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Sepsis Screening Decreases Mortality. Well, not really.

Sensible Medicine

The only problem was that the patient population would change over the course of the study – the unscreened population was studied mostly in 2019 and early 2020 while the screened population was mostly late 2020 early 2021. Thus, the results would have to be adjusted. These alerts only were reported in the screening group).

Sepsis 98
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EM@3AM: Leukopenia

EMDocs

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. BioMed Research International, 2020, 1-10. Disposition is based on overall clinical presentation, inciting etiology, and consultant evaluation. Journal of Blood Medicine, Volume 13, 243-253.

EMS 96
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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

RebelEM

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). CRITICAL CARE: HARD TIMES – RESUSCITATING MY PATIENT: FLUID, BLOOD AND OTHER STRATEGIES.

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Trauma Resuscitation Updates

RebelEM

Intensive Care Med 2020. [13] In the initial management of trauma patients there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from the resuscitation itself Promote hemostasis References: Dutton RP et al. Intensive Care Med 2020. 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% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Acute Crit Care. 2019 Nov;34(4):276-281. doi: 10.4266/acc.2019.00647.

Burns 52
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EM@3AM: Retroperitoneal Hematoma

EMDocs

The time taken to measure serum hemoglobin and hematocrit (B) and await a result would delay definitive surgical control of likely ongoing hemorrhage given this patient’s incomplete response to fluid resuscitation. 2020 May;13(5):545-555. Epub 2020 Mar 3. 2020 Jun;13(6):i. Expert Rev Hematol. PMID: 32089021.

EMS 98
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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Hypervolemia – leads to pulmonary edema: Consider diuresis If euvolemic – start maintenance fluids of D5 in 0.45%NS American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support.