Taming the SRU

FEBRUARY 7, 2024

For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

Administration 87

Administration PPE Ultrasounds Poisoning 87

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

ALiEM

JULY 22, 2023

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration. However, the crystalloid fluids are not flowing freely.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

The Trauma Pro

AUGUST 15, 2023

Two sets of documentation are crucial: accurate records of blood product administration (on the trauma flow sheet), and documentation of just about everything else (in the blood bank). One best practice to consider: a highly trained trauma resuscitation nurse or advanced practice provider (APP) can run the MTP from the sidelines.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Administration 130

The Bottom Line

OCTOBER 18, 2023

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Administration 139

Administration Operations Resuscitation 139

Pediatric EM Morsels

JULY 28, 2023

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 The mortality rate for cerebral edema is 21%–24%.

Fluid Resuscitation 212

Fluid Resuscitation Pediatrics Resuscitation Research 212

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate administration will increase the pH. *

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

EMDocs

NOVEMBER 6, 2023

Naloxone administration may reverse respiratory arrest, preventing progression to cardiac arrest. Standard advanced life support with the addition of administration of sodium bicarbonate is appropriate for the treatment of life-threatening dysrhythmias caused by cocaine or other sodium channel blockers. COR 2a, LOE B-NR.

Poisoning 92

Poisoning Hyperthermia / Hypothermia Seizures Administration 92

Don't Forget the Bubbles

NOVEMBER 15, 2023

Currently, the administration of water for the paediatric population is based on the Holliday-Segar formula (100ml/kg/day for the first 10kg of weight, 50ml/kg/day for the second 10kg of weight and 20ml/kg/day for weight over 20kg). As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

PulmCCM

NOVEMBER 6, 2023

Uncertainty has persisted about the ideal blood transfusion strategy to resuscitate and support trauma victims as they are prepared to undergo surgical and other mechanical interventions to achieve hemostasis. The intervention is called resuscitative endovascular balloon occlusion of the aorta (REBOA). Thromboelastometry (e.g.,

Operations 98

Operations Blood Transfusions Resuscitation Infectious Diseases 98

EMDocs

SEPTEMBER 6, 2023

Resuscitate and administer antibiotics. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Start resuscitation early with vasopressors, antibiotics. Complete primary and secondary survey. Start cooling as quickly as you can, and stop at 102. ROS unremarkable. Labs demonstrate critical illness.

Anaphylaxis 69

Anaphylaxis Shock Sepsis Stroke 69

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? This should continue to make TXA part of standard trauma resuscitation while additional studies are performed.

Outcomes 99

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 99

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

Emergency Medicine Education

JULY 21, 2022

Resuscitation journal also published another study on effect of calcium in OHCA, which it did not support calcium administration in OHCA JAMA Resuscitation

Resuscitation 40

Resuscitation Administration Hospitals 40

Taming the SRU

FEBRUARY 12, 2024

Given her intracranial hemorrhages, significant attempts were made to improve coagulation including administration of IV vitamin K, 3 units of fresh frozen plasma, and administration of four-factor prothrombin complex concentrate (PCC, Kcentra). This does not deviate from general resuscitation principles for acute hemorrhage.

Administration 71

Administration Fractures Anaphylaxis Emergency Department 71

Pediatric EM Morsels

SEPTEMBER 22, 2023

Crystalloid may help, but neurogenic shock may not respond to fluid administration. While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Alpha 1 agonists are necessary to maintain appropriate blood pressure.

Shock 273

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 273

American Medical Compliance

FEBRUARY 15, 2023

Congress established the Occupational Safety and Health Administration (OSHA), with the purpose of creating safe and health conscience work conditions. Passing the exam will qualify the individual for an assisted living administrator certificate. Furthermore, OSHA estimates that 5.6 The specific requirements of the exam vary.

Administration 52

Administration Infectious Diseases Operations Best Practices 52

American Medical Compliance

FEBRUARY 15, 2023

Congress established the Occupational Safety and Health Administration (OSHA), with the purpose of creating safe and health conscience work conditions. Passing the exam will qualify the individual for an assisted living administrator certificate. Furthermore, OSHA estimates that 5.6 The specific requirements of the exam vary.

EMS 52

EMS Administration Infectious Diseases Operations 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. Myth busting: Is peripheral administration safe? After 40ml/kg of IV 0.9% 2021;25(1):146.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Taming the SRU

NOVEMBER 21, 2023

Management IVF resuscitation: will want to give at least 20 cc/kg bolus, however there has been some discussion about doing this in two 10 cc/kg boluses to avoid cerebral edema (as noted below, recent evidence has not supported this). While we are often cautious with IVF, volume and rate of fluid administration does not cause cerebral edema.

Pediatrics 80

Pediatrics EKG/ECG Resuscitation Dehydration 80

JournalFeed

OCTOBER 29, 2022

WATEFALL RCT Spoon Feed Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload. However, with a possible signal of long term benefit, I will keep prescribing steroids in these patients.

Administration 40

Administration Resuscitation Outcomes 40

The Trauma Pro

AUGUST 18, 2023

The Broxton tool covers all the basics and includes some additional data points that cover activation criteria, TXA administration, and administration of uncrossmatched blood. Click here to check it out. The Australian tool is much more robust with more data points that make a lot of sense. You can download a copy by clicking here.

Administration 100

Administration Operations Hospitals Wellness 100

PHARM

JUNE 6, 2023

Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction.

Resuscitation 40

Resuscitation Administration Outcomes 40

EMDocs

NOVEMBER 20, 2023

Initial patient assessment and hemodynamic resuscitation should be performed simultaneously. DOAC reversal Recommendation: For patients on DOACs, we suggest reversal for the small subset of patients who present with a life-threatening LGIB that does not respond to initial resuscitation and cessation of the anticoagulant alone.

Resuscitation 78

Resuscitation Fluid Resuscitation Hospitals Research 78

Pediatric EM Morsels

JUNE 9, 2023

Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though. Call them early!

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

Cook County EM Blog

MAY 29, 2023

As resuscitation measures are underway, you obtain collateral from EMS and parents. If the patient does not respond to resuscitative measures, cardiopulmonary bypass and extracorporeal membrane oxygenation may be considered. Food and Drug Administration (FDA). Early consultation with the poison center is prudent. 2015.09.020.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Significant effort has been placed on the administration of IV crystalloids to address concerns for hypovolemia in septic shock.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

EMDocs

SEPTEMBER 7, 2023

2 Administration of an alcohol dehydrogenase (ADH) inhibitor, such as fomepizole, is recommended in suspected or known DEG poisoning. 2,10 Initial stabilization of DEG toxicity includes correcting acid-base abnormalities, electrolyte abnormalities, and volume resuscitation. JAMA , vol. 15, 15 Apr. link] Robinson, Corie N.,

Poisoning 64

Poisoning CDC Administration Emergency Department 64

The Skeptics' Guide to EM

JUNE 12, 2022

Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. saline, that may be partly driven by kidney injury associated with the administration of high-chloride content IV fluids. Blood pressure is 85/50 mmHg. You wonder which IV fluid should you order?

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Outcomes Administration 52

Emergency Medicine Ireland

JANUARY 22, 2024

This is of course hardly surprising as it is hopefully clear by now on this podcast that I am not especially good at what i do and continue to put my appointment to my current job down as some kind of administrative error that is yet to be detected. Firstly do a bit of resuscitation. Firstly do a bit of resuscitation.

Sepsis 52

Sepsis Resuscitation Wellness Administration 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

Poisoning 66

Poisoning Seizures Pediatrics Administration 66

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

Mind The Bleep

DECEMBER 19, 2023

Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Throughout therapy it is important to monitor fluid input and urine output so that fluid resuscitation measures can be adjusted. It is also vital to do a fluid balance assessment.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. The GCS must be obtained through interaction with the patient (i.e., References Lulla A, et al.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. Liberal: 14.9% Liberal: 14.9% Liberal: 14.9%

Sepsis 83

Sepsis Shock Resuscitation Outcomes 83

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52