Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Mount Sinai EM

OCTOBER 2, 2023

Example of when to use : picture your septic nursing home patient who has an EF of 30% cannot handle much fluid resuscitation, MAPs <65. MAPs improve with starting norepinephrine. The patient will be boarding in the ED a long time and has poor peripheral veins.

Resuscitation 231

Resuscitation Fluid Resuscitation Administration Shock 231

ALiEM

JULY 22, 2023

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

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

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

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. The two highest predictors of increased mortality in the literature include a large area of colonic involvement >40cm and perforation (32-60% mortality rate).

EMS 96

EMS Sepsis Shock Fluid Resuscitation 96

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

Mind The Bleep

DECEMBER 19, 2023

It is also vital to do a fluid balance assessment. Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. This is done with an initial bolus of 10ml/kg 0.9%

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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. The wide pulse pressure and transient response would suggest an afterload problem.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

RebelEM

FEBRUARY 24, 2025

lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial. Arterial Pulse Pressure Variation with Mechanical Ventilation. Am J Respir Crit Care Med. Jan 2019; PMID: 30138573. Castro R, et al. Effects of capillary refill time-vs.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

SEPTEMBER 7, 2024

The time taken to measure serum hemoglobin and hematocrit (B) and await a result would delay definitive surgical control of likely ongoing hemorrhage given this patient’s incomplete response to fluid resuscitation. Additionally, hemoglobin results often lag in real-time when compared to the degree of acute hemorrhage.

EMS 95

EMS Fluid Resuscitation Resuscitation Radiology 95

Emergency Medicine Cases

MAY 18, 2020

Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central access tips, glucose and temperature control and transport tips.

Resuscitation 52

Resuscitation Fluid Resuscitation Airway Management CPR 52

Emergency Medicine Cases

JUNE 4, 2019

Nonetheless, in this podcast we’ll give you the tools to help risk stratify electrical injuries, give some guidance on fluid resuscitation, describe immediate management of acute complications and make you aware of the potential delayed complications that must be anticipated.

Fluid Resuscitation 52

Fluid Resuscitation Burns Resuscitation EMS 52

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

Emergency Medicine Cases

MAY 21, 2019

Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care.

Airway Management 52

Airway Management Burns Resuscitation Fluid Resuscitation 52

Dr. Smith's ECG Blog

AUGUST 2, 2024

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 ).

EKG/ECG 120

EKG/ECG Fluid Resuscitation Academics Resuscitation 120

Thinking Critical Care

AUGUST 3, 2024

This exclusive event, produced in collaboration with Flosonics Medical, will take place on September 28th, 2024 , in Toronto , Ontario, Canada This masterclass is designed for those who seek a deep dive into the cutting-edge techniques of venous congestion, Doppler ultrasound, and fluid resuscitation.

Fluid Resuscitation 52

Fluid Resuscitation Documentation/Coding Resuscitation Ultrasounds 52

Critical Care Now

JUNE 30, 2024

The latest Surviving Sepsis Campaign (SSC 2021) guidelines say the following about albumin in in sepsis: The lack of proven benefit and higher cost of albumin compared to crystalloids contributed to our strong recommendation for the use of crystalloids as first-line fluid for resuscitation in sepsis and septic shock.

Sepsis 52

Sepsis Fluid Resuscitation Shock Resuscitation 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4,

Sepsis 88

Sepsis Shock Resuscitation Fluid Resuscitation 88

The Skeptics' Guide to EM

JUNE 12, 2022

Clinical Question: Is the 90-day mortality in critically ill adult patients lower with the use of Plasma-Lyte 148, a balanced crystalloid solution, for fluid resuscitation and therapy, than with the use of normal saline? Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Outcomes Administration 52

Clinical Correlations

SEPTEMBER 28, 2022

Bellevue Inpatient: What is the role of aggressive fluid resuscitation in acute pancreatitis? Bellevue Outpatient: What is the optimal duration of therapy for bisphosphates in osteoporosis? VA Inpatient: What is the treatment for allergic bronchopulmonary aspergillosis?

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation 40

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

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 105

Operations Academics Outcomes Fluid Resuscitation 105

Intensive Blog

AUGUST 21, 2024

Outline the initial assessment of severe burns injury, including how you will calculate fluid resuscitation requirements. Discuss the advantages and disadvantages of using pulse oximetry to target oxygen therapy (50%) What SpO2 targets do you use in ICU patients and why? (50%) 50%) Oxygen saturation targets in critical care Q2.

Burns 52

Burns Hyperthermia / Hypothermia Fluid Resuscitation Operations 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

Large volume fluid resuscitation was undertaken. Even after 3 liters of fluid, his CVP was very low. In this case, bedside echo did not reveal a no wall motion abnormality, but there was hyperdynamic function, which is not consistent with cardiogenic shock but rather with sepsis or volume deficit. The K returned at 6.9

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 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 101

Resuscitation Fluid Resuscitation Hospitals Research 101

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

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.

Operations 88

Operations Radiology Radiology Fluid Resuscitation 88

Ziqitza HealthCare Ltd

FEBRUARY 26, 2024

The paramedics are trained to provide immediate care, including cooling measures and fluid resuscitation, to mitigate the effects of extreme heat on the human body. Managing Health Crises During Extreme Weather Events Extreme weather events, whether it be a cyclone, flood, or heatwave, can lead to a surge in health crises.

Ambulance Services 52

Ambulance Services Disaster Management Fluid Resuscitation Resuscitation 52

The Skeptics' Guide to EM

JUNE 15, 2018

It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Background: Atrial fibrillation, rate control vs. rhythm control. This is a debate that has gone on for many years.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

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 84

OB/GYN EMS Sepsis Fluid Resuscitation 84

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. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Critical Care Now

APRIL 26, 2022

Many patients with adrenal insufficiency carry medical alerts or their own emergency medication that EMS can administer.

Resuscitation 52

Resuscitation Fluid Resuscitation EMS Sepsis 52

Broome Docs

OCTOBER 31, 2022

PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. PMID: 36103415 Bottom line: Less is more when it comes to intravenous fluids. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. N Engl J Med.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Intervention: Ceftriaxone 2g IV * Control: Usual care (fluid resuscitation and supplementary oxygen) * Outcome: * Primary: All-cause mortality at 28 days

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

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

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. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Emergency Medicine Ireland

APRIL 4, 2022

It doesn’t take them long to transition to the more conventional ICU patient where fluid does nothing but increase the oedema but in the first 6-12 hours fluid resuscitation often has a role. Likely driven by rewarming induced vasodilation and hypothermia induced diuresis they can be hypovolaemic.

Fluid Resuscitation 40

Fluid Resuscitation Hyperthermia / Hypothermia Outcomes Resuscitation 40