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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

RebelEM

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). CRITICAL CARE: HARD TIMES – RESUSCITATING MY PATIENT: FLUID, BLOOD AND OTHER STRATEGIES.

Sepsis 122
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emDOCs Videocast: EBM Update – Fluids in Pancreatitis and Hypertriglyceridemic Pancreatitis

EMDocs

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5 2.18) Fluid Overload: 20.5% 2023 Mar 22;27(1):122. N Engl J Med.

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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. Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 Lesson = treat early!

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Crit Care 2023. Crit Care 2023. septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. 95% CI 15.4

Shock 145
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emDOCs Videocast: EBM Update – Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis

EMDocs

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. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5 2.18) Fluid Overload: 20.5%

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Trauma Resuscitation Updates

RebelEM

In the initial management of trauma patients there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from the resuscitation itself Promote hemostasis References: Dutton RP et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality.

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Electrical injuries

Don't Forget the Bubbles

Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. Philadelphia, PA: Elsevier; 2023:chap 130. Volume resuscitation in patients with high-voltage electrical injuries. Resuscitation. Chen P, Bukhman AK. Electrical and lightning injuries.

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