ACEP Now

OCTOBER 29, 2024

In such cases, would you wait for a lactate, white blood cell count, bandemia, or other diagnostics to confirm a source of infection before starting antibiotics, fluid resuscitation, and/or pressors? In this study, clinical gestalt is not only fast, but accurate for the benefit of timely resuscitation and intervention.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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. of patients randomized to saline received at least 500 mL of open-label balanced fluids. saline received roughly 8.1

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1, RR 28, SpO2 89% on 6L NC.

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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

ACEP Now

OCTOBER 3, 2023

Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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 95

Operations Radiology Radiology Fluid Resuscitation 95

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED boarding. [1] A tricky cause of NMS is the removal of a dopamine agonist.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

Don't Forget the Bubbles

OCTOBER 7, 2024

The high voltage can cause direct thermal injuries, as well as mechanical injuries from falls or secondary trauma. Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. Electrical Injuries. Chen P, Bukhman AK. Electrical and lightning injuries.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

JULY 13, 2024

A) Administer ceftriaxone 500 mg IM and doxycycline 100 mg PO B) Consult OB/GYN for incision and drainage C) Establish IV access and administer clindamycin and gentamicin D) Prescribe doxycycline with metronidazole and ensure close OB/GYN follow-up Answer: C Most postpartum infections are identified after hospital discharge.

OB/GYN 91

OB/GYN EMS Sepsis Fluid Resuscitation 91

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. Of note, HTS is more effective in trauma patients because it is used as a resuscitative fluid as well. What do we do at UC?

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. How much fluid? saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. 0 5 5 4 0 Calcium 2.1-2.6

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

Mind The Bleep

DECEMBER 31, 2023

Hello, this is Dr so-and-so, renal SHO on call’ Depending on your hospital renal facilities, you are likely to only hold the renal bleep in F2 or above. pneumonia on top of chronic fluid overload / pulmonary oedema secondary to CKD) A pathology completely unrelated to their renal disease, but requiring renal input during admission (e.g.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Taming the SRU

APRIL 10, 2023

HOSPITAL COURSE The patient was initially found to be hypotensive in the Emergency Department with a blood pressure of 87/58 mmHg. He was given an intravenous fluid bolus with minimal improvement in his blood pressure, but remained alert. Her oxygen requirement decreased throughout her hospitalization. Diagnostics WBC : 8.6

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

Mind The Bleep

FEBRUARY 9, 2024

Intensive care units provide the highest-level care for patients within the hospital. At most hospitals, the CCOT service is run by nurses and other advanced healthcare professionals who are very experienced in assessing and looking after unwell patients. Some respiratory wards offer NIV – some renal units offer dialysis.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

ACEP Now

MARCH 14, 2024

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Mary’s Hospital in Leonardtown, Maryland.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 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

PulmCCM

SEPTEMBER 9, 2021

Septic sheep randomized to early, rapid volume resuscitation had greater vasopressor requirements 12 hours after initial fluid bolus. It is suggested that rapid, fluid resuscitation generates an abrupt rise in atrial natriuretic peptide, shears the glycocalyx which then impairs vascular reactivity. older than 65 years; b.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

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

Taming the SRU

MAY 5, 2023

This trial involved employing a restrictive versus standard strategy with the restrictive fluid strategy permitting fluid boluses only when the patient met one of several criteria, whereas the standard fluid strategy had no limit to fluid quantity administered. Mortality at 90 days was equivocal between groups (42.3%

Sepsis 52

Sepsis Shock Administration Resuscitation 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. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. In at least one study, the incidence of DVT in hospitalized burn patients was as high as 23%.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. I advise checking your local guidelines before prescribing antibiotics to treat NEC, as every hospital has different policies.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

DECEMBER 18, 2023

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. Additionally, the recommendation to use a 30 cc/kg bolus was downgraded.

Sepsis 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

EMDocs

JANUARY 20, 2024

The most common findings on ECG are ST elevation , most often in the anterior precordial leads, as well as sinus tachycardia and QT interval prolongation. 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.

EMS 102

EMS Fluid Resuscitation Shock EKG/ECG 102

EMDocs

OCTOBER 5, 2024

ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. IV fluid resuscitation as needed.

EMS 98

EMS Infectious Diseases Sepsis Hospitals 98

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. His immunizations are current and has received all pneumococcal vaccinations. C or 100.4

Pediatrics 98

Pediatrics Dehydration EMS Hospitals 98

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 128

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 128

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Taming the SRU

MARCH 3, 2025

In addition to smoke inhalation injury from fires, many chemical substances can cause inhalation injury as well including but not limited to nitrogen dioxide, ammonia, chlorine, hydrogen sulfide, ammonia, and by-products from rubber and plastic.

Burns 52

Burns Fluid Resuscitation Emergency Department Resuscitation 52

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. Can’t get enough of Bubble Wrap? 2024 Jun 25.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has been started on timely broad-spectrum antibiotics according to hospital protocol. Venous Congestion in Adult Critical Care In adults, venous congestion is a well-recognized contributor to organ dysfunction in many conditions, including septic shock and heart failure. Before transfer, he received another 20 ml/kg of IVF.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

NOVEMBER 18, 2024

Epidemiology in Australia In Australia, the reported prevalence of neonatal hypotension in preterm infants is like that in the UK, with around 20-30% of very low birth weight infants experiencing significant hypotension during their initial hospital stay. This can manifest as hypotension.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

MARCH 11, 2024

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. Risk Factors for Severe Cholera among Children under Five in Rural and Urban Bangladesh, 2000–2008: A Hospital-Based Surveillance Study. 2023;8(3):169.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111