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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

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. 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.

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EM@3AM: Stercoral Colitis

EMDocs

Well keep it short, while you keep that EM brain sharp. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. ISSN 2002-4436. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days.

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Proning for ARDS

Northwestern EM Blog

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Hemodynamic instability and ongoing cardiac arrhythmias are a strong contraindication as chest access for cardiopulmonary resuscitation is limited (Koulouras et.

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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?

EMDocs

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. 2002 May;33(5):1315-20. This includes intraparenchymal hemorrhage and subarachnoid hemorrhage (SAH). Stroke 2019; 50:e344.

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

The Skeptics' Guide to EM

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. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. NEJM January 2018.

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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.