The Skeptics' Guide to EM

NOVEMBER 12, 2022

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University. Guest Skeptic: Dr. Salim R.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

RebelEM

SEPTEMBER 29, 2022

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Article: de-Madaria E et al. cc/kg/hour.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Jeff: Let’s move on to evaluation in the emergency department. Jeff: You’re right. Jeff: You’re right.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). Therefore, fluid resuscitation and maintenance are important. NMS is hard to diagnose because it's rare.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. Large volume fluid resuscitation was undertaken. Even after 3 liters of fluid, his CVP was very low. He had this ECG recorded. The K returned at 6.9 The HCO3 was 8. Cr was 13.4. Troponins peaked at 0.275 ng/ml.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Taming the SRU

JANUARY 12, 2024

r4 case follow up - r1 clinical knowledge: interstitial lung disease - halo - pediatric simulation - pediatric small groups r4 case follow up WITH dr. yates Psychiatric emergency department visits are on the rise in the United States, with roughly 15-19% of all ED visits associated with mental health diagnoses Roughly twenty percent of patients presenting (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

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. Am J Emerg Med. Academic Emergency Medicine.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Mind The Bleep

APRIL 26, 2024

For all patients who come into the emergency department with a swelling, it is helpful to know if they have seen their GP or dentist recently and if they have had any treatment or recent courses of antibiotics. 2015) ‘Emergency Department’, in On-call in Oral and Maxillofacial Surgery.

Emergency Department 52

Emergency Department Fluid Resuscitation Dehydration Resuscitation 52

EMDocs

JULY 30, 2024

Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion. The father reported the patient was in his usual state of health approximately two hours ago. Niacin has been used but has a lower bioavailability than nicotinamide and can cause hypotension when given.

Poisoning 71

Poisoning Seizures Fluid Resuscitation Pediatrics 71

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. Am J Emerg Med.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

Broome Docs

OCTOBER 31, 2022

PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. PMID: 36103415 Bottom line: Less is more when it comes to intravenous fluids. Emerg Med J. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Other serious time-dependent conditions such as myocardial infarction and trauma have been improved significantly with emergency medical services (EMS). It has been reported that over half of patients with sepsis arrive to the emergency department via ambulance [1].

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Electrical injuries in the emergency department: an evidence-based review. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Taming the SRU

APRIL 10, 2023

HOSPITAL COURSE The patient was initially found to be hypotensive in the Emergency Department with a blood pressure of 87/58 mmHg. He was given an intravenous fluid bolus with minimal improvement in his blood pressure, but remained alert. J-point elevation in leads I, II, III, aVF, V5, V6.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Burns 52

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med. Patients should be assessed for evidence of hypovolemia or active exsanguination. Dionne JC, Oczkowski SJW, Hunt BJ, et al. Crit Care Med.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9%

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock." N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 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. The patient currently resides at a skilled nursing facility.

Sepsis 83

Sepsis Fluid Resuscitation Resuscitation Shock 83

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. Int J Emerg Med. Clin Biochem.

EMS 92

EMS Fluid Resuscitation Fractures Resuscitation 92

EMDocs

OCTOBER 5, 2024

A 62-year-old female patient with a history of recurrent urinary tract infections (UTIs) presents to the emergency department with fever, chills, and dysuria. Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV).

EMS 93

EMS Infectious Diseases Sepsis Hospitals 93

EMDocs

JULY 17, 2023

Bowel perforation demonstrated by CT, hard signs of peritonitis, or an overall toxic appearance warrant emergent surgical consultation. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients.

Operations 95

Operations EMS Fluid Resuscitation Resuscitation 95

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Temps greater than 41.5C

Hyperthermia / Hypothermia 87

Hyperthermia / Hypothermia EMS Stroke Seizures 87

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

Intensive Blog

FEBRUARY 9, 2023

Labs and Lytes 040 Author: Dr Nasreen Bahemia Peer reviewers: Dr Craig Johnston, A/Prof Chris Nickson A 56-year-old female presented to the Emergency Department (ED) with 2 days of severe nausea, vomiting and diarrhoea. She was also getting progressively drowsier while waiting in ED.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

JUNE 27, 2024

Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. Additional fluids will not improve her condition and may worsen it. Vital signs show T of 99.0°F

EMS 93

EMS Fluid Resuscitation Shock EKG/ECG 93

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 124

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 124

EMDocs

JANUARY 20, 2025

Much of our understanding of the clinical signs of hypovolemia comes from studies performed on phlebotomy volunteers 1,2 while our understanding of fluid overload comes from heart failure patients. For patients without frank signs of shock, it is reasonable to trial oral hydration prior to moving on to IV fluids. Acad Emerg Med.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Taming the SRU

MARCH 3, 2025

Because of this, emergency department (ED) physicians need to maintain a high index of suspicion for inhalation injury in the case of any exposure to smoke or fire, especially in closed or small space exposures. Upper Airway Injury to the upper airway, defined as airway structures proximal to the glottis (i.e.

Burns 52

Burns Fluid Resuscitation Emergency Department Resuscitation 52

Taming the SRU

FEBRUARY 3, 2025

Work-up and Diagnosis in the Emergency Department Initial presentation of TLS typically includes generalized symptoms such as gastrointestinal distress, decreased appetite, muscle cramping, palpitations, hematuria / oliguria, and altered mental status. in females and 2.5-7.0 in males) phosphate > 4.5 mg/dl (adults) and > 6.5

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

Don't Forget the Bubbles

FEBRUARY 17, 2025

1] Fred is a 3-year-old boy who presents to the emergency department. Pudjiadi, Inferior Vena Cava/Abdominal Aorta Ratio as a Guide for Fluid Resuscitation. J Emerg Trauma Shock, 2021. The literature exploring its nuances continues to grow in adults but remains poorly understood in paediatric populations.[1]

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

NOVEMBER 18, 2024

The other important moment to always think of the heart (sorry, cardiologists, I don’t think about the heart 24/7) is when a collapsed neonate presents to your emergency department, especially if blood pressure is present. This is one of the situations where you must not forget to feel for femoral pulses.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

MARCH 11, 2024

Louis) // Reviewed by: Joshua Lowe, MD (EM Staff Physician, USAF); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 25-year-old woman presented to the emergency department (ED) in Uganda with acute encephalopathy. Clinicians should switch from IV hydration to ORS once hydration is improved and the patient can drink.

Dehydration 107

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 107