Emergency Medicine Journal

SEPTEMBER 25, 2024

The article uses an illustrative case to highlight recent developments including advanced airway management and the contemporary approach to assessment of fluid requirements and the type and volume of fluid resuscitation.

Burns 98

Burns Fluid Resuscitation Airway Management Resuscitation 98

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5 2.18) Fluid Overload: 20.5% N Engl J Med. 2022 Sep 15;387(11):989-1000.

Fluid Resuscitation 84

Fluid Resuscitation Resuscitation Outcomes Hospitals 84

Mount Sinai EM

OCTOBER 2, 2023

Example of when to use : picture your septic nursing home patient who has an EF of 30% cannot handle much fluid resuscitation, MAPs <65. MAPs improve with starting norepinephrine. The patient will be boarding in the ED a long time and has poor peripheral veins.

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Resuscitation Fluid Resuscitation Administration Shock 231

ALiEM

JULY 22, 2023

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

PulmCCM

FEBRUARY 28, 2022

Further, the treating clinician must have deemed either normal saline or balanced crystalloid as appropriate resuscitation options; the patient’s expected-admission to the ICU must have been at least 3 days.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EMDocs

JUNE 25, 2024

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. Total amount over 24 hours.

Burns 74

Burns Fluid Resuscitation Resuscitation Poisoning 74

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

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Placebo 11.9%, NNT 18 Median Fluid Received: Aggressive: 7.8L (Range 6.5 2.18) Fluid Overload: 20.5%

Fluid Resuscitation 67

Fluid Resuscitation Resuscitation Outcomes Hospitals 67

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 77

Poisoning Fluid Resuscitation Seizures Resuscitation 77

Mind The Bleep

DECEMBER 19, 2023

It is also vital to do a fluid balance assessment. Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. This is done with an initial bolus of 10ml/kg 0.9%

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Don't Forget the Bubbles

NOVEMBER 27, 2023

So, fluid has been tried but has not got close to fixing the problem. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. The wide pulse pressure and transient response would suggest an afterload problem.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

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

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

Don't Forget the Bubbles

OCTOBER 7, 2024

Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. Deep tissue injuries may not be visible, and as muscle breaks down, it leads to myoglobinuria, rhabdomyolysis and renal failure.

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Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

MAY 15, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Hypervolemia – leads to pulmonary edema: Consider diuresis If euvolemic – start maintenance fluids of D5 in 0.45%NS times maintenance. Can decrease rate when they are tolerating PO.

Blood Transfusions 79

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 79

The Skeptics' Guide to EM

JUNE 12, 2022

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? Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Outcomes Administration 52

Clinical Correlations

SEPTEMBER 28, 2022

Bellevue Inpatient: What is the role of aggressive fluid resuscitation in acute pancreatitis? Bellevue Outpatient: What is the optimal duration of therapy for bisphosphates in osteoporosis? VA Inpatient: What is the treatment for allergic bronchopulmonary aspergillosis?

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation 40

EMDocs

SEPTEMBER 7, 2024

The time taken to measure serum hemoglobin and hematocrit (B) and await a result would delay definitive surgical control of likely ongoing hemorrhage given this patient’s incomplete response to fluid resuscitation. Additionally, hemoglobin results often lag in real-time when compared to the degree of acute hemorrhage.

EMS 75

EMS Fluid Resuscitation Resuscitation Radiology 75

ACEP Now

OCTOBER 3, 2023

Fluid Resuscitation Intravenous fluids should be administered in the prehospital setting to treat hypotension and/or limit hypotension to the shortest duration possible. 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

Dr. Smith's ECG Blog

AUGUST 2, 2024

Yet recognition of acute RV MI is extremely important clinically — because emergency treatment will often require different priorities (ie, avoidance of nitroglycerine; fluid resuscitation for hypotension ).

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EKG/ECG Fluid Resuscitation Academics Resuscitation 115

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS Decreases splinting and improves tidal volumes. Bronchodilators Indicated for patients with wheezing, history of asthma. times maintenance.

Blood Transfusions 76

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 76

Emergency Medicine Ireland

JUNE 21, 2021

Secondary causes are more likely to be related to medical illness with overly aggressive fluid resuscitation (otherwise known as iatrogenic salt water drowning) leading to oedematous abdominal structures and high pressures. If muscular tone is worsening things then get rid of it * optimise fluid resuscitation.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Wellness 52

EMDocs

JUNE 22, 2024

Answer : Amniotic fluid embolism Epidemiology: Incidence of 1:15,200 to 1:53,400 1 7% occur during labor Causes approximately 14% of all maternal peripartum death in United States Current fatality rate 13-60% 1-4 Risk factors: Advanced maternal age, amniocentesis, cesarean delivery, eclampsia, medical induction of labor, placental pathology, diabetes, (..)

EMS 97

EMS Resuscitation Blood Transfusions Seizures 97

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment.

Operations 105

Operations Academics Outcomes Fluid Resuscitation 105

Intensive Blog

AUGUST 21, 2024

Outline the initial assessment of severe burns injury, including how you will calculate fluid resuscitation requirements. Discuss the advantages and disadvantages of using pulse oximetry to target oxygen therapy (50%) What SpO2 targets do you use in ICU patients and why? (50%) 50%) Oxygen saturation targets in critical care Q2.

Burns 52

Burns Hyperthermia / Hypothermia Fluid Resuscitation Operations 52

Taming the SRU

JANUARY 12, 2024

Often AE-ILD is idiopathic, but treatable causes must be excluded (PNA, PE, volume overload) Treatment for AE-ILD should include antibiotics for CAP coverage (specifically including azithromycin), steroids, and respiratory support; consider opportunistic infection if immunosuppressed as well as diuresis as needed for euvolemia HFNC should be favored (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

Northwestern EM Blog

MAY 9, 2022

Therefore, fluid resuscitation and maintenance are important. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] 2] Rigidity will lead to rhabdomyolysis with subsequent hyperkalemia and myoglobin-induced renal failure. Profound immobility can precipitate DVT, so anticoagulation may be necessary.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

PulmCCM

MAY 22, 2023

Read in NEJM Fluid resuscitation and vasopressors are both usually needed in septic shock , but the ideal volume of fluid to infuse before starting vasopressors has been unclear. At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

Dr. Smith's ECG Blog

OCTOBER 26, 2010

Large volume fluid resuscitation was undertaken. Even after 3 liters of fluid, his CVP was very low. In this case, bedside echo did not reveal a no wall motion abnormality, but there was hyperdynamic function, which is not consistent with cardiogenic shock but rather with sepsis or volume deficit. The K returned at 6.9

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Ziqitza HealthCare Ltd

FEBRUARY 26, 2024

The paramedics are trained to provide immediate care, including cooling measures and fluid resuscitation, to mitigate the effects of extreme heat on the human body. Managing Health Crises During Extreme Weather Events Extreme weather events, whether it be a cyclone, flood, or heatwave, can lead to a surge in health crises.

Ambulance Services 52

Ambulance Services Disaster Management Fluid Resuscitation Resuscitation 52

Taming the SRU

MAY 11, 2024

Flood syndrome- start fluids, give antibiotics, consult surgery. Be careful with fluid resuscitation in renal transplant patients who can be at risk for volume overload. Have a high suspicion for infection in transplant patients. Immunosuppression can blunt the typical immune response.

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4,

Sepsis 68

Sepsis Shock Resuscitation Fluid Resuscitation 68

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. Academic Emergency Medicine. 2011 Aug 30;18(9):934–40. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52