Remove 2022 Remove Fluid Resuscitation Remove Shock
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Adjunctive Methylene Blue in Septic Shock?

RebelEM

septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. Crit Care 2023.

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Trauma Resuscitation Updates

RebelEM

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]

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But Can You Just PO?

Taming the SRU

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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Diabetic Ketoacidosis in Paediatrics

Mind The Bleep

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. NaCl fluid bolus over 15 minutes. We do not subtract the bolus as the child was shocked.

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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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EM@3AM: Stercoral Colitis

EMDocs

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. EMRA Antibiotic Guide.

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Chemical Burns

Mind The Bleep

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4.

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