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SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study

The Skeptics' Guide to EM

Date: June 12th, 2022 Reference: Finfer et al. He is board certified […] The post SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study first appeared on The Skeptics Guide to Emergency Medicine. Date: June 12th, 2022 Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

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Snake Bites and Children

Pediatric EM Morsels

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

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Transfusion Reactions

Core EM

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

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ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] McGraw Hill; 2022. 2] This linking group can be either an amide (e.g.,

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Transfusion Reactions

Core EM

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

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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. 2022 Dec;57(12):986-993. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. to −0.5%]; P  = 0.03.).

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Sepsis Updates Relevant to the Emergency Physician

EMDocs

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. The first was the suggestion to use balanced crystalloid fluids, such as lactated ringers or plasma-lyte, instead of normal saline. 2020;157(2):286-292. N Engl J Med. 2022;386:2459-2470.

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