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Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

RebelEM

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.

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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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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Hypervolemia – leads to pulmonary edema: Consider diuresis If euvolemic – start maintenance fluids of D5 in 0.45%NS times maintenance. Can decrease rate when they are tolerating PO. Everyone needs atypical coverage.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS Blood transfusion Reduces the overall proportion of HbS. Decreases splinting and improves tidal volumes. times maintenance. Improves oxygen carrying capacity.

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

Don't Forget the Bubbles

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. The wide pulse pressure and transient response would suggest an afterload problem.

Shock 143
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EM@3AM: Amniotic Fluid Embolism

EMDocs

Answer : Amniotic fluid embolism Epidemiology: Incidence of 1:15,200 to 1:53,400 1 7% occur during labor Causes approximately 14% of all maternal peripartum death in United States Current fatality rate 13-60% 1-4 Risk factors: Advanced maternal age, amniocentesis, cesarean delivery, eclampsia, medical induction of labor, placental pathology, diabetes, (..)

EMS 96
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ToxCard: Iron

EMDocs

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Blood transfusion for clinically significant blood loss. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Basic assessment: airway, breathing, circulation.