Remove Fluid Resuscitation Remove Operations Remove Outcomes
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ToxCard: Iron

EMDocs

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion. 2 L/hr in adults.

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EM@3AM: Stercoral Colitis

EMDocs

Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. 2-4, 6, 8, 9, 12, 13, 14 Operative intervention typically consists of emergency laparotomy with bowel resection, colostomy formation, and Hartmann pouch creation. Mathis, K.

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The SQuID Protocol: SQ Insulin in DKA?

RebelEM

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. A more optimal, and promising, solution may be the use of SQ insulin in mild to moderate DKA.

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EM@3AM: Retroperitoneal Hematoma

EMDocs

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

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Balanced Fluid Resuscitation for the Critically-Ill: the PLUS study mirrors the BaSICS

PulmCCM

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. Death, from any cause, within 90 days of randomization was the primary outcome.

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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. Have a high suspicion for infection in transplant patients. Immunosuppression can blunt the typical immune response.

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Sepsis Updates Relevant to the Emergency Physician

EMDocs

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation.

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