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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. Low morbidity and mortality in children with diabetic ketoacidosis treated with isotonic fluids. 2010 Dec;1(2):103-20. The mortality rate for cerebral edema is 21%–24%.

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Trauma Resuscitation Updates

RebelEM

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2] NEJM 1994. [2]

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EM@3AM: Leukopenia

EMDocs

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. An update on the diagnosis and treatment of chronic idiopathic neutropenia.

EMS 80
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Episode 7: Sepsis

PHEM Cast

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. 2010 Apr;38(4):1045–53. 2014 Oct 28;:1–9.

Sepsis 52
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Review of the ATHOS 3 trial

Northwestern EM Blog

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52
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EM@3AM: Hyperthermia

EMDocs

Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke. Temps greater than 41.5C BMC research notes , 8 , 758. link] Swee, duS., L., & Lim, A.

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

EMDocs

One of the hallmarks of sepsis care, based on the Rivers 2001 17 trial and still recommended by the latest SCCM guidelines is early detection of sepsis and initiation of early resuscitation. link] During the 2017 IV fluid shortage, Patino et al. Inwald et al. Choudhari et al.