical prediction rules/
biosignatures

Surviving sepsis campaign update

Surviving sepsis campaignevidence12

044
GRADE EBM quality
Screeningperformance (1c)
screening tool
biomarkerlactatebiomarker
normalizing lactatetargetclearance >10% (1c)
Venous saturationcentral venous saturation 70%
mixed venous saturation 65%biomarker (1c)
on CVCScvO2peripheral veinmodality
Resuscitation fluidupdate
Recommend Crystalloid only (1a)
Suggest Albumin (2b)colloid
Recommend Against starches with molecular weight > 200 Da or degree of
substation >0.4 (1b)against
Recommend 1000ml started 30ml/kg in first 4-6hr (1b)2030
Recommend Incremental boluses as long as hemodynamic improvement (1c)
fluid responsiveness
hemodynamic
Extra-vascularfluidextra-lung
Diagnosisone size fit allGuidelines
Blood cultureindwelling catheter
procalcitoninguideline()

Early antibiotics < 1 hour (1b)Early source control (< 12 hr)
VasopressorupdateMAP> 65
mmHg (1c)dopaminenorepinephrine (1b)dopamine
myocardial depressionDobutamine
+vasopressor (1c)
Low dose corticosteroidstimulation test (2b)

ARDSlow tidal volume 6 ml/kg (1a) + Plateau < 30 cm

H2O
glucose control180 mg/dLrather than 110 now


2012

Therapeutic hypothermia (TH)

(TH)guidelinespostresuscitationischemia/reperfusion (IRI) injuryIRIproinflammatory and pro apoptosisin vitroMild hypothermia
injuryanimal model
THMITBI (traumatic brain injury)
THbrainrecovery

Toxicology

toxicologydidactic session
acetaminophen (APAP) overdosesessionbiomarker, risk
stratification, & treatment

Biomarker

(surrogate)exposure or
outcomeBiomarker

APAP overdose
acetaminophen levelALT>1000
biomarker: APAP Cysteine protein
adductbiomarkerperformance
biomarkerpromisingpoint of care (POC) assay
underdevelopment

Risk stratification
APAP
overdoserisk stratificationpredictorspeak level, HtD50 level, rate of
elimination, APAP * ALT levelcost-effectiveness

Treatment
20IV
72tailored
treatmentAPAP levelliver functionclinical picture

Emergency medical service (EMS)

Geographic Information Systems (GIS)EMS

GIS for EMSGIS
GIS
John Snowcholera
4


2012

Broad street
GISEMS
EMSbystander CPR
Public access defibrillatorcardiac arrest

Emergency ultrasound (EUS)

appendicitis, intussusception, Pyloric stenosis, Vascular

access, and Skeleton muscular

Clinical prediction rulessepsis