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Grand Rounds Recap 3.29.23

Taming the SRU

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9% Do not prepare a sterile field (but be as clean as possible). Do not transport to an alternative location.

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The CLOVERS Trial

Taming the SRU

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock." N Engl J Med. 2023;388(6):499-510.

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EM@3AM: Crush Injury

EMDocs

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min. Published June 2009. Critical Care.

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EM@3AM: Hyperthermia

EMDocs

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. The American Journal of Emergency Medicine.,

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Sepsis Updates Relevant to the Emergency Physician

EMDocs

13,14 Fluids Fluid resuscitation is a mainstay of sepsis therapy, as the condition is commonly associated with both absolute and relative hypovolemia. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation. The patient currently resides at a skilled nursing facility.

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EM@3AM: Takotsubo Cardiomyopathy

EMDocs

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. Additional fluids will not improve her condition and may worsen it. Vital signs show T of 99.0°F Am Heart J. Am Heart J.

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