Remove 2015 Remove Fluid Resuscitation Remove Shock
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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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Chemical Burns

Mind The Bleep

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. 2015 Jun;11(2):227-31. J Toxicol Clin Toxicol.

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Review of the ATHOS 3 trial

Northwestern EM Blog

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. 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.

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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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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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emDOCs Revamp – Acute Chest Syndrome

EMDocs

2015 May;169(4):492-505. Epub 2015 Mar 30. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 Br J Haematol.

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. If you can use Doppler, then you can diagnose it.

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