ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 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

Emergency Medicine Ireland

APRIL 4, 2022

The scheduled, usually elective nature of cardiac surgery lends itself to large scale outcome prediction and indeed, cardiac surgery has found its outcomes examined very closely over the past few decades. Likely driven by rewarming induced vasodilation and hypothermia induced diuresis they can be hypovolaemic.

Fluid Resuscitation 40

Fluid Resuscitation Hyperthermia / Hypothermia Outcomes Resuscitation 40

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

ACEP Now

NOVEMBER 16, 2023

Fluid resuscitation should be initiated. There are few data on the outcomes of UGIB when balloon tamponade is used as a temporizing measure. Outcomes in variceal hemorrhage following the use of a balloon tamponade device. Patients should be assessed for evidence of hypovolemia or active exsanguination. Acad Emerg Med.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 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

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 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. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). 4-year-old Stephanie presents with vomiting, diarrhoea, and lethargy.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2] NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Taming the SRU

MAY 5, 2023

The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups. versus 59.2%). versus 14.9%

Sepsis 52

Sepsis Shock Administration 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. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007 Jan 21;13(3):432-7.

Operations 76

Operations EMS Fluid Resuscitation Shock 76

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. Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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

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. more than 2].

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

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

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

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0 tests/hr (0.8 Pre-Intervention: 1.0

Operations 81

Operations Academics Outcomes Fluid Resuscitation 81

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, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 66

Sepsis Shock Resuscitation Fluid Resuscitation 66

PulmCCM

MAY 22, 2023

Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. Academic Emergency Medicine. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EMDocs

DECEMBER 16, 2023

Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. Outcome and risk factors associated with extent of central nervous system injury due to exertional heat stroke. Temps greater than 41.5C BMC research notes , 8 , 758. link] Swee, duS., L., & Lim, A.

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation.

Sepsis 64

Sepsis Fluid Resuscitation Shock Resuscitation 64

EMDocs

JANUARY 20, 2024

This patient’s recent diarrheal illness raises suspicion for hypovolemia, which would be treated with fluid resuscitation (D) , but her moist oral mucosa and dilated inferior vena cava suggest an eu- or hypervolemic state. Additional fluids will not improve her condition and may worsen it. J Neurosurg. 2006;105(2):264-270.

EMS 73

EMS Fluid Resuscitation Shock EKG/ECG 73

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