ACEP Now

OCTOBER 3, 2023

There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day. 2,3 TBI outcomes are profoundly linked to the timing and quality of care provided before patients reach the hospital. Hypotensive patients should be treated with blood products and/or isotonic fluids in the prehospital setting.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

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

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

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. Guidelines also support not administering HTS in the pre-hospital setting, yet the available data is weak. What do we do at UC?

Administration 81

Administration Resuscitation Research Fluid Resuscitation 81

Mind The Bleep

DECEMBER 31, 2023

Hello, this is Dr so-and-so, renal SHO on call’ Depending on your hospital renal facilities, you are likely to only hold the renal bleep in F2 or above. pneumonia on top of chronic fluid overload / pulmonary oedema secondary to CKD) A pathology completely unrelated to their renal disease, but requiring renal input during admission (e.g.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Mind The Bleep

FEBRUARY 9, 2024

Intensive care units provide the highest-level care for patients within the hospital. At most hospitals, the CCOT service is run by nurses and other advanced healthcare professionals who are very experienced in assessing and looking after unwell patients. Some respiratory wards offer NIV – some renal units offer dialysis.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 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. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Mary’s Hospital in Leonardtown, Maryland.

Burns 52

Burns Fluid Resuscitation EKG/ECG Operations 52

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 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. How much fluid? saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. 0 5 5 4 0 Calcium 2.1-2.6

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med. 2023;73:34-39. 2.89, p = 0.01.

Sepsis 104

Sepsis Fluid Resuscitation Resuscitation Administration 104

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

Don't Forget the Bubbles

MARCH 18, 2024

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Manage hydration Children may be dehydrated or present with signs of fluid overload. What causes haematuria in children?

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

ACEP Now

NOVEMBER 16, 2023

with 350,000 hospitalizations annually and a mortality rate of five to 10 percent. Fluid resuscitation should be initiated. However, a 2017 study of 34 patients suggests that balloon tamponade, when used as a bridge to EGD, improves patient mortality, with 59 percent of patients surviving to hospital discharge.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 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% Do not transport to an alternative location.

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Emergency Medicine Ireland

APRIL 4, 2022

Outcomes are often examined in great detail and are more likely than most patient cohorts to be reflected onto the hospital and even individual surgeons. Today we’ll focus mainly on the routine cardiac surgery patient and some of the common significant issues you’ll see.

Fluid Resuscitation 40

Fluid Resuscitation Hyperthermia / Hypothermia Outcomes Resuscitation 40

RebelEM

MAY 25, 2023

Lancet 2010 [10] >20,000 adult trauma patients with SBP <90mmHg Patients randomized to TXA 1g over 10 min + 1g IV over 8hrs vs Placebo given within 8hrs of injury In-hospital mortality by 28d reduced (14.5% NEJM 1994. [2] NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Mind The Bleep

MAY 12, 2023

9 There is no role for Tranexamic acid in upper GI bleeding and its use is harmful to patients 11 Escalate to a senior early for consideration of a higher level of care Refer for early endoscopy after resuscitation with haemodynamic stability. On Day 3 (i.e. 48 hours later) albumin is administered at 1g/kg. On Day 3 (i.e.

Fluid Resuscitation 52

Fluid Resuscitation Dehydration Resuscitation Administration 52

Northwestern EM Blog

FEBRUARY 14, 2022

ICU length of stay, hospital length of stay, ventilator-dependent days, or rate of renal replacement therapy: these are all things that matter to our patients and to our health systems and they are more fruitful targets when we investigate interventions.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52

EMDocs

JULY 17, 2023

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. 13 Depending on the hospital staffing, this may be a gastroenterology consult or a surgical consult.

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

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

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. It also reduced length of stay in ICU and hospital without adverse effects. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

Shock 142

Shock Fluid Resuscitation Sepsis Resuscitation 142

Taming the SRU

MAY 5, 2023

This trial involved employing a restrictive versus standard strategy with the restrictive fluid strategy permitting fluid boluses only when the patient met one of several criteria, whereas the standard fluid strategy had no limit to fluid quantity administered. Mortality at 90 days was equivocal between groups (42.3%

Sepsis 52

Sepsis Shock Administration Resuscitation 52

PulmCCM

MAY 22, 2023

In the TEAM trial conducted by the ANZICS group, 750 ICU patients in 49 hospitals in 6 countries were randomized to either early mobilization or usual care (which usually included in-bed physical therapy). g/kg per day) or usual dose (≥1.2 g/kg per day). At least one expert questioned whether the study was adequately powered.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min. 1997;42(3):470-475; discussion 475-476.

EMS 71

EMS Fluid Resuscitation Fractures Resuscitation 71

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. tests/hr (0.8

Operations 81

Operations Academics Outcomes Fluid Resuscitation 81

Taming the SRU

APRIL 10, 2023

HOSPITAL COURSE The patient was initially found to be hypotensive in the Emergency Department with a blood pressure of 87/58 mmHg. He was given an intravenous fluid bolus with minimal improvement in his blood pressure, but remained alert. Her oxygen requirement decreased throughout her hospitalization. Diagnostics WBC : 8.6

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. Risk Factors for Severe Cholera among Children under Five in Rural and Urban Bangladesh, 2000–2008: A Hospital-Based Surveillance Study. 2023;8(3):169.

Dehydration 87

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 87

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, vs 48.4% (OR 3.4,

Sepsis 65

Sepsis Shock Resuscitation Fluid Resuscitation 65

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC.

Poisoning 65

Poisoning Fluid Resuscitation Administration Seizures 65

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. Severe Sepsis in Pre-Hospital Emergency Care. 2009;13(5):R167.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EB Medicine

NOVEMBER 1, 2018

It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. In at least one study, the incidence of DVT in hospitalized burn patients was as high as 23%. Schieche from the Oklahoma University School of Community Medicine. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. A few days later an ECG was repeated which showed normal sinus rhythm with no further hyperkalemia findings: After a 3-week hospitalization for acute renal failure, hyperkalemia, and compartment syndrome, the patient was discharged to acute rehab. Here is the initial ED ECG: What do you think?

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

EB Medicine

OCTOBER 1, 2018

For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. clearly this is an important topic if it warrants it’s own chair at a major hospital in NYC. At our hospital in southern Manhattan, patients tend to breathe around 16.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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