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. appeared first on REBEL EM - Emergency Medicine Blog. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 vs 0.5% (Range 0.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

MAY 25, 2023

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.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Background: It’s interesting to see how fluid resuscitation has been debated over the years. Date: November 10th, 2022 Reference: de-Madaria E et al.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

ACEP Now

OCTOBER 3, 2023

This guideline revision is particularly timely as EMS systems have shown their abilities to dramatically improve survival and neurologic outcome after cardiac arrest, STEMI, acute stroke, and other time-sensitive conditions. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Emergency Medicine Cases

MAY 21, 2019

Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care.

Airway Management 52

Airway Management Burns Resuscitation Fluid Resuscitation 52

RebelEM

SEPTEMBER 29, 2022

There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

EMDocs

DECEMBER 6, 2024

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Basic assessment: airway, breathing, circulation. Antiemetics as needed. Consider GI decontamination with whole bowel irrigation (WBI).

Poisoning 85

Poisoning Fluid Resuscitation Seizures Resuscitation 85

Emergency Medicine Cases

NOVEMBER 22, 2022

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence.

Fractures 52

Fractures EMS Fluid Resuscitation Resuscitation 52

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery. Ways to get involved?

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

Emergency Medicine Cases

MARCH 1, 2022

The post EM Quick Hits 36 – Surviving Sepsis, Angle Closure Glaucoma, Bougies, Frostbite, Hot/Altered Patient, Central Cord Syndrome appeared first on Emergency Medicine Cases.

Sepsis 52

Sepsis EMS Fluid Resuscitation Hyperthermia / Hypothermia 52

Emergency Medicine Cases

MAY 18, 2020

Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central access tips, glucose and temperature control and transport tips.

Resuscitation 52

Resuscitation Fluid Resuscitation Airway Management CPR 52

The Skeptics' Guide to EM

JUNE 12, 2022

Case: A 62-year-old man is brought in by EMS from home with lethargy and hypotension. Clinical Question: Is the 90-day mortality in critically ill adult patients lower with the use of Plasma-Lyte 148, a balanced crystalloid solution, for fluid resuscitation and therapy, than with the use of normal saline?

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Outcomes Administration 52

Emergency Medicine Cases

JUNE 4, 2019

Nonetheless, in this podcast we’ll give you the tools to help risk stratify electrical injuries, give some guidance on fluid resuscitation, describe immediate management of acute complications and make you aware of the potential delayed complications that must be anticipated.

Fluid Resuscitation 52

Fluid Resuscitation Burns Resuscitation EMS 52

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 75

Operations Radiology Radiology Fluid Resuscitation 75

EMDocs

AUGUST 17, 2023

Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. Today we look at the CENSER trial. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 75

Sepsis Shock Resuscitation Fluid Resuscitation 75

Critical Care Now

APRIL 26, 2022

Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director. His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. When EMS arrived, they found the patient to be responsive only to painful stimuli and was moaning.

Resuscitation 52

Resuscitation Fluid Resuscitation EMS Sepsis 52

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. appeared first on REBEL EM - Emergency Medicine Blog. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. Acad Emerg Med 2023.

Operations 93

Operations Academics Outcomes Fluid Resuscitation 93

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. An amazing podcast on the subject can be found at SMART EM: SMART Testing: Back to Basics As always, any feedback, comments etc. Báez AA, Hanudel P, Perez MT, Giráldez EM, Wilcox SR. March 2016. South Med J.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Case: EMS is dispatched to a retirement home. Other serious time-dependent conditions such as myocardial infarction and trauma have been improved significantly with emergency medical services (EMS).

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

EMDocs

JULY 30, 2024

Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion. Niacin has been used but has a lower bioavailability than nicotinamide and can cause hypotension when given. Orthostatic hypotension can persist for months after ingestion.

Poisoning 63

Poisoning Seizures Fluid Resuscitation Pediatrics 63

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC.

Poisoning 74

Poisoning Fluid Resuscitation Administration Seizures 74

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. 14 In clinically stable patients who do not require resuscitation, EGD is less urgent and may be performed within six to 24 hours. Dr. Matthew Turner , originally trained at the Medical University of South Carolina, is an EM intern at Hershey Medical Center in Hershey, Pa.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 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. Jeff : I’m an EMS fellow, what can I say… Anyway, on to my favorite section -- prehospital care. Let’s start with fluids.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). CRITICAL CARE: HARD TIMES – RESUSCITATING MY PATIENT: FLUID, BLOOD AND OTHER STRATEGIES.

Sepsis 116

Sepsis Fluid Resuscitation Resuscitation Administration 116

Emergency Medicine Cases

OCTOBER 13, 2020

In this podcast, Part 2 of our diabetic emergencies series with Melanie Baimel, Bourke Tillmann and Leeor Sommer, we dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS). We answer questions such as: how does one differentiate DKA from HHS clinically? How do patients with HHS become hyperglycemic, dry and altered?

Diabetic Emergencies 52

Diabetic Emergencies Fluid Resuscitation Resuscitation EMS 52

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. The post EM@3AM: Endometritis appeared first on emDOCs.net - Emergency Medicine Education. A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. Cochrane Database Syst Rev.

OB/GYN 70

OB/GYN EMS Sepsis Fluid Resuscitation 70

EMDocs

OCTOBER 7, 2023

We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her.

EMS 82

EMS Fluid Resuscitation Fractures Resuscitation 82

EMDocs

OCTOBER 5, 2024

We’ll keep it short, while you keep that EM brain sharp. 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). IV fluid resuscitation as needed. mcg/kg/min and titrated to MAP >65). 2018;320(10):984–994.

EMS 83

EMS Infectious Diseases Sepsis Hospitals 83

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. 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.

Sepsis 72

Sepsis Fluid Resuscitation Resuscitation Shock 72

EMDocs

JULY 17, 2023

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

Operations 86

Operations EMS Fluid Resuscitation Resuscitation 86

EMDocs

JUNE 27, 2024

Sundd P, Gladwin MT, Novelli EM. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 2020 Feb 12;10(1):2470. Annu Rev Pathol.

Pediatrics 85

Pediatrics EMS Dehydration Hospitals 85

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. Fluid resuscitation was initiated.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Don't Forget the Bubbles

JULY 3, 2024

Thornley EM, et al. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. RSV in Young Children During and After the COVID-19 Pandemic-Implications for Delaying the Age of First Infection. Hancock Z, et al. Pediatr Infect Dis J. 2024 Jun 26. Pediatr Infect Dis J.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

Broome Docs

OCTOBER 31, 2022

PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2018 Sep 11;362:k3843.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

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. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52