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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. 2009 Apr;10(2):155-7. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. The mortality rate for cerebral edema is 21%–24%.

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The 90th Bubble wrap DFTB X The Bridge

Don't Forget the Bubbles

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. Whats it about?

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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

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Awake, and Paralysed: A Never Event

Don't Forget the Bubbles

Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. Rocuronium ( a muscle relaxant ) alone was administered as he became combative.

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Hypothermic Cardiac Arrest: Pearls and Pitfalls

EMDocs

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

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Chemical Burns

Mind The Bleep

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. Sagoschen, I. 2020.0056.

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Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Dr. Smith's ECG Blog

Because the patient had asystole, was resuscitated without difficulty, and had no neurologic function, suspected a cerebral hemorrhage was suspected as the etiology of the arrest, specifically subarachnoid hemorrhage. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. Sprenkle M.