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EM@3AM: Leukopenia

EMDocs

Well keep it short, while you keep that EM brain sharp. Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. Philadelphia, PA: Elsevier; 2022:1-11. 101,33 (2022): e30116. Updated 2022 Nov 14]. Curr Opin Hematol. 2017;24(1):46-53.

EMS 95
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EM@3AM: Stercoral Colitis

EMDocs

Well keep it short, while you keep that EM brain sharp. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Stercoral Colitis.

EMS 98
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First10EM Journal Club: October 2022

Broome Docs

2022 Jan;48(1):78-91. PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. 2022 Sep;21(9):781-791. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. 2022 Sep 18.

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SGEM#382: Don’t Go Chasing Waterfalls to Treat Pancreatitis

The Skeptics' Guide to EM

Date: November 10th, 2022 Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Date: November 10th, 2022 Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R.

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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

RebelEM

There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

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SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study

The Skeptics' Guide to EM

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Case: A 62-year-old man is brought in by EMS from home with lethargy and hypotension. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. 2022; 23( 7): 835- 856. Lesson = treat early!