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

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 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JUNE 25, 2024

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. Total amount over 24 hours.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Therefore, administration of IV morphine (A) would not be recommended. What is the best next step in management? Additionally, pain typically improves with relief of impaction.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

ALiEM

JULY 22, 2023

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

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. Myth busting: Is peripheral administration safe? What are vasoactive drugs?

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Taming the SRU

MAY 11, 2024

Flood syndrome- start fluids, give antibiotics, consult surgery. Be careful with fluid resuscitation in renal transplant patients who can be at risk for volume overload. 3% HTS appears to be safe for peripheral IV administration and does not require a central line. Immunosuppression can blunt the typical immune response.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

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

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 97

EMS Fluid Resuscitation Resuscitation Radiology 97

EMDocs

AUGUST 17, 2023

The median amount of fluids administered between the groups before initiation of NE was not statistically significant (2080 mL vs. 1900 mL). The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4,

Sepsis 93

Sepsis Shock Resuscitation Fluid Resuscitation 93

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. 5 Consider antifungal administration.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment.

Operations 103

Operations Academics Fluid Resuscitation Outcomes 103

The Skeptics' Guide to EM

JUNE 12, 2022

saline, that may be partly driven by kidney injury associated with the administration of high-chloride content IV fluids. Population: Patients 18 years or older, admitted to 53 ANZ ICUs over 38 months, whom the treating clinician deemed to need fluid resuscitation and were expected to be in the ICU on three consecutive days.

Fluid Resuscitation 53

Fluid Resuscitation Resuscitation Outcomes Administration 53

Northwestern EM Blog

MAY 9, 2022

Therefore, fluid resuscitation and maintenance are important. Delayed Administration and Contraindicated Drugs Place Hospitalized Parkinson’s Disease Patients at Risk. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] Profound immobility can precipitate DVT, so anticoagulation may be necessary.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

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. (Conditional recommendation, low-quality evidence).

Resuscitation 104

Resuscitation Fluid Resuscitation Hospitals Research 104

ACEP Now

OCTOBER 3, 2023

Fluid Resuscitation Intravenous fluids should be administered in the prehospital setting to treat hypotension and/or limit hypotension to the shortest duration possible. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting. References Lulla A, et al.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

The Skeptics' Guide to EM

FEBRUARY 17, 2018

There are studies showing that early recognition and prehospital administration of antibiotics are associated with increased survival rates [2-4]. Now we have better evidence with the publication of the first prospective, randomized study investigating the effects of early antibiotic administration in patients with suspected sepsis.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

PHEM Cast

APRIL 10, 2016

The control group received many similar treatments as the ‘intervention’ group (just not full protocolised EGDT) highlighting that with good sepsis care (fluid resuscitation, close monitoring, early appropriate antibiotic administration), mortality can be reduced. Academic Emergency Medicine. 2011 Aug 30;18(9):934–40.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Taming the SRU

APRIL 10, 2023

Patient remained hypotensive after fluid resuscitation and was admitted to the CVICU for management. During his admission, the patient’s blood pressure improved with correction of hypovolemia with crystalloid fluid resuscitation, and his CK and troponin trended downward.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. 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.

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. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55;

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Mind The Bleep

MAY 12, 2023

Administration of human albumin solution (HAS) in SBP reduces the incidence of renal failure by 72% and mortality by 47%. In those who are grossly obese, it may be better to employ a more cautious approach with regard to albumin administration. The number needed to treat to prevent one death is around 5 in SBP. On Day 3 (i.e.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

ACEP Now

FEBRUARY 11, 2024

Regulatory and pharmaceutical availability barriers have even resulted in changing of such medications while in treatment, incomplete usage, and alternative patterns of administration. Management of symptoms is the same for all of these, relying upon fluid resuscitation, antiemetics, and electrolyte repletion.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

PulmCCM

SEPTEMBER 9, 2021

Septic sheep randomized to early, rapid volume resuscitation had greater vasopressor requirements 12 hours after initial fluid bolus. It is suggested that rapid, fluid resuscitation generates an abrupt rise in atrial natriuretic peptide, shears the glycocalyx which then impairs vascular reactivity.

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Don't Forget the Bubbles

JUNE 10, 2024

Initial Management Supportive Care : Initial management involves stabilising the infant, which includes fluid resuscitation, cessation of enteral feeds, and provision of total parenteral nutrition (TPN) to rest the bowel and meet the nutritional needs of the infant. How do you treat necrotising enterocolitis?

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EB Medicine

OCTOBER 1, 2018

And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. Let’s start with fluids. Patient’s need adequate fluid resuscitation. So quite a few changes!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

MARCH 31, 2023

Yates Anaphylaxis Pathophysiology Type 1 Hypersensitivity Reaction IgE-mediated Mast-cell degranulation of vasoactive materials Reaction occurs in minutes Clinical Definition: Acute onset of illness with involvement of the skin, mucosal tissue or both + one of the following Respiratory compromise Reduced BP Or, acute onset of illness with at least (..)

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s. Here is the initial ED ECG: What do you think?

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

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 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

EMDocs

JULY 17, 2023

3,14 There are currently no good studies of enteric or rectal contrast administration in the evaluation of LBO and there are no society recommendations for its use. This also serves as a tool for surgical planning. 2,3,5 A CT scan with IV contrast is reported as 96% sensitive and 93% specific for LBO.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

Intensive Blog

FEBRUARY 9, 2023

The timeframe for administration of charcoal post Amanita phalloides poisoning may be up to 48 hours 9. Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). This should be discussed with a toxicologist.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

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 128

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 128

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. Food and Drug Administration. Food and Drug Administration. This condition is difficult to reverse; supportive measures should be undertaken, with chelation considered. Resources: S. 2022, February 25).

Poisoning 92

Poisoning Fluid Resuscitation Administration Seizures 92

Taming the SRU

AUGUST 25, 2023

Left ventricular assist devices (LVAD’s) mechanically augment left ventricular function some patients retain enough native function to have a palpable pulse -- conventionally measured BP is reliable in these patients hemodynamic stability is best assessed by MAP in patients without a palpable pulse clinical indicators of perfusion (mental status, capillary (..)

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

JANUARY 20, 2025

Since the 2010s multiple trials have explored the feasibility of fluid restrictive resuscitation both on initial resuscitation in the ED, as well as in the intensive care unit (ICU). It may be reasonable to consider IV fluid administration in patients with moderate dehydration or prolonged vomiting. Keijzers, G.,

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

NOVEMBER 18, 2024

Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. It is generally safe for short-term peripheral administration, but central access is preferred for prolonged use to minimise the risk of tissue necrosis.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59