Remove Fluid Resuscitation Remove Fractures Remove Wellness
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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. NEJM 1994. [2] NEJM 1994. [2] PMID: 12045644 Bickell WH et al.

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emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

Most common traumatic injuries are fractures, TBIs, and thoracic or abdominal injuries. Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms.

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IVC Distensibility Index vs Collapsibility Index: Using the Correct Index

RebelEM

Well, the established cutoff for the distensibility index is 18%. A cutoff of 18% has a positive predictive value (PPV) of 92% and NPV of 90% for fluid responsiveness. 14,15 You might use a passive leg raise, which carries a roughly 250cc fluid challenge. Why does it matter? Am J Respir Crit Care Med. Jan 2019; PMID: 30138573.

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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: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence. Let’s move on to treatment.

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Grand Rounds Recap 8.9.23

Taming the SRU

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?