EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

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

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. A cutoff of 18% has a positive predictive value (PPV) of 92% and NPV of 90% for fluid responsiveness. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

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

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. So, fluid has been tried but has not got close to fixing the problem. What are vasoactive drugs?

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

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 110

EMS Resuscitation Blood Transfusions Seizures 110

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 121

EKG/ECG Fluid Resuscitation Academics Resuscitation 121

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 EMS 98

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.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

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

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

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 86

Operations Radiology Radiology Fluid Resuscitation 86

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

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

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

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.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

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 81

OB/GYN EMS Sepsis Fluid Resuscitation 81

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

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

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. Sleep well, endoscopist: January 2021 Annals of Emergency Medicine journal club. Patients should be assessed for evidence of hypovolemia or active exsanguination. Initial laboratory studies should include CBC, complete metabolic profile, blood type and screening, and coagulation studies.

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

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

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

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. Some examples of this; A 68 year-old lady being admitted for monitoring and a limited amount of vasopressors (e.g.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

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

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

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

NOVEMBER 1, 2018

Nachi: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock." Kuttab, H.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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 83

Sepsis Fluid Resuscitation Shock Resuscitation 83

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

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 93

EMS Infectious Diseases Sepsis Hospitals 93

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 94

Pediatrics Dehydration EMS Hospitals 94