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Podcast 731: Fluid Resuscitation in Burns

Emergency Medical Minute

Release Date: 11/22/2021

Podcast 746: Elderly Head Trauma on Anticoagulation show art Podcast 746: Elderly Head Trauma on Anticoagulation

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Biggest study to date examined new protocol for repeat head CT in anticoagulated elderly patients with head trauma and an initial negative head CT 0.5%-6% of patients in this category will get a delayed ICH and this can occur up to a week out from initial injury 18% of the study group had an ICH on initial head CT, but the rest who had negative head CT initially received a repeat head CT at 6 hours 0.9% had a bleed identified on repeat head CT 6 hours after initial imaging, but of this group no one had an intervention for this bleed...

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Emergency Medical Minute

Contributor: Alicia Oberle, MD Educational Pearls: Nitrous oxide (N2O) can cause a vitamin B12 deficiency in patients after regular use N2O is used in procedural sedation but also as a popular recreational drug  N2O binds and inactivate B12 in the body, therefore decreasing usable supply Lack of B12, which is essential for myelinating nerves, can lead to subacute combined degeneration of the spinal cord Presentation may include paresthesias, ataxia, gait changes, or bilateral lower extremity motor weakness B12 can be normal on labs, as the B12 is present but inactivated Treatment is...

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Podcast 744: Glucagon for Beta Blocker Toxicity show art Podcast 744: Glucagon for Beta Blocker Toxicity

Emergency Medical Minute

Educational Pearls: Glucagon can be used to treat hypoglycemia and esophageal foreign body, but it can also be used in beta-blocker toxicity to bypass cardiac beta-blockade The superior option for treating bradycardia due to beta-blocker toxicity is glucagon Glucagon has decreased efficacy in patients with heart failure, so increased doses up to 10 mg might be required in the event of beta-blocker toxicity References Khalid MM, Galuska MA, Hamilton RJ. Beta-Blocker Toxicity. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available...

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Podcast 743: Rust Rings show art Podcast 743: Rust Rings

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: A rust ring can occur after a metallic foreign body is left in the eye for a prolonged period of time Issues occur when the rust ring is left as it can epithelialize and become a permanent spot in the patient’s vision An eye burr or Alger brush can help to gouge out the rust ring in the emergency setting These tools have a failsafe mechanism to prevent the eye burr from going through layers past the cornea (though this does not work if the foreign body is already through the cornea) Referral to ophthalmology, antibiotic drops, and dilating...

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Podcast 742: Pulse Check During CPR show art Podcast 742: Pulse Check During CPR

Emergency Medical Minute

  Contributor: Aaron Lessen, MD Educational Pearls: Pulse checks are necessary during CPR to check for return of spontaneous circulation (ROSC) Previous studies have shown that assessing ROSC with palpating for pulse are not a very consistent Study compared palpating pulses at carotid/femoral artery versus a newly contrived gold standard for pulse checks The gold standard used was an increase in end tidal CO2 + cardiac activity on ultrasound + perfusing rhythm on ECG Carotid artery palpation was the best location to confirm pulse during pulse check, although femoral artery palpation ...

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Podcast 741: Calcium for Cardiac Arrest show art Podcast 741: Calcium for Cardiac Arrest

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Study of nearly 400 patients evaluating giving calcium during cardiac arrest with the endpoint as return of spontaneous circulation (ROSC) Compared giving 1 amp calcium chloride with each round of epinephrine for the first two rounds of epinephrine versus saline placebo ROSC occurred in 19% of patients in the calcium groups versus 27% in saline placebo group No magic drugs in cardiac arrest, good CPR and early defibrillation are still the most important factors for ROSC in cardiac arrest  References Vallentin MF, Granfeldt A, Meilandt C,...

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Podcast 740: Placenta Previa show art Podcast 740: Placenta Previa

Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: High concern causes of third trimester vaginal bleeding include placenta previa, placental abruption, or vasa previa In placenta previa, the placenta implants over the cervix and this condition Often noted during routine prenatal care on transabdominal ultrasound Patients present with painful vaginal bleeding, usually in the absence of trauma Avoid pelvic exam, transvaginal ultrasound, or digital vaginal exam in placenta previa Risk factors for placenta previa include multiple gestations, previous medical abortions, advanced maternal age,...

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Podcast 739: Perceptions of Dress show art Podcast 739: Perceptions of Dress

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Study examined patient perceptions of providers wearing traditional white coats,  fleece coats and soft-shell jackets Found that white coats were seen as more professional than other types of dress Also found that female physicians were viewed as less professional than their male counterparts regardless of dress Older respondents thought more of white coats than younger respondents Patient perspective should be considered and reiterating roles may help build relationships with patients References Xun H, Chen J, Sun AH, Jenny HE, Liang F,...

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Podcast 738: Acute Mesenteric Ischemia show art Podcast 738: Acute Mesenteric Ischemia

Emergency Medical Minute

Contributor: Ian Gillman, PA-C Educational Pearls: Acute mesenteric ischemia is a condition where bowel loses blood supply from an acute occlusion of the mesenteric arteries A frequent sign is abdominal pain that is out of proportion to the exam Atrial fibrillation is one risk factor for mesenteric ischemia Treatment includes anticoagulation and possible surgical intervention depending on the extent of the ischemia References Monita MM, Gonzalez L. Acute Mesenteric Ischemia. [Updated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Kühn F,...

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Podcast 737: TBI Outcomes show art Podcast 737: TBI Outcomes

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Study evaluating patient outcomes after traumatic brain injury (TBI) over 1 year Trial followed patients with severe TBI (GCS 3-8) and moderate TBI (GCS 9-12) At 1 year out ½ of the severe TBI group were able to be independent for at least 8 hours per day; ⅔ were independent to this level at one year in the moderate TBI group ¼ of the patient who were in a vegetative state 2 weeks after the traumatic brain injury had good outcomes at 1 year References McCrea MA, Giacino JT, Barber J, et al. Functional Outcomes Over the First Year After...

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Contributor: Chris Holmes, MD

Educational Pearls:

  • Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours
    • 50% given over 8 hours and 50% given over the next 16 hours
  • Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours
    • 50% given over 8 hours and 50% given over the next 16 hours
  • 2009 military study evaluated Parkland vs. Brooke formulas for severe burn patients and found the outcomes were the same
  • Guidelines are in flux on which formula to use, but reducing the overall volume using the Brooke formula can be done without significant change in morbidity or mortality
  • Using fluid responsiveness by measuring urine output and signs of fluid overload can help guide overall resuscitative approach in burn patients

References

Chung KK, Wolf SE, Cancio LC, et al. Resuscitation of severely burned military casualties: fluid begets more fluid. J Trauma. 2009;67(2):231-237. doi:10.1097/TA.0b013e3181ac68cf

Schaefer TJ, Nunez Lopez O. Burn Resuscitation And Management. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430795/

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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