Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510. 2021, Im, Kang et al.

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Sepsis Shock Administration Resuscitation 52

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

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Operations Radiology Radiology Fluid Resuscitation 66

Critical Care Now

APRIL 26, 2022

One can also see the following signs and symptoms: Fever Nausea, vomiting, and abdominal pain Delirium and altered mental state Secondary features of the stressors (sepsis, trauma, surgical complications) Cutaneous manifestations such as hyperpigmentation (in patients with Addison’s disease) Treat with fluid, fluid, and steroids.

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Resuscitation Fluid Resuscitation EMS Sepsis 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.

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Emergency Department Fluid Resuscitation Hospitals Sepsis 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%

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Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Mind The Bleep

DECEMBER 31, 2023

For IV fluid requirements, be gentle and cautious, especially in dialysis patients. Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. These require swabs, antibiotics, potentially a sepsis screen and bleeping your registrar / consultant for further advice.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

More often, tachycardia with ST segment abnormalities (elevation or depression) is due to an underlying illness (PE, sepsis, hemorrhage, dehydration, hypoxia, respiratory failure, etc.). Large volume fluid resuscitation was undertaken. Even after 3 liters of fluid, his CVP was very low. The K returned at 6.9 Cr was 13.4.

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EKG/ECG Dehydration Fluid Resuscitation 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. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. .

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Fluid Resuscitation Hospitals Dehydration Research 96

Northwestern EM Blog

FEBRUARY 14, 2022

This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation.

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Shock Resuscitation Outcomes Fluid Resuscitation 52

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.

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Fluid Resuscitation Dehydration Resuscitation Administration 52

Mind The Bleep

FEBRUARY 9, 2024

48 hours) to help her through the initial period of sepsis while her antibiotics take time to work. It is important to set out the goals for that patient’s ICU stay, and also the limits of care. Some examples of this; A 68 year-old lady being admitted for monitoring and a limited amount of vasopressors (e.g.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

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. older than 65 years; b.]

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Resuscitation Fluid Resuscitation Sepsis Outcomes 40

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

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Shock Fluid Resuscitation Sepsis Resuscitation 142

PHEM Cast

APRIL 10, 2016

[link] We hope you enjoyed our sepsis podcast. St Emlyns Induction podcast on Sepsis. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. A great summary of what to do when a patient with suspected sepsis first arrives in the ED. March 2016.

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Taming the SRU

AUGUST 25, 2023

bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.)

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Seizures Fractures EKG/ECG Resuscitation 66

EMDocs

AUGUST 17, 2023

The median amount of fluids administered between the groups before initiation of NE was not statistically significant (2080 mL vs. 1900 mL). The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis.

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Sepsis Shock Resuscitation Fluid Resuscitation 66

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeff : Sepsis chair. Sepsis-3!!

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Sepsis Shock Fluid Resuscitation Hospitals 40

PulmCCM

MAY 22, 2023

Read in NEJM Fluid resuscitation and vasopressors are both usually needed in septic shock , but the ideal volume of fluid to infuse before starting vasopressors has been unclear. centers, patients with sepsis and systolic blood pressure <100 mm Hg all received at least 1000 mL of crystalloid.

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Fluid Resuscitation Resuscitation Hospitals Sepsis 86

EMDocs

DECEMBER 18, 2023

Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. vs. 0.91), positive predictive value (0.27

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Sepsis Fluid Resuscitation Shock Resuscitation 64

EB Medicine

NOVEMBER 1, 2018

Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. Nachi: Additionally, for those with severe electrical injuries, an IV should be placed and fluid resuscitation should begin.

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Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. As with other cases of shock, initial fluid resuscitation may be considered. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. In the cath lab, the patient’s blood pressure remained low.

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52