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. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds.

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Shock Sepsis Fluid Resuscitation Resuscitation 143

EMergucate

AUGUST 23, 2017

An 80 year old women with severe anaemia secondary to GI bleed Severe anaemia requiring urgent blood transfusion, correction of … Continue reading →

Blood Transfusions 40

Blood Transfusions Resuscitation EMS 40

Dr. Smith's ECG Blog

JULY 3, 2020

The patient was in shock on arrival in the ED — and multiple blood transfusions were needed. ANSWERS regarding ECG #1: Severe trauma requiring blood transfusions is a common emergency presentation. Consider that the patient in this case was promptly resuscitated in the ED. WHAT is the rhythm in this tracing?

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

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%

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

University of Maryland CC Project

OCTOBER 11, 2023

In his lecture, he reviews the results of prior studies of transfusion hemoglobin thresholds during critical illness and discusses the use of regression discontinuity study design to help answer this important. Nick Bosch, MD, MSc is an assistant professor in the pulmonary division at the Boston University School of Medicine.

Blood Transfusions 40

Blood Transfusions Resuscitation 40

EMDocs

DECEMBER 6, 2024

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Blood transfusion for clinically significant blood loss. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Basic assessment: airway, breathing, circulation. Antiemetics as needed.

Poisoning 96

Poisoning Fluid Resuscitation Seizures Resuscitation 96

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Blood transfusion Reduces the overall proportion of HbS. Decreases splinting and improves tidal volumes. Bronchodilators Indicated for patients with wheezing, history of asthma. Hypervolemia – leads to pulmonary edema: Consider diuresis.

Blood Transfusions 95

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 95

EMDocs

MAY 15, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Simple blood transfusion should be considered early in the hypoxemic patient with advancement to red cell exchange transfusion if there are clinical features of severe pathology or evidence of progression despite initial simple transfusion.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 100

The Trauma Pro

SEPTEMBER 18, 2023

They compared adult patients who arrived as a highest-level of activation and received blood during their resuscitation. Severe injury and blood transfusion are already known to be associated with a higher likelihood of VTE. The authors retrospectively reviewed their registry data over four years.

Blood Transfusions 113

Blood Transfusions Resuscitation Hospitals Wellness 113

Taming the SRU

JUNE 26, 2024

Other medical interventions include PPIs, octreotide, erythromycin, and blood transfusion as needed. TEE can be helpful in guiding resuscitation if available. Blood transfusion may be useful in patients with penetrating trauma, although we must acknowledge when efforts are futile.

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Blood Transfusions Sepsis CPR EKG/ECG 90

EMDocs

JUNE 22, 2024

Answer : Amniotic fluid embolism Epidemiology: Incidence of 1:15,200 to 1:53,400 1 7% occur during labor Causes approximately 14% of all maternal peripartum death in United States Current fatality rate 13-60% 1-4 Risk factors: Advanced maternal age, amniocentesis, cesarean delivery, eclampsia, medical induction of labor, placental pathology, diabetes, (..)

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

RebelEM

SEPTEMBER 26, 2022

Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: a randomized clinical trial. Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

RebelEM

JUNE 19, 2023

We should expect TXA to help in immediate stabilization and allow trauma teams the time to intervene (whether that be continued resuscitation, interventional or operative procedures). This should continue to make TXA part of standard trauma resuscitation while additional studies are performed.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

PHEM Cast

FEBRUARY 23, 2017

Prehospital Blood Product Resuscitation for Trauma. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. .: Prehospital transfusion of plasma and red blood cells in trauma patients. Lots to think about! 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

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. This can interrupt massive blood loss and buy time for potentially life-saving damage control surgery.

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Blood Transfusions Operations Resuscitation Infectious Diseases 98

EMDocs

JUNE 12, 2024

Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic. Up to 56% have an ionized Ca < 1 mmol/L, and this increases mortality and need for transfusion. Transfusion induced hypoCa is common in patients undergoing massive transfusion. Transfusion-Related Hypocalcemia After Trauma.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 105

EMDocs

AUGUST 22, 2023

2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation.

Emergency Department 90

Emergency Department Blood Transfusions Resuscitation Sepsis 90

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. due to inadequate access.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9%

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Taming the SRU

MAY 30, 2023

Legal implications vary from country to country. mg/mL) single-dose 2*-mL ampule or equivalent, 2 Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2 Nitroglycerin, 0.4-mg

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Downeast Emergency Medicine

APRIL 26, 2021

The primary outcome was 30-day mortality with secondary outcomes looking at 24 hour in-hospital mortality, blood resuscitation at 6 and 24 hours, incidence of multiorgan failure, ARDS, nosocomial infection, early seizures, PE/DVT, crystalloid resuscitation after 24 hours, and the incidence of coagulopathy.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

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. Patient’s need adequate fluid resuscitation. Just a reminder that a history of CHF doesn’t preclude proper fluid resuscitation.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EB Medicine

MARCH 1, 2019

Jeff: In terms of initial resuscitation, there is an ever increasing body of literature to support blood transfusion over crystalloid in patients requiring volume expansion in trauma. There are no specific guidelines for transfusion in the setting of blunt cardiac injury, so stick to your standard trauma protocols.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

MARCH 6, 2024

In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. Severe bleeding and hemodynamically unstable patients: Not the time for colonoscopy; resuscitate and get the CTA. 2017;2(5):354–60.

Blood Transfusions 104

Blood Transfusions Outcomes Resuscitation Radiology 104

EMDocs

JUNE 3, 2023

5 Initial Evaluation The key to the initial resuscitation of the unstable pelvic trauma patient is to rapidly identify and treat the most life-threatening pathology. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures 61

Fractures Resuscitation Operations EMS 61

RebelEM

DECEMBER 23, 2024

saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). PMID: 39250114 Clinical Question: In adult patients admitted for a vaso-occlusive episode, does early fluid resuscitation with Lactated Ringer solution compared to 0.9%

Fluid Resuscitation 129

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 129

Broome Docs

DECEMBER 22, 2024

Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. 2024 Oct 9. doi: 10.1001/jama.2024.20424. 2024.20424.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes Emergency Department 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Effective management of MAS will often result in the stabilization of blood pressure. Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia.

Sepsis 57

Sepsis Shock Hyperthermia / Hypothermia Administration 57

Pediatric EM Morsels

MARCH 7, 2025

While transfusing blood can be beneficial to those who have lost it or continue to lose it quickly, blood may not always be immediately available. Or maybe the family does not desire blood transfusions. Military Application of Tranexamic Acid in TraumaEmergency Resuscitation (MATTERs) Study.

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

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. Triage vital signs include BP 127/81, HR 119, T 102.9 C or 100.4 mg/kg, max 0.4

Pediatrics 95

Pediatrics Dehydration EMS Hospitals 95

RCEM Learning

NOVEMBER 28, 2022

REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used as a non-invasive clamp of the aorta. Case courtesy of Dr Paul Clarke Learning bite Avoid unnecessary movement of the patient. DO NOT “spring” the pelvis on examination and DO NOT log-roll if pelvic injury suspected. From the case rID 52597 Fig.

Fractures 40

Fractures Blood Transfusions Sepsis Operations 40

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 67

Documentation/Coding Seizures Psychiatric Wellness 67

EMDocs

JANUARY 6, 2025

A whole blood transfusion is initiated for the management of her anemia. ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. After isolation, the patient is placed on supplemental oxygen therapy at 15 L/min via a non-rebreather mask. Hypoglycemia is managed with IV dextrose.

Infectious Diseases 73

Infectious Diseases CDC PPE Rapid Diagnostic Testing 73