RebelEM

MAY 25, 2023

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%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Pediatric EM Morsels

JULY 28, 2023

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%.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

EMDocs

JULY 30, 2024

Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion. Elsevier; 2010:2153-2217. Niacin has been used but has a lower bioavailability than nicotinamide and can cause hypotension when given. Orthostatic hypotension can persist for months after ingestion.

Poisoning 56

Poisoning Seizures Fluid Resuscitation Pediatrics 56

PHEM Cast

APRIL 10, 2016

It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required… The Rivers’ paper can be accessed here: [link] It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT).

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Mind The Bleep

MAY 12, 2023

9 There is no role for Tranexamic acid in upper GI bleeding and its use is harmful to patients 11 Escalate to a senior early for consideration of a higher level of care Refer for early endoscopy after resuscitation with haemodynamic stability. 2010 Feb;12(1):1-6. On Day 3 (i.e. 48 hours later) albumin is administered at 1g/kg.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

Northwestern EM Blog

FEBRUARY 14, 2022

Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. Expert Review of Cardiovascular Therapy 2010; 8(12): 1723-9 PMID: 21108554 Santacruz CA, Pereira AJ, Celis E, Vincent JL. NEJM 2008; 358(9): 877 – 87.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Taming the SRU

MARCH 31, 2023

Yates Anaphylaxis Pathophysiology Type 1 Hypersensitivity Reaction IgE-mediated Mast-cell degranulation of vasoactive materials Reaction occurs in minutes Clinical Definition: Acute onset of illness with involvement of the skin, mucosal tissue or both + one of the following Respiratory compromise Reduced BP Or, acute onset of illness with at least (..)

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40