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Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

REBEL EM

saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). Lactated Ringer (LR) and 0.9% However, without more granular clinical data, it is unclear whether all relevant confounders were included.

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emDOCs Revamp: Alcohol Withdrawal

EMDocs

A 36-year-old male presents to the emergency department after being found down at home by his spouse. 2013; 88(9): 589-595. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Upon EMS arrival the male is noted to be anxious and tremulous with a GCS of 14.

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emDOCs Podcast – Episode 123: Sympathetic Crashing Acute Pulmonary Edema

EMDocs

Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Heart Failure Syndromes. Ann Emerg Med. J Am Coll Cardiol 2013; 62(16):e147–239. West J Emerg Med. J Emerg Med. Am J Emerg Med.

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REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal

REBEL EM

The 30-day emergency department readmission rate and all-cause 30-day readmission were significantly lower only when adjusted for propensity scores. Although CIWA has subjective components, when a patient has a CIWA in the 20s ICU transfer should be considered.

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The Current Status of Continuous-Seizure Management

ACEP Now

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Ann Emerg Med.

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Post-Intubation Sedation and Analgesia

Core EM

The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. It was found that patients exposed to deep sedation in the ED had an independent higher incidence of continued deep sedation on ICU day one ( Fuller, 2019 ).

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Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84(11): 1500 – 4.

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