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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.

Shock 145
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But Can You Just PO?

Taming the SRU

This article serves to briefly discuss IV fluids administration in the ED and the instances where they are not indicated. Other conditions that lead to intravascular fluid depletion include but are not limited to starvation/dehydration, vomiting, diarrhea, burns/trauma, hyperglycemia, and hemorrhage.

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover the evaluation and management of the patient with a burn injury. Episode 103: Thermal Burn Injury Initial evaluation of thermal burns Range of burn severities and types: minor sunburns to full thickness burns and severe inhalation injury.

Burns 92
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Another Study on Peripheral Vasopressors

RebelEM

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Peripheral Administration of Norepinephrine: A Prospective Observational Study. CHEST 2024.

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ACMT Toxicology Visual Pearl: Salt, not Shock

ALiEM

Here is the patient’s EKG after administration of a 300 mEq sodium bicarbonate showing significant improvement of the cardiac sodium channel blockade as evidenced by a narrower QRS complex. Bruccoleri RE, Burns MM. What are other agents that block cardiac socium channels? Acute Card Care. 2013 Dec;15(4):90-2. Epub 2013 Nov 7.

Shock 73
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Grand Rounds Recap 1.31.24

Taming the SRU

For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

PPE 98
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52 in 52 – #41: The CENSER Trial

EMDocs

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 86