Don't Forget the Bubbles

NOVEMBER 27, 2023

So, fluid has been tried but has not got close to fixing the problem. In middle-to-high-income countries, after 40-60ml/kg of fluid resuscitation, the Surviving Sepsis Campaign International Guidelines recommend using vasoactive drugs. Myth busting: Is peripheral administration safe? What are vasoactive drugs?

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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. 5 Consider antifungal administration.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

ACEP Now

OCTOBER 3, 2023

Fluid Resuscitation Intravenous fluids should be administered in the prehospital setting to treat hypotension and/or limit hypotension to the shortest duration possible. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting. References Lulla A, et al.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration.

Sepsis 104

Sepsis Fluid Resuscitation Resuscitation Administration 104

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

Taming the SRU

MAY 5, 2023

Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55;

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

NOVEMBER 20, 2023

Hemodynamic resuscitation Key Concept: Patients with hemodynamic instability and/or suspected ongoing bleeding should receive intravenous fluid resuscitation with the goal of optimization of blood pressure and heart rate before endoscopic evaluation/intervention. (Conditional recommendation, low-quality evidence).

Resuscitation 78

Resuscitation Fluid Resuscitation Hospitals Research 78

The Skeptics' Guide to EM

FEBRUARY 17, 2018

There are studies showing that early recognition and prehospital administration of antibiotics are associated with increased survival rates [2-4]. Now we have better evidence with the publication of the first prospective, randomized study investigating the effects of early antibiotic administration in patients with suspected sepsis.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Mind The Bleep

MAY 12, 2023

Administration of human albumin solution (HAS) in SBP reduces the incidence of renal failure by 72% and mortality by 47%. In those who are grossly obese, it may be better to employ a more cautious approach with regard to albumin administration. The number needed to treat to prevent one death is around 5 in SBP. On Day 3 (i.e.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

ACEP Now

FEBRUARY 11, 2024

Regulatory and pharmaceutical availability barriers have even resulted in changing of such medications while in treatment, incomplete usage, and alternative patterns of administration. 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

RebelEM

MAY 25, 2023

In the initial management of trauma patients there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from the resuscitation itself Promote hemostasis References: Dutton RP et al. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JULY 17, 2023

3,14 There are currently no good studies of enteric or rectal contrast administration in the evaluation of LBO and there are no society recommendations for its use. This also serves as a tool for surgical planning. 2,3,5 A CT scan with IV contrast is reported as 96% sensitive and 93% specific for LBO.

Operations 75

Operations EMS Fluid Resuscitation Shock 75

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.

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Taming the SRU

AUGUST 25, 2023

Left ventricular assist devices (LVAD’s) mechanically augment left ventricular function some patients retain enough native function to have a palpable pulse -- conventionally measured BP is reliable in these patients hemodynamic stability is best assessed by MAP in patients without a palpable pulse clinical indicators of perfusion (mental status, capillary (..)

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66

RebelEM

MAY 29, 2023

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e.

Shock 142

Shock Fluid Resuscitation Sepsis Resuscitation 142

Taming the SRU

MARCH 31, 2023

Yates Anaphylaxis Pathophysiology Type 1 Hypersensitivity Reaction IgE-mediated Mast-cell degranulation of vasoactive materials Reaction occurs in minutes Clinical Definition: Acute onset of illness with involvement of the skin, mucosal tissue or both + one of the following Respiratory compromise Reduced BP Or, acute onset of illness with at least (..)

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Mount Sinai EM

OCTOBER 2, 2023

. – Using the sheath aspect prevents multiple skin punctures/introduction of bacteria Side port : for rapid admin of blood products, IV fluids, or other meds Of note: IV fluids (including blood) can ONLY be administered through the side port tubing via a luer lock connection. Fluid cannot be administered via the main hub.

Resuscitation 240

Resuscitation Fluid Resuscitation Administration Shock 240

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

EMDocs

MARCH 11, 2024

Patients who cannot tolerate oral intake of fluids should receive intravenous (IV) fluid resuscitation but are encouraged to start drinking ORS as soon as they are able. Clinicians should switch from IV hydration to ORS once hydration is improved and the patient can drink.

Dehydration 87

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 87

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. Food and Drug Administration. Food and Drug Administration. This condition is difficult to reverse; supportive measures should be undertaken, with chelation considered. Resources: S. 2022, February 25).

Poisoning 65

Poisoning Fluid Resuscitation Administration Seizures 65

EMDocs

AUGUST 17, 2023

The median amount of fluids administered between the groups before initiation of NE was not statistically significant (2080 mL vs. 1900 mL). The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4,

Sepsis 65

Sepsis Shock Resuscitation Fluid Resuscitation 65

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment.

Operations 81

Operations Academics Outcomes Fluid Resuscitation 81

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. Academic Emergency Medicine. 2011 Aug 30;18(9):934–40.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Intensive Blog

FEBRUARY 9, 2023

The timeframe for administration of charcoal post Amanita phalloides poisoning may be up to 48 hours 9. Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). This should be discussed with a toxicologist.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s. Here is the initial ED ECG: What do you think?

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 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 64

Sepsis Fluid Resuscitation Shock Resuscitation 64

EB Medicine

OCTOBER 1, 2018

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. Patient’s need adequate fluid resuscitation. So quite a few changes!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40