ACEP Now

OCTOBER 3, 2023

There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day. 2,3 TBI outcomes are profoundly linked to the timing and quality of care provided before patients reach the hospital. The guidelines also address issues related to EMS provider skill level, transportation modality, and destination for the patient.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 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

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. tests/hr (0.8

Operations 97

Operations Academics Fluid Resuscitation Outcomes 97

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. Clearly something infectious is going on and you wonder if starting antibiotics on route to the hospital would help?

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

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

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 86

Operations Radiology Radiology Fluid Resuscitation 86

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 92

Administration Resuscitation Fluid Resuscitation Research 92

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. vs 48.4% (OR 3.4,

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

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. Severe Sepsis in Pre-Hospital Emergency Care. March 2016. 2009;13(5):R167.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EMDocs

JULY 30, 2024

Treat the DKA as you would with any other patient; insulin, appropriate fluid resuscitation, and electrolyte repletion. His neurologic symptoms resolved fully by hospital day 2. 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

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

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

NOVEMBER 16, 2023

with 350,000 hospitalizations annually and a mortality rate of five to 10 percent. Fluid resuscitation should be initiated. However, a 2017 study of 34 patients suggests that balloon tamponade, when used as a bridge to EGD, improves patient mortality, with 59 percent of patients surviving to hospital discharge.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

EB Medicine

OCTOBER 1, 2018

For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. clearly this is an important topic if it warrants it’s own chair at a major hospital in NYC. At our hospital in southern Manhattan, patients tend to breathe around 16.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

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

EB Medicine

NOVEMBER 1, 2018

It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. In at least one study, the incidence of DVT in hospitalized burn patients was as high as 23%. Schieche from the Oklahoma University School of Community Medicine. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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 92

EMS Fluid Resuscitation Fractures Resuscitation 92

EMDocs

OCTOBER 5, 2024

We’ll keep it short, while you keep that EM brain sharp. They are found primarily in hospital specimens but are increasing in frequency in samples from the community. 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

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 83

Sepsis Fluid Resuscitation Resuscitation Shock 83

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. 13 Depending on the hospital staffing, this may be a gastroenterology consult or a surgical consult.

Operations 95

Operations EMS Fluid Resuscitation Shock 95

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

EMDocs

JUNE 27, 2024

768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Sundd P, Gladwin MT, Novelli EM. Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. Patients should be admitted to the hospital for rhythm monitoring and serial cardiac enzymes , but the long-term prognosis of takotsubo syndrome is generally good. Which of the following is the best next step in the management of this patient’s condition?

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 ). saline affect hospital-free days by day 30?

Fluid Resuscitation 124

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 124

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 84

Poisoning Fluid Resuscitation Administration Seizures 84

EMDocs

JANUARY 20, 2025

2024, 33 use of ultrasound may lead to a reduction in mortality, less volume of fluids given, and decreased hospital stay. 2018 56 retrospectively analyzed visits from 30,000 children from 36 hospitals across the US and found that patients who received IV antibiotics were just as likely to return at 72 hours as those who did not.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Don't Forget the Bubbles

JULY 3, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Thornley EM, et al. van der Zande JMJ, et al.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

EMDocs

MARCH 11, 2024

Authors: Gaston Omba, MD (EM Resident Physician, Makerere University); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Patients who cannot tolerate oral intake of fluids should receive intravenous (IV) fluid resuscitation but are encouraged to start drinking ORS as soon as they are able.

Dehydration 107

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 107