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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

So, fluid has been tried but has not got close to fixing the problem. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. Published 2021 Apr 16. What are vasoactive drugs? Ed makes a full recovery.

Shock 143
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The CLOVERS Trial

Taming the SRU

2021, Jarczak, Kluge et al. Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2021, Im, Kang et al. N Engl J Med. 2023;388(6):499-510. 2019, Bauer, Gerlach et al.

Sepsis 52
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emDOCs Revamp – Acute Chest Syndrome

EMDocs

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors. 2021 Sep;194(5):899-907. Epub 2021 Jul 15.

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Best Practices for Upper Gastrointestinal Hemorrhage

ACEP Now

Fluid resuscitation should be initiated. There are few data on the outcomes of UGIB when balloon tamponade is used as a temporizing measure. Outcomes in variceal hemorrhage following the use of a balloon tamponade device. Sleep well, endoscopist: January 2021 Annals of Emergency Medicine journal club.

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Large bowel obstruction: ED presentation, evaluation, and management

EMDocs

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. Published 2021 Apr 22. Cancers (Basel ).

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Paediatric IV Fluid Prescribing

Mind The Bleep

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. Boluses were given in 20-40ml/kg aliquots.

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Trauma Resuscitation Updates

RebelEM

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2] NEJM 1994. [2]