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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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SGEM#382: Don’t Go Chasing Waterfalls to Treat Pancreatitis

The Skeptics' Guide to EM

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.

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EM@3AM: Leukopenia

EMDocs

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. A 45-year-old outdoor enthusiast presents to the emergency department with fever, headache, myalgias, and malaise. BioMed Research International, 2020, 1-10. link] Fan, L., link] Lu, W.,

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Episode 7: Sepsis

PHEM Cast

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. These tables are used when assessing the usefulness of a test (or it’s sensitivity and specificity), and, when researching how useful tests are we need the majority of patients to fall into the green boxes.

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ToxCard: PNU (Vacor)

EMDocs

PNU was withdrawn from the US market in 1979, however, there is still active small-scale manufacturing in the People’s Republic of China, and it is available online for purchase as a research chemical.¹ In these cases, PNU ingestion would most likely originate from exposure to an old household rodenticide or exposure to a “research chemical”.

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Sepsis Updates Relevant to the Emergency Physician

EMDocs

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.

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Neonatal Hypotension

Don't Forget the Bubbles

Various studies, such as those pooling data from the National Neonatal Research Database, indicate that the incidence of hypotension varies based on neonatal age, with the highest rates observed immediately post-birth and within the first days of life. This is one of the situations where you must not forget to feel for femoral pulses.

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