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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%

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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. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. 95% CI 15.4

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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. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. 2002 Dec;141(6):793-7. The mortality rate for cerebral edema is 21%–24%.

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The Science on Targeted Temperature Management

ACEP Now

Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Finally, the guidelines support active temperature management’s (though not necessarily hypothermia) role in improving post-arrest outcomes. degrees Celsius for 72 hours.

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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Causes and outcomes of the acute chest syndrome in sickle cell disease. Clinical Guide for the Management of Sickle Cell Disease, 2002. Published January 2002. times maintenance. Can decrease rate when they are tolerating PO.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Causes and outcomes of the acute chest syndrome in sickle cell disease. 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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The Latest in Critical Care, 1/22/24 (Issue #26)

PulmCCM

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.