Remove 2012 Remove Fluid Resuscitation Remove Shock
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ToxCard: Iron

EMDocs

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. Published 2012 Jul 1.

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Trauma Resuscitation Updates

RebelEM

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]

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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

RebelEM

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. Simply put, a difference greater than or equal to 12% between the largest and smallest pulse pressure can predict fluid responsiveness. Oct 2012; PMID: 23043910 Kumar A, et al. Castro R, et al.

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EM@3AM: Stercoral Colitis

EMDocs

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. 2012 May-Jun;13(3):283-289.

EMS 94
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52 in 52 – #41: The CENSER Trial

EMDocs

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

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EM@3AM: Retroperitoneal Hematoma

EMDocs

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 2012 Aug;43(2):e157-61. For blunt injury to zone III, an alternative method for hemorrhage control should be pursued (e.g., angioembolization). J Emerg Med.

EMS 93
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Episode 7: Sepsis

PHEM Cast

The control group received many similar treatments as the ‘intervention’ group (just not full protocolised EGDT) highlighting that with good sepsis care (fluid resuscitation, close monitoring, early appropriate antibiotic administration), mortality can be reduced. 2012 Jan;30(1):51–6. 2012 Dec 15;186(12):1264–71.

Sepsis 52