Remove 2019 Remove Fluid Resuscitation Remove Wellness
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Sepsis Screening Decreases Mortality. Well, not really.

Sensible Medicine

If there is one thing a medicine resident or hospitalist should be able to do well is identify the patients who are sick and need attention. I’ve predicted that any screening tool would be more sensitive but less specific than a well-trained doctor. .” So said my program director during my internship.

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ToxCard: Iron

EMDocs

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. McGraw Hill; 2019. Basic assessment: airway, breathing, circulation. Antiemetics as needed. 2 L/hr in adults. Tenenbein M.

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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. NEJM 1994. [2] NEJM 1994. [2] PMID: 12045644 Bickell WH et al.

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Chemical Burns

Mind The Bleep

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% 2019 Nov;34(4):276-281. Epub 2019 Nov 29. J Med Toxicol. Murari A, Singh KN.

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion.

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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

RebelEM

Well, the established cutoff for the distensibility index is 18%. A cutoff of 18% has a positive predictive value (PPV) of 92% and NPV of 90% for fluid responsiveness. Jan 2019; PMID: 30138573. Why does it matter? Sep 2010; PMID: 20502865 Teboul JL, et al. Arterial Pulse Pressure Variation with Mechanical Ventilation.

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Anterior OMI. What does the angiogram show?

Dr. Smith's ECG Blog

The LCx and OM branches are not as well seen. Yet recognition of acute RV MI is extremely important clinically — because emergency treatment will often require different priorities (ie, avoidance of nitroglycerine; fluid resuscitation for hypotension ). This shot is typically best for viewing the LAD and its diagonal branches.

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