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Trauma Resuscitation Updates

RebelEM

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]

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

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.

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EM@3AM: Murine Typhus

EMDocs

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.

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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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SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock

The Skeptics' Guide to EM

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.

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Tasty Morsels of Critical Care 082 | Carbon Monoxide Poisoning

Emergency Medicine Ireland

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).

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EM@3AM: Stercoral Colitis

EMDocs

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.

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