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Review of the ATHOS 3 trial

Northwestern EM Blog

Interestingly, when vasopressin was studied in 2008, it similarly did not show a mortality benefit when added to norepinephrine infusion in septic shock2. This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation.

Shock 52
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Haemolytic Uraemic Syndrome

Don't Forget the Bubbles

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. 4-year-old Stephanie presents with vomiting, diarrhoea, and lethargy. She appears pale and dehydrated , and her level of alertness fluctuates. She is apyrexial, tachycardic and normotensive. What causes haematuria in children? Andreoli SP.

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Necrotising Enterocolitis

Don't Forget the Bubbles

Initial Management Supportive Care : Initial management involves stabilising the infant, which includes fluid resuscitation, cessation of enteral feeds, and provision of total parenteral nutrition (TPN) to rest the bowel and meet the nutritional needs of the infant. How do you treat necrotising enterocolitis? Pediatrics, 133(1), 1-12.

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EM@3AM: Takotsubo Cardiomyopathy

EMDocs

This patient’s recent diarrheal illness raises suspicion for hypovolemia, which would be treated with fluid resuscitation (D) , but her moist oral mucosa and dilated inferior vena cava suggest an eu- or hypervolemic state. Additional fluids will not improve her condition and may worsen it. 2008 Mar;155(3):408-17.

EMS 102
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ToxCard: Organic Mercury Poisoning

EMDocs

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. doi: 10.1186/2008-2231-22-46. In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC.

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IV fluids in the ED: When do we really need them?

EMDocs

For patients without frank signs of shock, it is reasonable to trial oral hydration prior to moving on to IV fluids. 2008 Sep;1(3):170-7. The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study. Fluid resuscitation in sepsis: the great 30 mL per kg hoax. Circ Heart Fail.

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Cholera: ED presentation, evaluation, and management

EMDocs

Patients who cannot tolerate oral intake of fluids should receive intravenous (IV) fluid resuscitation but are encouraged to start drinking ORS as soon as they are able. Risk Factors for Severe Cholera among Children under Five in Rural and Urban Bangladesh, 2000–2008: A Hospital-Based Surveillance Study. 2023;8(3):169.