To improve identification, it is recommended to have a consistent approach to every patient who is identified as meeting SIRs criteria. Use our prior posts on sepsis for more education (New Sepsis Guidelines) (Qsofa Score). It is also recommended to utilize a smart phrase to identify any potential infectious etiology and medical decision making to prevent missing a potential source of infection, such as an indwelling catheter or orthopedic device. 

Utilizing peripheral IVs for short-term treatment with IV vasopressors is frequently utilized while obtaining additional access. Are we risking skin necrosis for short term gains? 

The NIH stroke scale it used to identify the severity of stroke like symptoms, and should be scored on the patient's initial presentation, without coaching or duplication. It is important to be consistent when scoring all patients, and identify all deficits. 

NIH stroke scale scores patients 0-42, with higher scores indicating increased severity.

Training for appropriate use of the NIH stroke scale is free, at http://nihss-english.trainingcampus.net/

iPhone applications, such as StatCoder, are available and free.

Lithium is an effective treatment for bipolar disorder, and is known to decrease rates of suicide associated with affective disorders. Additionally, lithium is uncommonly used to augment treatments for depression, aggression, and PTSD. Unfortunately, lithium is also frequently the cause of toxic ingestions due to its narrow therapeudic window, renal clearance, and utilization for intentional overdoses.