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Podcast 716: Resuscitation Fluids

Emergency Medical Minute

Release Date: 09/29/2021

Podcast 846: Early Repolarization vs. Anterior STEMI show art Podcast 846: Early Repolarization vs. Anterior STEMI

Emergency Medical Minute

Contributor: Travis Barlock, MD Educational Pearls: Early repolarization a benign EKG pattern that can mimic an anterior STEMI Can be seen in the anterior leads typically in young male patients Can differentiate Early Repolarization vs Anterior STEMI by looking at four variables: Corrected QT interval QRS amplitude in V2 R wave amplitude in V4 ST elevation 60 ms after J point in V3 These four variables can be plugged into a formula (available on MDCalc) Note that a longer QT is more corelated with STEMI   References Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The Early...

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Podcast 845: Hyperkalemic Cardiac Arrest show art Podcast 845: Hyperkalemic Cardiac Arrest

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Hyperkalemia may cause cardiac arrest  Treatment of suspected hyperkalemic cardiac arrest begins with typical management of cardiac arrest including high-quality CPR, defibrillation if appropriate, and resuscitation medications  Administer calcium products to stabilize cardiac membrane and potassium shifting medications  If ROSC is achieved, initiate dialysis  There are several case reports of patients being dialyzed while CPR is ongoing, with some success   Dialysis during resuscitation may be an appropriate...

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Podcast 844: Dental Infections show art Podcast 844: Dental Infections

Emergency Medical Minute

Contributor: Meghan Hurley, MD Educational Pearls: Educational Pearls: Dental infections can be categorized into two main groups Infections of the gums Pericoronitis Tooth eruption leading to inflammation/irritation Can progress to an infection Requires pain control, no antibiotics Gingivitis Inflammation of the gums Can lead to an infection requiring antibiotics Abscess (gums) If an infection develops in the gums it can progress to an abscess May require drainage Acute necrotizing ulcerative gingivitis (ANUG) aka Trench Mouth Filmy, grayish discoloration of the gums with “punched...

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Podcast 843: Commotio Cordis show art Podcast 843: Commotio Cordis

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: Commotio cordis is sudden ventricular fibrillation precipitated by direct impact to the chest  A national registry, US Commotio Cordis Registry, reports an average of 10-20 cases annually  95% of reported cases occur in males, indicating possible genetic component  Average age of patient in registry is 15  Most cases occur during sporting events (baseball in particular), in addition to physical altercations and industrial accidents  Treatment is high quality CPR and early defibrillation  Survival rate is...

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Podcast 842: “History of Wound Care” show art Podcast 842: “History of Wound Care”

Emergency Medical Minute

Contributor: Chris Holmes, MD Educational Pearls: Through world history, there have been various interesting approaches to wound care Ancient Egyptians applied honey, lint, and grease which provided antimicrobial, absorptive and moisturizing properties, respectively  Ancient Greeks irrigated wounds with clean water and applied wine and vinegar which may have been antimicrobial  One of the first synthetic topical antimicrobials was a dye researched by scientist and later produced by Bayer under the name Prontosil  Some current wound care methods include wet-to-dry dressings,...

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Podcast 841: Wound Care show art Podcast 841: Wound Care

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Wound care in the emergency department aims to prevent future infection Copious wound irrigation is the important step in preventing wound infection Studies have shown that irrigation with tap water is just as effective, if not superior,  to  irrigation with saline or other solutions Several studies have shown no reduction in wound infection rates when using sterile gloves during wound care Recent study in the Netherlands compared infection rates between patients undergoing wound repair with and without sterile gloves Receiving...

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Podcast 840: Abnormal Pediatric Vitals at Discharge show art Podcast 840: Abnormal Pediatric Vitals at Discharge

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Pediatric patients frequently have vital signs considered abnormal for age at discharge Large multicenter study recently evaluated if pediatric patients discharged with abnormal vital signs have worse outcomes  97,824 pediatric discharges were included in the study 18.1% were discharged with vitals considered abnormal for age No significant difference in readmission rates at 48 hours (2.28% in abnormal cohort vs. 2.45% in normal cohort) No significant adverse outcomes in those discharged with abnormal vital signs (4 total PICU admissions...

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Podcast 839: Causes of Pancreatitis show art Podcast 839: Causes of Pancreatitis

Emergency Medical Minute

Contributor: Travis Barlock, MD Educational Pearls: The causes of pancreatitis can be remembered with the mnemonic: “GET SMASHED”  G: Gallstones (Most common cause of pancreatitis overall)  E: Ethanol (Alcohol consumption is the most common cause of chronic pancreatitis) T: Trauma  S: Steroids M: Malignancy A: Autoimmune  S: Scorpion Sting H: Hypertryglyceridemia  E: ERCP D: Drugs (e.g. Valproate, Antiretrovirals)    References Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic pancreatitis. Lancet. 2020;396(10249):499-512....

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Podcast 838: Sternoclavicular Septic Arthritis show art Podcast 838: Sternoclavicular Septic Arthritis

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Septic arthritis of the sternoclavicular joint is uncommon accounting for <1% of septic arthritis cases Immunosuppression and IV drug use increases the risk  Can account for up to 17% of septic arthritis cases in patients who use IV drugs Symptoms are typically vague with pain presenting around where the sternum meets the clavicle Consider imaging with CT or MRI and draining/analyzing the fluid if possible Antibiotics are the mainstay of treatment, but surgery may be required to wash out joint and resect infected bone As septic...

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Podcast 837: Snakebites show art Podcast 837: Snakebites

Emergency Medical Minute

Contributor: Meghan Hurley, MD Educational Pearls: Venomous snakes in the United States include species from the family Elapidae and subfamily Crotalinae In prehospital setting, elevate the bitten extremity and transport to hospital immediately Do not attempt interventions with the bite site  Monitor for progression of swelling past any joint line, systemic symptoms or lab abnormalities for 8-12 hours  Symptoms may present up to hours after bite   Crotalinae venom has heme toxicity and may present with lab pattern of DIC  Treatment for all symptoms is antivenom ...

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More Episodes

Contributor: Nick Tsipis, MD

Educational Pearls:

  • Fluid choice may have an impact on outcomes in resuscitation, and a meta-analysis has relevant insight into their use in sepsis and trauma patients
  • Large volume normal saline fluid resuscitation in sepsis is associated with acute kidney injury and metabolic acidosis compared to Lactated Ringers
  • Choice of fluid did not have significant differences in trauma patients for initial resuscitation

References

Tseng CH, Chen TT, Wu MY, Chan MC, Shih MC, Tu YK. Resuscitation fluid types in sepsis, surgical, and trauma patients: a systematic review and sequential network meta-analyses. Crit Care. 2020;24(1):693. Published 2020 Dec 14. doi:10.1186/s13054-020-03419-y

 

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