Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. NaCl fluid bolus over 15 minutes. We do not subtract the bolus as the child was shocked.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

JUNE 25, 2024

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. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. Total amount over 24 hours.

Burns 73

Burns Fluid Resuscitation Resuscitation Poisoning 73

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.

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Fluid Resuscitation Resuscitation Emergency Department Shock 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% I will continue to reach for pressors early in resuscitation of the septic shock patient.

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Sepsis Shock Resuscitation Fluid Resuscitation 67

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. Antiemetics as needed.

Poisoning 76

Poisoning Fluid Resuscitation Seizures Resuscitation 76

EMDocs

SEPTEMBER 7, 2024

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

EMS 75

EMS Fluid Resuscitation Resuscitation Radiology 75

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

Dr. Smith's ECG Blog

OCTOBER 26, 2010

ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. Large volume fluid resuscitation was undertaken. Even after 3 liters of fluid, his CVP was very low. Are the lungs clear? Is the patient cool and pale? Cr was 13.4.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. 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.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

PulmCCM

MAY 22, 2023

Read in NEJM Fluid resuscitation and vasopressors are both usually needed in septic shock , but the ideal volume of fluid to infuse before starting vasopressors has been unclear. At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

PHEM Cast

APRIL 10, 2016

The control group received many similar treatments as the ‘intervention’ group (just not full protocolised EGDT) highlighting that with good sepsis care (fluid resuscitation, close monitoring, early appropriate antibiotic administration), mortality can be reduced. Puskarich MA, Marchick MR, Kline JA, Steuerwald MT, Jones AE.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Critical Care Now

APRIL 26, 2022

A reduced supply of cortisol will decrease vascular tone, causing systemic vasodilation, shock, and hemodynamic collapse. Some examples include: Infection Volume loss Recent surgery or trauma Physical or emotional stress (e.g.,

Resuscitation 52

Resuscitation Fluid Resuscitation EMS Sepsis 52

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510. 2021, Jarczak, Kluge et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

JULY 17, 2023

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. Bowel perforation demonstrated by CT, hard signs of peritonitis, or an overall toxic appearance warrant emergent surgical consultation.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

Don't Forget the Bubbles

NOVEMBER 18, 2024

Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. Check electrolytes and consider the diagnosis, especially if the infant shows signs of shock or has a family history suggestive of CAH. This can lead to peripheral vasoconstriction and hypotension. Fernandez, E.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. If you can use Doppler, then you can diagnose it.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate.

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Operations Radiology Radiology Fluid Resuscitation 67

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Click to enlarge.) J Burn Care Rehabil.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Mind The Bleep

FEBRUARY 9, 2024

Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this? Breathing Is there evidence of respiratory failure?If If so, what is the most likely cause and the most appropriate means of respiratory support? Is it reversible?

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

EMDocs

JUNE 27, 2024

-smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. Their search yielded 477 articles, which was narrowed to 88 after initial review. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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.

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Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. Here is the initial ED ECG: What do you think? Another Shark Fin.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

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Sepsis Fluid Resuscitation Resuscitation Shock 65

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

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. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose.

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Fluid Resuscitation Hospitals Dehydration Research 96

EMDocs

MARCH 11, 2024

Inspection of the canister showed approximately ten liters of nearly odorless watery fluid containing flecks of mucus (“rice-water” stools) consistent with cholera infection. The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection.

Dehydration 90

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 90

Don't Forget the Bubbles

JULY 3, 2024

Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2024 Jun 7. Complementary feeding approaches and risk of choking: A systematic review. Correia L, et al. J Pediatr Gastroenterol Nutr. 2024 Jun 27. Sankar J, et al. Eur J Pediatr.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

EMDocs

OCTOBER 5, 2024

Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV). IV fluid resuscitation as needed. Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05

EMS 74

EMS Infectious Diseases Sepsis Hospitals 74

EMDocs

DECEMBER 16, 2023

Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. Temps greater than 41.5C

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

Intensive Blog

FEBRUARY 9, 2023

Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Disability- treat hypoglycaemia if present.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. One of the hallmarks of sepsis care, based on the Rivers 2001 17 trial and still recommended by the latest SCCM guidelines is early detection of sepsis and initiation of early resuscitation. Similar to Andrews et al., Inwald et al.

Dehydration 50

Dehydration Fluid Resuscitation Sepsis Resuscitation 50