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

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Stercoral Colitis.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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

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

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

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. 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 EMS 98

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 88

Poisoning Fluid Resuscitation Seizures Resuscitation 88

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

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

AUGUST 17, 2023

Additionally, 80% of patients in the control group required open label NE use indicating that NE was going to be needed in most of these patients regardless of initial resuscitation method. The median amount of fluids administered between the groups before initiation of NE was not statistically significant (2080 mL vs. 1900 mL).

Sepsis 78

Sepsis Shock Resuscitation Fluid Resuscitation 78

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

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. You wonder which IV fluid should you order? Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. Blood pressure is 85/50 mmHg.

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 78

Operations Radiology Radiology Fluid Resuscitation 78

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. St Emlyns Induction podcast on Sepsis. March 2016. Scand J Trauma Resusc Emerg Med.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 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

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

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

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 66

Poisoning Seizures Fluid Resuscitation Pediatrics 66

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 77

Poisoning Fluid Resuscitation Administration Seizures 77

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. Stable Patients For both stable and resuscitated patients, high-dose IV proton pump inhibitor therapy (i.e., 14 In clinically stable patients who do not require resuscitation, EGD is less urgent and may be performed within six to 24 hours. 6 Balloon tamponade (i.e.,

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). Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Am J Emerg Med. 2023;73:34-39. Am J Emerg Med.

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 73

OB/GYN EMS Sepsis Fluid Resuscitation 73

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 86

EMS Fluid Resuscitation Fractures Resuscitation 86

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 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

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 86

EMS Infectious Diseases Sepsis Hospitals 86

EMDocs

JULY 17, 2023

However, routine labs, including a complete blood count and metabolic panel, can guide resuscitative efforts preoperatively and may identify clinically relevant abnormalities associated with obstruction, including electrolyte changes, renal injury from hypoperfusion, or anemia secondary to underlying malignancy.

Operations 89

Operations EMS Fluid Resuscitation Resuscitation 89

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 C or 100.4 mg/kg, max 0.4

Pediatrics 88

Pediatrics Dehydration EMS Hospitals 88

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

The Skeptics' Guide to EM

JUNE 15, 2018

It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Dr. Ian Stiell and colleagues published an article in 2011 in Annals of EM looking at variation in recent-onset atrial fibrillation management in Canada and found a lot of variability.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52