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Podcast # 472: SMART Crystalloids

Emergency Medical Minute

Release Date: 05/23/2019

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Emergency Medical Minute

Contributor: John Winkler, MD Educational Pearls: Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO It is thought to be related to the contents of homemade vaping fluid, mostly in THC-containing products (“brands” include DankVapes, PaxPen) Ask patients with vague constitutional or respiratory symptoms about their vape use References What are the respiratory effects of e-cigarettes? Gotts JE, Jordt SE, McConnell R, Tarran R BMJ. 2019;366:l5275. Epub 2019 Sep 30. Pulmonary Illness...

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Emergency Medical Minute

Author: Jared Scott, MD Educational Pearls: A hyphema is blood in the anterior chamber of the eye, typically caused by trauma While there is a spectrum of disease, blurred vision and eye pain are common presenting complaints after direct trauma to the eye Hyphema are graded between Grade 1 and Grade 5, depending on the amount of blood in the anterior chamber. Higher grades are associated with worse outcomes and more complications Other important diagnoses to consider include globe rupture and retrobulbar hematoma Complications of a hyphema can include glaucoma and vision loss  ...

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Emergency Medical Minute

Contributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical  The differential for near cardiac arrest includes the “H’s and T’s”, just as in true cardiac arrest  The 6 H’s include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia  The 6 T’s include: tension pneumothorax, cardiac tamponade, thrombus (PE/MI), toxins, trauma  Use your history skills to narrow down this list (i.e renal failure leads to...

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Emergency Medical Minute

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor:  Michael Miller, Strategic Initiatives Coordinator, Jefferson County Public Health

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Emergency Medical Minute

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Judith Shlay, MD, MSPH, Associate Director, Denver Public Health, and Brooke Bender, MPH, Center for Addiction Medicine Planner, Denver Health

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From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor:  Christopher Urbina, MD, MPH, Colorado Consortium for Prescription Drug Abuse Prevention

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From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Jason Vitello, MSW, Behavioral Health Coordinator, Denver Public Health/CPHA

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Emergency Medical Minute

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Sarah Davidon, EdD, Director of Research & Child and Adolescent Strategy, Mental Health Colorado, and Sarah Younggren, LCSW, Child & Adolescent Specialist, Mental Health Colorado

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Emergency Medical Minute

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Carl Clark, MD, President & Chief Executive Officer, Mental Health Center of Denver

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Emergency Medical Minute

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Karen Prestia, MBA, Director, Marketing & Communications, Mental Health Center of Denver

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Author: Gretchen Hinson, MD

Educational Pearls:

  • In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks
  • Compared to normal saline, a balanced crystalloid (either lactated Ringer’s or Plasma-Lyte) was associated with a lower composite endpoint of mortality, renal replacement therapy, and renal injury in SMART (Isotonic Solutions and Major Adverse Renal Events Trial)
  • Balanced crystalloids such as lactate Ringer’s may be preferable in more critically ill populations

References

Yau YW, Kuan WS. Choice of crystalloids in sepsis: a conundrum waiting to be solved. Ann Transl Med. 2016;4(6):121. doi:10.21037/atm.2016.02.09

Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829–839. doi:10.1056/NEJMoa1711584

Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD