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Maintenance Fluids in Critical Illness

Don't Forget the Bubbles

Have a look to see how their osmolarity and tonicity across the cell membrane compare to plasma. Renal (= urine output) : anti-diuretic hormone (ADH) release from the posterior pituitary is stimulated by microchanges in plasma osmolarity. 2018 Apr;44(4):409-417. Epub 2018 Mar 27. Intensive Care Med. 2018;44(4):409-417.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

7 Check out ToxCard: Nerve Agents by Dr. Sahi & Dr. Santos from July 2018 Organophosphates exert their toxic effects by inhibiting acetylcholinesterase within the synaptic cleft, which leads to accumulation of acetylcholine, with subsequent overstimulation of postsynaptic nicotinic and muscarinic receptors, and a predominant cholinergic effect.

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A middle aged man with unwitnessed cardiac arrest

Dr. Smith's ECG Blog

Terbutaline and Albuterol for Lowering of Plasma Postassium Initial labs returned and confirmed critical hyperkalemia and new renal failure. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. In 2018 there is generally a delay to onset of dialysis in most EDs.

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Penetrating chest trauma

Don't Forget the Bubbles

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P  = 0.03.).

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

REBEL EM

Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial. J Trauma Acute Care Surg 2018. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 Lancet Haematol 2017.

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Sickle Cell Disease Module

Don't Forget the Bubbles

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting.

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