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

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

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. Academic Emergency Medicine. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

EMDocs

DECEMBER 6, 2024

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. 7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Antiemetics as needed.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

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. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

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.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2] NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation.

Sepsis 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

Don't Forget the Bubbles

MARCH 31, 2025

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. Lack of fluid monitoring throughout the PICU stay led to underreporting of MODS resulting from late-onset FO. Whats it about?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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

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

ACEP Now

OCTOBER 11, 2024

1,2 Clinical outcomes in submersion injuries are largely dependent on the degree of hypoxic injury experienced by the victim, making prehospital care of paramount importance. Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. Acad Pediatr.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

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. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. This also serves as a tool for surgical planning. World J Gastroenterol.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

Don't Forget the Bubbles

JUNE 10, 2024

Despite advancements in neonatal care, NEC remains a significant concern due to its association with adverse outcomes, including prolonged hospitalisation, the need for surgical intervention, and increased mortality rates. What is the pathophysiology of necrotising enterocolitis? How do you treat necrotising enterocolitis? Can we prevent NEC?

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

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. more than 2].

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis 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

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

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. and Roberts, N.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

JANUARY 20, 2025

One of the hallmarks of sepsis care, based on the Rivers 2001 17 trial and still recommended by the latest SCCM guidelines is early detection of sepsis and initiation of early resuscitation. link] During the 2017 IV fluid shortage, Patino et al. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75