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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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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 Mar;68(3):240-3; discussion 243-4.

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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. 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 Lesson = treat early!

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EM@3AM: Murine Typhus

EMDocs

Murine Typhus—United States, 2002. California Department of Public Health. Flea-Borne Typhus: Epidemiology Summary 2013-2019. Accessed August 19, 2024. Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2003;52(50):1209-1211. Accessed August 19, 2024. Peniche Lara G, Dzul-Rosado KR, Zavala Velázquez JE, Zavala-Castro J.

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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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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. Recent Clinical Evidence on Post-Arrest TTM The accumulated post-arrest care literature makes clear that careful fever avoidance following resuscitation is essential. Circulation.

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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

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