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

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

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.)

Operations 94

Operations Radiology Radiology Fluid Resuscitation 94

Dr. Smith's ECG Blog

AUGUST 2, 2024

The LCx and OM branches are not as well seen. 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 ). This shot is typically best for viewing the LAD and its diagonal branches.

EKG/ECG 119

EKG/ECG Fluid Resuscitation Academics Resuscitation 119

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

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. Furthermore, notice the well-formed Q-waves in inferior leads. Large volume fluid resuscitation was undertaken. The HCO3 was 8.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 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

EMDocs

JULY 13, 2024

Evaluate for retained products of conception as etiology Diagnosis Diagnosis of endometritis with at least two of the following: 8 Fever >100.4F

OB/GYN 91

OB/GYN EMS Sepsis Fluid Resuscitation 91

Ziqitza HealthCare Ltd

FEBRUARY 26, 2024

Ziqitza Health care Limited , with its fleet of well-equipped ambulances and highly trained paramedics, plays a vital role in providing emergency medical services during such calamities. One of the key challenges during floods and cyclones is accessing affected areas.

Ambulance Services 52

Ambulance Services Disaster Management Fluid Resuscitation Resuscitation 52

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. They will want daily weights and closely monitored fluid balance.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Mind The Bleep

APRIL 26, 2024

Note: Painful teeth in well patients with mild, soft swellings with no palpable collection are often treatable with a course of oral antibiotics and seeking emergency dental treatment in the community via NHS111. Is there any asymmetry/fullness in the pharyngeal area? Is there tenderness of teeth to percussion/palpation?

Emergency Department 52

Emergency Department Fluid Resuscitation Dehydration Resuscitation 52

Taming the SRU

APRIL 10, 2023

Patient remained hypotensive after fluid resuscitation and was admitted to the CVICU for management. During his admission, the patient’s blood pressure improved with correction of hypovolemia with crystalloid fluid resuscitation, and his CK and troponin trended downward.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

Mind The Bleep

DECEMBER 31, 2023

Damaged kidneys don’t handle drugs well Or fluids! For IV fluid requirements, be gentle and cautious, especially in dialysis patients. Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. Too much fluid may have been taken off in dialysis.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

ACEP Now

FEBRUARY 11, 2024

4 It is believed that substantial gastrointestinal loss causes chloride and potassium depletion, as well as hypovolemia, acute kidney injury, and renal potassium loss. Management of symptoms is the same for all of these, relying upon fluid resuscitation, antiemetics, and electrolyte repletion.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

Sensible Medicine

MARCH 14, 2025

If there is one thing a medicine resident or hospitalist should be able to do well is identify the patients who are sick and need attention. I’ve predicted that any screening tool would be more sensitive but less specific than a well-trained doctor. .” So said my program director during my internship.

Sepsis 107

Sepsis Wellness Documentation/Coding Fluid Resuscitation 107

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. As with other cases of shock, initial fluid resuscitation may be considered. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. 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.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

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. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

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. The patients were randomized and the trial fluids were double-blinded. In the 24 hours prior to randomization, 55.5%

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

Don't Forget the Bubbles

MARCH 31, 2025

Lack of fluid monitoring throughout the PICU stay led to underreporting of MODS resulting from late-onset FO. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. Prolonged fluid overload may still contribute to organ dysfunction over time. Why does it matter?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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. Volume resuscitation in patients with high-voltage electrical injuries.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

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. Validity Evidence for a Team-Leading Assessment Tool in Pediatric Emergency Resuscitation Using Video Review (Hartwell et al.)

Resuscitation 92

Resuscitation Administration Fluid Resuscitation Research 92

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

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). Therefore, fluid resuscitation and maintenance are important. NMS is hard to diagnose because it's rare. A tricky cause of NMS is the removal of a dopamine agonist.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. Stable Patients For both stable and resuscitated patients, high-dose IV proton pump inhibitor therapy (i.e., 14 In clinically stable patients who do not require resuscitation, EGD is less urgent and may be performed within six to 24 hours. 6 Balloon tamponade (i.e., Am J Emerg Med.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

Taming the SRU

MAY 5, 2023

RESULTS A total of 1,563 patients were enrolled with 782 assigned to the restrictive and 781 assigned to the liberal fluid groups. There were similar baseline characteristics and the groups were well-matched.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. 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

Mind The Bleep

FEBRUARY 9, 2024

She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. Because she would not be for intubation, they discuss resuscitation status because, naturally, care during- and post-arrest would involve airway support.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

PulmCCM

SEPTEMBER 9, 2021

Sylvia Plath Background Implicit in resuscitation is speed. Septic sheep randomized to early, rapid volume resuscitation had greater vasopressor requirements 12 hours after initial fluid bolus. needed at least 1 fluid expansion, 2.] needed at least 1 fluid expansion, 2.] Jon-Emile S. older than 65 years; b.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

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. Lastly, vessels can be damaged by internal burns, which may lead to poor perfusion and delayed complications as thrombosis or third spacing.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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. Welcome to your first day with the neonates! Upon arriving for your initial shift, you set down your bag, and shortly after, you’re asked to evaluate Baby A.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. Let’s start with fluids.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40