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Trauma Resuscitation Updates

RebelEM

Pelvic Fracture A score ≥2 present, consider MTP Clinical Take Home Point: Use of balanced transfusion (including PRBCs and clotting factors) helps avoid dilutional coagulopathy WHOLE BLOOD VS COMPONENT THERAPY Kronstedt S et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. NEJM 1994. [2]

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

Most common traumatic injuries are fractures, TBIs, and thoracic or abdominal injuries. 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. May be associated with fluid overload.

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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

RebelEM

14,15 You might use a passive leg raise, which carries a roughly 250cc fluid challenge. just be careful with pelvic fractures or any femoral arterial punctures/ devices. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial.

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EM Quick Hits 44 Fluids in Pancreatitis, Nasal Fractures, Delirium, DOSE VF, Intimate Partner Violence

Emergency Medicine Cases

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.

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Grand Rounds 5.8.24

Taming the SRU

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. For mid-shaft femur fractures, traction appears to may reduce blood loss and pulmonary complications, but the available data is very scarce.

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Case Report: a High-Voltage Victim

ACEP Now

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Lastly, vessels can be damaged by internal burns, which may lead to poor perfusion and delayed complications as thrombosis or third spacing. His ECG was unremarkable.

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Episode 22 - Electrical Injuries in the Emergency Department An Evidence-Based Review

EB Medicine

Nachi: Additionally, for those with severe electrical injuries, an IV should be placed and fluid resuscitation should begin. Fluid requirements will likely be higher than those predicted by the parkland formula, and you should aim for a goal of maintaining urine output of 1-1.5