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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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Chemical Burns

Mind The Bleep

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% First aid done pre-hospital. 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.

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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

For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED boarding. [1] Therefore, fluid resuscitation and maintenance are important. Delayed Administration and Contraindicated Drugs Place Hospitalized Parkinson’s Disease Patients at Risk. 12 March 2015. References 1.

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emDOCs Revamp: Esophageal Perforation

EMDocs

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! Am J Emerg Med.

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EM@3AM: Endometritis

EMDocs

A) Administer ceftriaxone 500 mg IM and doxycycline 100 mg PO B) Consult OB/GYN for incision and drainage C) Establish IV access and administer clindamycin and gentamicin D) Prescribe doxycycline with metronidazole and ensure close OB/GYN follow-up Answer: C Most postpartum infections are identified after hospital discharge.

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SGEM#222: Rhythm is Gonna Get You – Into an Atrial Fibrillation Pathway

The Skeptics' Guide to EM

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.