Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none. 2022 Sep 11;5(5):e827.

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Dehydration Fluid Resuscitation Administration Resuscitation 82

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. 2022 Sep 15;387(11):989-1000. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5

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Fluid Resuscitation Resuscitation Outcomes Hospitals 66

RebelEM

SEPTEMBER 29, 2022

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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Administration Fluid Resuscitation Resuscitation Outcomes 52

Mind The Bleep

DECEMBER 19, 2023

It is also vital to do a fluid balance assessment. Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. This is done with an initial bolus of 10ml/kg 0.9%

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Dehydration Fluid Resuscitation Shock Resuscitation 98

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Clinical Question: Is the 90-day mortality in critically ill adult patients lower with the use of Plasma-Lyte 148, a balanced crystalloid solution, for fluid resuscitation and therapy, than with the use of normal saline?

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Fluid Resuscitation Resuscitation Outcomes Administration 52

EMDocs

MAY 15, 2024

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 2022 Aug;58:235-244. Epub 2022 Jun 11. times maintenance. Am J Emerg Med. PMID: 35717760.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

Northwestern EM Blog

MAY 9, 2022

Therefore, fluid resuscitation and maintenance are important. Accessed February 11, 2022. Accessed February 11, 2022. 2022, May 9). Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] Profound immobility can precipitate DVT, so anticoagulation may be necessary. 12 March 2015.

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Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS 2022 Aug;58:235-244. Epub 2022 Jun 11. Decreases splinting and improves tidal volumes. Bronchodilators Indicated for patients with wheezing, history of asthma.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 76

Dr. Smith's ECG Blog

AUGUST 2, 2024

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 ).

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EKG/ECG Fluid Resuscitation Academics Resuscitation 105

ACEP Now

OCTOBER 3, 2023

Fluid Resuscitation Intravenous fluids should be administered in the prehospital setting to treat hypotension and/or limit hypotension to the shortest duration possible. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting. Accessed 2022, [link]. J Safety Res.

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Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Mind The Bleep

OCTOBER 29, 2024

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. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

JANUARY 20, 2025

For patients without frank signs of shock, it is reasonable to trial oral hydration prior to moving on to IV fluids. Crit Care 26, 19 (2022) Liu VX, Fielding-Singh V, et al. Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial.

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Dehydration Fluid Resuscitation Sepsis Resuscitation 40

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. C or 100.4 mg/kg, max 0.4

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Pediatrics Dehydration EMS Hospitals 76

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. The two highest predictors of increased mortality in the literature include a large area of colonic involvement >40cm and perforation (32-60% mortality rate). EMRA Antibiotic Guide.

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EMS Sepsis Shock Fluid Resuscitation 72

EMDocs

NOVEMBER 20, 2023

Hemodynamic resuscitation Key Concept: Patients with hemodynamic instability and/or suspected ongoing bleeding should receive intravenous fluid resuscitation with the goal of optimization of blood pressure and heart rate before endoscopic evaluation/intervention. Epub 2022 Sep 21. Am J Gastroenterol. doi: 10.14309/ajg.0000000000002130.

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Resuscitation Fluid Resuscitation Hospitals Research 80

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. 2022, February 25). link] Accessed 21 November 2022 The post ToxCard: Organic Mercury Poisoning appeared first on emDOCs.net - Emergency Medicine Education. Whole blood mercury concentrations should be measured.

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Poisoning Fluid Resuscitation Administration Seizures 66

ACEP Now

OCTOBER 9, 2024

However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. Published 2022. Given his history, it could have been easy to attribute his current presentation to his known mental health conditions.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. Effective management of MAS will often result in the stabilization of blood pressure. Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia. Batton, B., Li, L., & Newman, N. Kleinman, M.

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Sepsis Shock Hyperthermia / Hypothermia Administration 59

ACEP Now

OCTOBER 11, 2024

Fluid resuscitation will likely be warranted, and with crystalloid solution is most appropriate. Buckets associated home drowning in Indian infants and toddlers: an analysis of 18 fatalities from 2016-2022. Oxygen administration, with or without ventilatory support, is the mainstay of treatment. 2022;17(11):e0276374.

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Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

ACEP Now

MARCH 14, 2024

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Lastly, vessels can be damaged by internal burns, which may lead to poor perfusion and delayed complications as thrombosis or third spacing. Am J Emerg Med. 2008;26(4):413-418.

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Burns Fluid Resuscitation EKG/ECG EMS 52

Taming the SRU

MAY 5, 2023

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. In 2022, the CLASSIC trial was published which provided one investigational angle to this important question.

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Sepsis Shock Administration Resuscitation 52

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9%

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Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Northwestern EM Blog

FEBRUARY 14, 2022

This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation. 2022, Feb 14). Successful Treatment of Antihypertensive Overdose Using Intravenous Angiotensin II. J Emerg Med. 2019;57(3):339-344. doi:10.1016/j.jemermed.2019.05.027

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Shock Resuscitation Fluid Resuscitation Sepsis 52

ACEP Now

FEBRUARY 11, 2024

Management of symptoms is the same for all of these, relying upon fluid resuscitation, antiemetics, and electrolyte repletion. Updated December 11, 2022. Bansal AB, Al Khalili Y. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Available from: [link]. Published January 2023. 2006;47(12):2207.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. Bradycardia, SOB, in a Dialysis Patient == MY Comment by K EN G RAUER, MD ( 5/5/2022 ): == If I was allowed to ask 2 Questions , with use of a single ECG to assess the ECG interpretation astuteness of emergency providers — I would select the initial ECG in today's case ( Figure-1 ).

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EKG/ECG Fluid Resuscitation EMS Shock 52

EMDocs

DECEMBER 18, 2023

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. 13,14 Fluids Fluid resuscitation is a mainstay of sepsis therapy, as the condition is commonly associated with both absolute and relative hypovolemia.

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Sepsis Fluid Resuscitation Resuscitation Shock 65

Mind The Bleep

FEBRUARY 27, 2024

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. .

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Fluid Resuscitation Hospitals Dehydration Research 96

EMDocs

JANUARY 20, 2024

This patient’s recent diarrheal illness raises suspicion for hypovolemia, which would be treated with fluid resuscitation (D) , but her moist oral mucosa and dilated inferior vena cava suggest an eu- or hypervolemic state. Additional fluids will not improve her condition and may worsen it. 2022 May 17;145(20):e1053].

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EMS Fluid Resuscitation Shock EKG/ECG 74

EMDocs

MARCH 11, 2024

2 As of 2022 cholera was estimated to be responsible for over 4 million cases and 143,000 deaths each year, with a case fatality rate of 50% without timely and appropriate treatment. Published online November 14, 2022. Published online June 1, 2022. Published online November 14, 2022. Published online November 14, 2022.

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Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 90

Don't Forget the Bubbles

JULY 3, 2024

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Current practice in the care of children with functional constipation: What is the hold up? van der Zande JMJ, et al.

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Pediatrics Fluid Resuscitation Research Hospitals 105

Intensive Blog

FEBRUARY 9, 2023

Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Gastroenterology, 97 (2), 439-445. link] Nickson, C. Mushroom toxicity. Available from URL: [link] [Accessed 10 February 2023] Death Cap – Amanita phalloides. Royal Botanical Gardens Victoria. link] Berger, K. J., & Guss, D.

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Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

DECEMBER 16, 2023

Updated 2022 Oct 24]. Temps greater than 41.5C per minute) 1,4 Body bag may be utilized if no immersion tank available 3 Evaporative cooling (DT 0.1C Neurogenic fever due to injury of the hypothalamus in a stroke patient: Case report. Medicine , 100 (13), e24053. link] Sánchez-Manso JC, Gujarathi R, Varacallo M. Autonomic Dysfunction.

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Hyperthermia / Hypothermia EMS Stroke Seizures 68