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Surviving Sepsis NEONATAL MENINGITIS WELLNESS SKEPTICS' GUIDE Big Disease Encouraging Hydrocortisone in a Tiny Host Resilience and Sepsis SEE PAGE 8 SEE PAGE 15 SEE PAGE 14 MARCH 2017 Volume 36 Number 3 FACEBOOK/ACEPFAN TWITTER/ACEPNOW ACEPNOW.COM PLUS THE NEW SURVIVING SOUND ADVICE OPIOID-SPARING TECHNIQUE FOR PATIENTS WITH RIB SEPSIS FRACTURES ILLUSTRATION:CHRIS WHISSEN; PHOTOS: SHUTTERSTOCK.COM SEE PAGE 12 RECOMMENDATIONS HIGHLIGHTS FROM THE LATEST GUIDELINES BUZZARRE A new continuing medical education feature of ACEP Now by TIFFANY M. OSBORN, MD, MPH BEE STING LOG ON TO http://www.acep.org/ Cura te ipsum: ACEPeCME/ CEP endorsed the latest iteration of the Surviv- TO COMPLETE THE Doctor, heal thy uvula ACTIVITY AND EARN ing Sepsis Campaign (SSC) guidelines, totaling FREE AMA PRA by GREGORY PODOLEJ, MD CATEGORY 1 CREDIT. 67 pages with 93 statements on early manage- A 1,2 ment and 655 references. An important note: Guide- was supposed to be a nice refreshing lines should be a counselor, not a jailer. Guidelines IT run along a country road. provide a framework for direction and standardization On my return loop, about a mile from my EM CASES where possible but require clinical context for house, I felt an insect fly into my mouth. I FIXING individual patients. This summary includes immediately coughed it out and was a lit- HYPONATREMIA items specifically pertinent to emergency tle surprised when I saw that it was not WHILE AVOIDING medicine and is not intended to be all- just a regular house fly—it had some yel- CATASTROPHE inclusive. low stripes on it. Nonetheless, I was having SEE PAGE 11 a good run and didn’t feel like stopping to DEFINITIONS take a better look. “Even if it was a bee or a All the data informing guideline devel- wasp,” I thought to myself as I kept running, opment were based on the established “thank God I’m not allergic.” definitions, not Sepsis-3. The Sepsis-3 and Literally 30 seconds later, I started to feel FIND IT ONLINE established definitions were modified for the intense pain in the back of my throat, much For more clinical stories and like a sore throat from hell. Granted, even practice trends, plus commentary and opinion pieces, go to: CONTINUED on page 6 though I am more out of shape now than I www.acepnow.com SHUTTERSTOCK.COM used to be, it started feeling like it was get- ting harder to breathe. A few scenarios started running through my head: 1. If my throat closes, at least I’ll be by a bigger road soon and somebody will see me. 2. I wonder how long the paramedics will MEET take to get to my rural house. 3. I’m not that far from home. I know I have a scalpel, a bougie, and an endotra- cheal tube somewhere. EDIE I managed to get home and took a cur- PAGE 4 sory look at the back of my throat. My pos- terior pharynx was quite erythematous, but most noticeably, my uvula was the size of CONTINUED on page 10 2017 Course Topics Updated & Revised Topics! n Acute and Chronic Back Pain in the ED n BRUE in Low Risk Infants: AAP Guidelines n SEPSIS, SOFA, So What? n Sore Throat: 2017 Sate-of-the-Art n Imaging in Chest Trauma n Myths in Emergency Medicine n Poisoning / Overdose 2017 28 State-of-the-Art Topics Focused on Clinical Questions n ED-Related “Choosing Wisely” - Part 1 Four 90-Minute Faculty Panels Literature-Derived Evidence n ED-Related “Choosing Wisely” - Part 2 Seasoned Clinical Faculty Top Dates & Destinations n Gastrointestinal Pearls n ACLS Literature Update - Part 1 n ACLS Literature Update - Part 2 n Unusual Antibiotic Side Effects n The Dilemma of PE Overdiagnosis n The Challenges of Physician Variability n Assessing Suicide Risk n TIAs in the ED Course Has Passed Course Has Passed n Clinician Burnout: 2017 Update Key West, Florida Cancún, Mexico Vail, Colorado n Getting to Know Tranexamic Acid Feb. 27 - March 3, 2017 March 6 - 10, 2017 March 20 - 24, 2017 n Management of CPR Survival - Part 1 n Management of CPR Survival - Part 2 n SAH Ongoing Diagnostic Challenges n Minor Head Trauma: Special Cases n Ongoing Challenge of Managing Pediatric UTI n Steroids: Uses and Misuses in EM n Topics in COPD 2017: Is Anything New? Scottsdale, Arizona Orlando, Florida San Francisco, California n Visual Diagnosis Challenges - Part 1 March 23 - 26, 2017 April 12 - 15, 2017 April 20 - 23, 2017 n Visual Diagnosis Challenges - Part 2 n Important Recent EM Literature - Part 1* n Important Recent EM Literature - Part 2* n Diagnostic and Therapeutic Controversies* n Challenging ED Scenarios* *Topics listed with an asterisk (*) are 90-minute faculty panel New Orleans, Louisiana Hilton Head, South Carolina San Diego, California discussions; all other topics are 30 minutes. April 27 - 30, 2017 May 10 - 13, 2017 June 1 - 4, 2017 Experience the Course Enjoyed by Over 45,000 Nashville, Tennessee New York, New York Girdwood, Alaska of Your Colleagues! June 14 - 17, 2017 June 22 - 25, 2017 June 26 - 30, 2017 Take Advantage of Early Bird For Complete Details and to Register, Registration Visit www. or and Discounted EMAcourse.com Hotel Rates! Call 800-458-4779 (9:00am-4:30pm ET, M-F) Jointly Sponsored by THE CENTER FOR MEDICAL EDUCATION MARCH 2017 Volume 36 Number 3 ACEPNOW.COM EDITORIAL STAFF MEDICAL EDITOR-IN-CHIEF EDITOR Kevin Klauer, DO, EJD, FACEP Dawn Antoline-Wang [email protected] [email protected] Time Saving Features. ART DIRECTOR Chris Whissen Streamlined Asynchronous Learning. [email protected] My Residency Learning ACEP STAFF Robust, peer-reviewed content Portal is a customized, EXECUTIVE DIRECTOR DIRECTOR, MEMBER Dean Wilkerson, JD, MBA, CAE COMMUNICATIONS AND personalized, single entry point World-renowned EM educators [email protected] MARKETING Nancy Calaway, CAE for high-quality, EM on-demand Over 875 hours of course selections ASSOCIATE EXECUTIVE DIRECTOR, [email protected] education. 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