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Trauma Resuscitation Updates

RebelEM

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al. NEJM 1994. [2] NEJM 1994. [2]

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EM@3AM: Amniotic Fluid Embolism

EMDocs

Amniotic fluid embolism: antepartum, intrapartum and demographic factors. 2015 May;28(7):793-8. Amniotic fluid embolism: a reappraisal. ” Am J Obstet Gynecol 201(5): 445 e441-413. link] Fong A, Chau CT, Pan D, Ogunyemi DA. J Matern Fetal Neonatal Med. doi: 10.3109/14767058.2014.932766. Epub 2014 Jun 30. PMID: 24974876.

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Neuroleptic Malignant Syndrome

Northwestern EM Blog

Therefore, fluid resuscitation and maintenance are important. 12 March 2015. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] 2] Rigidity will lead to rhabdomyolysis with subsequent hyperkalemia and myoglobin-induced renal failure. References 1. Institute for Safe Medication Practices.

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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. 2015 Aug 26;:1–31. 2015 Oct 17;:1–16. 2015 Apr 24;:1–10.

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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. 2015 Jun;11(2):227-31. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. J Toxicol Clin Toxicol.

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emDOCs Revamp: Esophageal Perforation

EMDocs

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate. McGraw-Hill Education; 2015.

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ToxCard: Organic Mercury Poisoning

EMDocs

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. 2015, March 26). In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC. Winship KA.