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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. 2002 Dec;141(6):793-7. Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 PMID: 12461495.

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Anaesth Intensive Care 2002. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 vs 0.5% (Range 0.4 vs 0.5% (Range 0.4

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Trauma Resuscitation Updates

RebelEM

In the initial management of trauma patients there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from the resuscitation itself Promote hemostasis References: Dutton RP et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality.

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. 2002 Nov;28(7):665-9.

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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Hypervolemia – leads to pulmonary edema: Consider diuresis If euvolemic – start maintenance fluids of D5 in 0.45%NS Clinical Guide for the Management of Sickle Cell Disease, 2002. Published January 2002.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS Clinical Guide for the Management of Sickle Cell Disease, 2002. Published January 2002. Decreases splinting and improves tidal volumes. times maintenance.

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Case Report: a High-Voltage Victim

ACEP Now

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. 30(11):p S424-S430, November 2002. Lastly, vessels can be damaged by internal burns, which may lead to poor perfusion and delayed complications as thrombosis or third spacing.

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