Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

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

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

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. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Large volume fluid resuscitation was undertaken.

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

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 93

Operations Radiology Radiology Fluid Resuscitation 93

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

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

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

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

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. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. ml/kg/h.

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. older than 65 years; b.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 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. Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this?

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation 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?

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. 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. Which of the following is the best next step in the management of this patient’s condition?

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

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 97

EMS Infectious Diseases Sepsis Hospitals 97

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 97

Pediatrics Dehydration EMS Hospitals 97

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

Don't Forget the Bubbles

FEBRUARY 17, 2025

Watching these signs, you pause he’s had 60ml/kg as fluid boluses, but what do you do with these signs? Volume resuscitation has historically been the first-line therapy for patients in septic shock. Is more fluid the answer? congenital heart disease, septic cardiomyopathy), aggressive volume resuscitation (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

JULY 3, 2024

In this month’s issue of Pediatrics, Brewster and colleagues investigated how well Google Translate and ChatGPT perform in translating discharge instructions. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. J Pediatr Gastroenterol Nutr. 2024 Jun 7.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

Don't Forget the Bubbles

NOVEMBER 18, 2024

However, if the infant is well-perfused, cardiovascularly stable, and showing no signs of organ dysfunction, active treatment may not be necessary. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. This can manifest as hypotension. Fernandez, E.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111