2023 and Fluid Resuscitation - Emergency Care Today

Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

JULY 28, 2023

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!

Fluid Resuscitation

Fluid Resuscitation Pediatrics Resuscitation Research

Adjunctive Methylene Blue in Septic Shock?

RebelEM

MAY 29, 2023

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

Shock Fluid Resuscitation Sepsis Resuscitation

Trauma Resuscitation Updates

RebelEM

MAY 25, 2023

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.

Resuscitation

Resuscitation Fluid Resuscitation Head Injuries Shock

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

EMDocs

FEBRUARY 20, 2024

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.

Fluid Resuscitation

Fluid Resuscitation Resuscitation Outcomes Hospitals

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

NOVEMBER 27, 2023

So, fluid has been tried but has not got close to fixing the problem. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. Treasure Island (FL): StatPearls Publishing; January 30, 2023. Hibberd O, Kanaris C.

Shock

Shock Sepsis Fluid Resuscitation Resuscitation

But Can You Just PO?

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. Fluid Management.

Dehydration

Dehydration Fluid Resuscitation Administration Resuscitation

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

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

Fluid Resuscitation

Fluid Resuscitation Resuscitation Outcomes Hospitals

EM@3AM: Amniotic Fluid Embolism

EMDocs

JUNE 22, 2024

Amniotic fluid embolism: a reappraisal. 2023 Dec 13;52(2):126-135. doi: 10.1515/jpm-2023-0365. “Amniotic fluid embolism.” J Matern Fetal Neonatal Med. 2015 May;28(7):793-8. doi: 10.3109/14767058.2014.932766. Epub 2014 Jun 30. PMID: 24974876. Young BK, Florine Magdelijns P, Chervenak JL, Chan M. J Perinat Med.

EMS

EMS Resuscitation Blood Transfusions Seizures

Anterior OMI. What does the angiogram show?

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

EKG/ECG Fluid Resuscitation Academics Resuscitation

EM@3AM: Stercoral Colitis

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. May 18, 2023) Stercoral Colitis: A Diagnostic Challenge and Therapeutic Approach in an Elderly Patient With Chronic Constipation. 2023 Oct;48(10):3050-3062. Epub 2023 Jun 27.

EMS

EMS Sepsis Shock Fluid Resuscitation

The SQuID Protocol: SQ Insulin in DKA?

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. Acad Emerg Med 2023. Acad Emerg Med 2023. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. Paper: Griffey RT et al.

Operations

Operations Academics Outcomes Fluid Resuscitation

Brain Trauma Guidelines for Emergency Medicine

ACEP Now

OCTOBER 3, 2023

In April 2023, the third edition of the Brain Trauma Foundation’s evidence-based guidelines for the prehospital management of traumatic brain injury (TBI) was published in Prehospital Emergency Care. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting. References Lulla A, et al.

Fluid Resuscitation

Fluid Resuscitation Documentation/Coding Resuscitation EMS

EM@3AM: Retroperitoneal Hematoma

EMDocs

SEPTEMBER 7, 2024

The time taken to measure serum hemoglobin and hematocrit (B) and await a result would delay definitive surgical control of likely ongoing hemorrhage given this patient’s incomplete response to fluid resuscitation. Additionally, hemoglobin results often lag in real-time when compared to the degree of acute hemorrhage.

EMS

EMS Fluid Resuscitation Resuscitation Radiology

EM@3AM: Leukopenia

EMDocs

JANUARY 25, 2025

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. Updated 2023 Aug 23]. Dale DC, Bolyard AA. Curr Opin Hematol. Gedefie, A.,

EMS

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation

Chemical Burns

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. Updated 2023 Jul 17]. Updated 2023 Jul 17]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns

Burns Fluid Resuscitation PPE Resuscitation

Haemolytic Uraemic Syndrome

Don't Forget the Bubbles

MARCH 18, 2024

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. 2021 [cited 2023 Nov 30]. 2019 [cited 2023 Nov 30]. 2023 Aug 23 [cited 2023 Nov 30];151. 2016 Oct 10 [cited 2023 Nov 30];281(2):123–48. 2012 Mar 19 [cited 2023 Nov 30];55(1):33–41. Rch.org.au.

Dehydration

Dehydration Infectious Diseases Seizures Pediatrics

emDOCs Revamp: Esophageal Perforation

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate. Accessed September 30, 2023.

Operations

Operations Radiology Radiology Fluid Resuscitation

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

ACEP Now

FEBRUARY 11, 2024

Management of symptoms is the same for all of these, relying upon fluid resuscitation, antiemetics, and electrolyte repletion. Published December 18, 2023. Published January 2023.Updated Updated May 16, 2023. Published January 2023. Diabetes Care. 2018;41:258–66. CNN website. Accessed January 11, 2024.

Seizures

Seizures Fluid Resuscitation Poisoning EKG/ECG

Pediatric Submersion Injury Tips

ACEP Now

OCTOBER 11, 2024

Fluid resuscitation will likely be warranted, and with crystalloid solution is most appropriate. 2023 Jun 14;49(1):74. Pediatric submersion injuries: emergency care and resuscitation. Oxygen administration, with or without ventilatory support, is the mainstay of treatment. South Med J. 2021;114(5):266-270. Ital J Pediatr.

Pediatrics

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation

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

RebelEM

NOVEMBER 30, 2023

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

Sepsis Fluid Resuscitation Resuscitation Administration

Electrical injuries

Don't Forget the Bubbles

OCTOBER 7, 2024

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.

Burns

Burns Fluid Resuscitation Shock Resuscitation

Sepsis Updates Relevant to the Emergency Physician

EMDocs

DECEMBER 18, 2023

13,14 Fluids Fluid resuscitation is a mainstay of sepsis therapy, as the condition is commonly associated with both absolute and relative hypovolemia. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation. Additionally, the recommendation to use a 30 cc/kg bolus was downgraded.

Sepsis

Sepsis Fluid Resuscitation Resuscitation Shock

EM@3AM: Crush Injury

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min. Accessed February 3, 2023.

EMS

EMS Fluid Resuscitation Fractures Resuscitation

Neonatal Hypotension

Don't Forget the Bubbles

NOVEMBER 18, 2024

Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. “Epidemiology of Hypotension in Neonates,” Journal of Perinatology , 2023. Effective management of MAS will often result in the stabilization of blood pressure. and Roberts, N. Batton, B.,

Sepsis

Sepsis Shock Hyperthermia / Hypothermia Administration

EM@3AM: Takotsubo Cardiomyopathy

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. Updated 2023 Jan 9]. J Med Life.

EMS

EMS Fluid Resuscitation Shock EKG/ECG

Guideline Update: Acute Lower GI Bleeding

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. 2023 Feb 1;118(2):208-231. Am J Gastroenterol.

Resuscitation

Resuscitation Fluid Resuscitation Hospitals Research

Bubble Wrap PLUS – July 2024

Don't Forget the Bubbles

JULY 3, 2024

2023 Oct 16;29(3):171-173. 2024 Jun 26:fetalneonatal-2023-326691. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Kidney function evaluation in children and adolescents with obesity: a not-negligible need. Barlabà A, et al. Eur J Pediatr. 2024 Jun 13.

Pediatrics

Pediatrics Fluid Resuscitation Research Hospitals

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Epub 2023 Nov 27. Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors. 2023 Apr;98(4):620-627.

Pediatrics

Pediatrics EMS Dehydration Hospitals

EM@3AM: ESBL-Producing Organisms and Their Management

EMDocs

OCTOBER 5, 2024

Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV). IV fluid resuscitation as needed. Updated 2023 Nov 12]. Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05

EMS

EMS Infectious Diseases Sepsis Hospitals

Something she ate?

Intensive Blog

FEBRUARY 9, 2023

Available from URL: [link] [Accessed 10 February 2023] Death Cap – Amanita phalloides. link] [Accessed 10 February 2023] Yartsev, A. link] [Accessed 10February 2023] Austin Clinical Toxicology Service. Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). link] Nickson, C.

Poisoning

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation

Case Report: a High-Voltage Victim

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. 2023 Jul 17. Treasure Island (FL): StatPearls Publishing; 2023 Jan– PMID: 28846317. Accessed October 21, 2023. In: StatPearls [Internet]. McGraw Hill; 2016.

Burns

Burns Fluid Resuscitation EKG/ECG EMS

The CLOVERS Trial

Taming the SRU

MAY 5, 2023

Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock." May 5, 2023) The CLOVERS Trial. Front Med (Lausanne) 8 : 628302. Kuttab, H. Lykins, M. Wroblewski, E. Kukoyi, J. Hall and M. Ward (2019). Crit Care Med 47 (11): 1582-1590. Evans and A. Rhodes (2018). TamingtheSRU.

Sepsis

Sepsis Shock Administration Resuscitation

EM@3AM: Hyperthermia

EMDocs

DECEMBER 16, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 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 Medicine , 100 (13), e24053. link] Sánchez-Manso JC, Gujarathi R, Varacallo M. Autonomic Dysfunction. Updated 2022 Oct 24]. In: StatPearls [Internet].

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia EMS Stroke Seizures

Cholera: ED presentation, evaluation, and management

EMDocs

MARCH 11, 2024

Patients who cannot tolerate oral intake of fluids should receive intravenous (IV) fluid resuscitation but are encouraged to start drinking ORS as soon as they are able. Published online August 7, 2023. Published online August 7, 2023. Published online July 25, 2023. 32 Table 3. Cholera vaccines. Int Health.

Dehydration

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation

IV fluids in the ED: When do we really need them?

EMDocs

JANUARY 20, 2025

2023 10 found that clinicians were 56% accurate in their assessments of patients admitted for heart failure when compared to the gold standard of blood volume measurement – a nuclear study utilizing radiolabeled red blood cells and albumin. 2023 Feb 25;14(1):211 Wang CS, FitzGerald MJ, et al. 11 A study by Stephan et al.

Dehydration

Dehydration Fluid Resuscitation Sepsis Resuscitation

Emergency Care Today

Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Adjunctive Methylene Blue in Septic Shock?

Trending Sources

Trauma Resuscitation Updates

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

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

But Can You Just PO?

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

EM@3AM: Amniotic Fluid Embolism

Anterior OMI. What does the angiogram show?

EM@3AM: Stercoral Colitis

The SQuID Protocol: SQ Insulin in DKA?

Brain Trauma Guidelines for Emergency Medicine

EM@3AM: Retroperitoneal Hematoma

EM@3AM: Leukopenia

Chemical Burns

Haemolytic Uraemic Syndrome

emDOCs Revamp: Esophageal Perforation

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

Pediatric Submersion Injury Tips

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

Electrical injuries

Sepsis Updates Relevant to the Emergency Physician

EM@3AM: Crush Injury

Neonatal Hypotension

EM@3AM: Takotsubo Cardiomyopathy

Guideline Update: Acute Lower GI Bleeding

Bubble Wrap PLUS – July 2024

emDOCs Revamp – Acute Chest Syndrome

EM@3AM: ESBL-Producing Organisms and Their Management

Something she ate?

Case Report: a High-Voltage Victim

The CLOVERS Trial

EM@3AM: Hyperthermia

Cholera: ED presentation, evaluation, and management

IV fluids in the ED: When do we really need them?

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