Don't Forget the Bubbles

MARCH 31, 2025

Lack of fluid monitoring throughout the PICU stay led to underreporting of MODS resulting from late-onset FO. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. Prolonged fluid overload may still contribute to organ dysfunction over time. Why does it matter?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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

Fluid Resuscitation 93

Fluid Resuscitation Resuscitation Outcomes Hospitals 93

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 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.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

The Skeptics' Guide to EM

NOVEMBER 12, 2022

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.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. 2022 Sep 15;387(11):989-1000. 2022 Sep 18. 2022 Aug;41(4):101096.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 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.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

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.

Administration 52

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%

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

EMDocs

NOVEMBER 20, 2023

Initial patient assessment and hemodynamic resuscitation should be performed simultaneously. DOAC reversal Recommendation: For patients on DOACs, we suggest reversal for the small subset of patients who present with a life-threatening LGIB that does not respond to initial resuscitation and cessation of the anticoagulant alone.

Resuscitation 104

Resuscitation Fluid Resuscitation Hospitals Research 104

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. You wonder which IV fluid should you order? Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. Blood pressure is 85/50 mmHg.

Fluid Resuscitation 53

Fluid Resuscitation Resuscitation Outcomes Administration 53

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting. Accessed 2022, [link].

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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 ).

EKG/ECG 119

EKG/ECG Fluid Resuscitation Academics Resuscitation 119

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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

ACEP Now

OCTOBER 11, 2024

3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. Fluid resuscitation will likely be warranted, and with crystalloid solution is most appropriate. Pediatric submersion injuries: emergency care and resuscitation.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. 2022, Feb 14). Two classes of vasopressors have been used in the past for hypotension. They are catecholamines and vasopressin-like peptides.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

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. .

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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%

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

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 Burns 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.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 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 ).

EKG/ECG 52

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.

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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].

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

Intensive Blog

FEBRUARY 9, 2023

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. 2005, 2005/01/01/). Mycotoxins revisited: Part I. The Journal of Emergency Medicine, 28 (1), 53-62.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

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

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

RebelEM

DECEMBER 23, 2024

VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ). saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). Lactated Ringer (LR) and 0.9% JAMA Intern Med.

Fluid Resuscitation 129

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 129

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.

Poisoning 92

Poisoning Fluid Resuscitation Administration Seizures 92

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. In lower-resource settings, the evidence is stronger against a liberal approach to volume resuscitation. Andrews et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Taming the SRU

MARCH 3, 2025

Because inhalational injuries often co-occur with large cutaneous burns, aggressive fluid resuscitation can rapidly worsen upper airway edema making airway management especially challenging. Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Published 2022. Published 2022.

Burns 52

Burns Fluid Resuscitation Emergency Department Resuscitation 52

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.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

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.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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. Rehydration therapy for patients with cholera should include volume resuscitation and electrolyte repletion. Published online November 14, 2022.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111