Taming the SRU

APRIL 10, 2023

UDS : positive for amphetamines, benzodiazepines, fentanyl, THC EKG : Normal sinus rhythm, incomplete right bundle branch block, normal axis, normal intervals. He was given an intravenous fluid bolus with minimal improvement in his blood pressure, but remained alert. Diagnostics WBC : 8.6 Plt : 190 Na : 136 K : 4.4 TSH : 18.04

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.)

Operations 92

Operations Radiology Radiology Fluid Resuscitation 92

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. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Mind The Bleep

DECEMBER 31, 2023

For IV fluid requirements, be gentle and cautious, especially in dialysis patients. Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. or the patient is symptomatic or shows signs of hypokalaemia (ECG changes, weakness, arrhythmias).

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

ACEP Now

FEBRUARY 11, 2024

This patient’s syncope is most likely due to metabolic disruptions and fluid-status physiology; nevertheless, assessment of cardiogenic etiologies through an EKG, troponin, and cardiac risk factors should be considered as appropriate.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. 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 Overestimates arterial oxygen saturation.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients. times maintenance.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

EMDocs

JUNE 22, 2024

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 111

EMS Resuscitation Blood Transfusions Seizures 111

ACEP Now

OCTOBER 9, 2024

However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. Our workup started with an ultrasound and EKG. EKGs will have abnormalities in about 90 percent, but they are typically nonspecific findings.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Burns 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Suspected low voltage injuries (<1000v) should still be approached with an A-E assessment, but if 12 lead ECG and urinalysis are normal, it’s reasonable to discharge the patient. If the ECG is abnormal, the patient should be managed as if exposed to a high voltage (>1000v).

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

EB Medicine

NOVEMBER 1, 2018

Jeff: Next, make sure that all patients with high voltage injuries have an EKG and continuous cardiac monitoring. Those with low voltage injuries and a normal EKG do not require monitoring. Nachi: Additionally, for those with severe electrical injuries, an IV should be placed and fluid resuscitation should begin.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. Here is the initial ED ECG: What do you think? The ECG shows peaked T waves, QRS widening, a coved-type ST segment with inverted T waves most prominent in V1 and V2 consistent with Brugada pattern. They opined that the ECG could instead be "metabolic." Creatinine elevated at 3.09

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Triage vital signs include BP 80/40 mm Hg, HR 154 bpm, T 41C rectal, RR 28 breaths per minute, saturation 94% on room air. The patient is agitated, not oriented, and becoming combative with ED staff. Temps greater than 41.5C Temps greater than 41.5C

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

ACEP Now

MARCH 14, 2024

1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. His ECG was unremarkable.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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.

EMS 97

EMS Fluid Resuscitation Fractures Resuscitation 97

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5. On exam, she is clutching her chest and is in acute distress due to pain with no other remarkable findings. Initial troponin is mildly elevated.

EMS 100

EMS Fluid Resuscitation Shock EKG/ECG 100

Taming the SRU

FEBRUARY 3, 2025

Initial work up when suspicious of this process should include ECG, chest x-ray, urinalysis, and the following labs: CBC, CMP, magnesium, phosphate, calcium, uric acid, VBG (for pH), and lactate dehydrogenase (10). Therefore, it should only be administered in life-threatening arrhythmia and not simply for peaked t waves on ECG (2,20).

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. Mercury, in all forms, reacts with sulfhydryl groups in intracellular sites ultimately interfering with multiple enzymatic processes.

Poisoning 91

Poisoning Fluid Resuscitation Administration Seizures 91

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

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75