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I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]
septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. Crit Care 2023.
Murine Typhus—United States, 2002. Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. California Department of Public Health. Flea-Borne Typhus: Epidemiology Summary 2013-2019. Accessed August 19, 2024.
2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. ISSN 2002-4436.
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.
Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. NEJM January 2018. NEJM January 2018.
Patients are going to be pretty sick often from multiple pathologies but COHb on its own is enough to produce severe neurological injury, shock and even cardiac injury is also quite prevalent. Resuscitate and investigate as you would any sick patient. The New England journal of medicine 347 , 1057–1067 (2002).
Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. degrees Celsius.
Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. 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.
The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?
The patient was in shock on arrival in the ED — and multiple blood transfusions were needed. Consider that the patient in this case was promptly resuscitated in the ED. The mechanism for these ECG changes of hyperkalemia is interesting ( Webster et al: Emerg Med J 19:74-77, 2002 ). WHAT is the rhythm in this tracing?
He is in compensated shock. The Huber needle is not a resuscitative line. Vascular Devices: assume the line is not functional, and use another to resuscitate, especially in port-a-caths. Pediatr Surg Int (2002) 18: 50-53 DiBaise JK, Scolapio JS. Obtain proper access to give fluids -- do not rely on the port-a-cath.
Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2002; 12:411-413. 2002; 78:27-30.
Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.
2002, Mar). Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Disability- treat hypoglycaemia if present. Supportive care and monitoring Prioritise short-acting agents, avoid medications that accumulate in hepatic failure Usually ICU measures (e.g. Mycotoxins revisited: Part I.
Neonatal pain pathways are particularly plastic; prompt assessment of and increased alertness to neonatal pain may help to mitigate long-lived pain sensitivity and hyperalgesia ( Taddio 2002 ). For many medications, these children will have a greater weight-normalized clearance than adults ( Berde 2002 ). 2002 Oct 3;347(14):1094-103.
Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Andrews et al.
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