Comparison of Emergency Resuscitation with Colloids and Crystalloids

1985 ◽  
Vol 1 (S1) ◽  
pp. 10-17
Author(s):  
William C. Shoemaker
Keyword(s):  
Emergency Department ◽  
Time Delay ◽  
Fluid Resuscitation ◽  
Clinical Management ◽  
Fluid Management ◽  
State Of Health ◽  
Direct Effects ◽  
Management Protocol ◽  
Fluid Losses ◽  
Prior State

Clinical management is exceedingly difficult to evaluate in emergency patients because resuscitation is often chaotic, disorderly, and frantic. Resuscitation depends upon many factors: the primary illness or injury, the amount of blood and fluid losses, the patient's age, the prior state of health, the associated medical conditions, the time delay in instituting therapy, the volume and rate of fluids administered, and, finally, the choice of fluids given. Although it is difficult to control the effects of these complex interrelated factors, their influence may be evaluated by stratifying patients and then comparing the direct effects and outcome measures within each stratum.There has been persistent controversy over the relative merits of crystalloids and colloids in fluid resuscitation. We studied reviews of fluid management of all hypotensive patients seen in the adult surgical section of the Emergency Department (ED) during a 2½ year period, to compare the conventional crystalloid resuscitation which had been standard for this busy university-run county hospital with a fluid management protocol consisting of about 1/4 A colloids depending on age, cardiac history, and CVP.

scholarly journals Radiological Reporting of Urgencies Related to Medical Devices: Commentary on a Possible Systematic Approach

Tomography ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. 268-277
Author(s):  
Andrea Contegiacomo ◽  
Marco Conti ◽  
Massimo Muciaccia ◽  
Pietro Trombatore ◽  
Michele Dezio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Devices ◽  
Clinical Management ◽  
Systematic Approach ◽  
Patient Access ◽  
Radiological Images ◽  
Radiological Report

Most medical devices are routinely recognized on radiological images and described as normal findings in the radiological report, but sometimes they can cause patient access to the emergency department. Multiple possible complications have been described and most of them require prompt recognition by radiologists for proper clinical management. This commentary proposes a systematic approach to radiological reporting of the most common emergent complications related to medical devices with the intent to avoid the omission of important findings in the final radiological report.

scholarly journals Renal colic, where is it headed? An observational study

2016 ◽  
Vol 88 (1) ◽  
pp. 7 ◽  
Author(s):  
Paolo Beltrami ◽  
Andrea Guttilla ◽  
Lorenzo Ruggera ◽  
Patrizia Bernich ◽  
Filiberto Zattoni
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Observational Study ◽  
Clinical Management ◽  
Renal Colic ◽  
Ureteral Stone ◽  
Ureteral Calculi ◽  
Ureteral Calculus ◽  
Spontaneous Expulsion ◽  
Pain Symptoms

Aim: In the last thirty years, the treatment for renal and ureteral calculi has undergone profound variations. The objective of this study has been to evaluate the existence of parameters which can affect the spontaneous expulsion of a symptomatic ureteral stone in a reasonably brief period of time and to identify whether certain parameters such as sex, age, the location and dimension of the stone, the presence of dilation in the urinary tract together with the administered therapy, can be used for a correct clinical management of the patient. Methods: In a period of 9 months, 486 cases of renal colic were registered at emergency department. Results: The cases of renal colic due to ureteral calculus were 188 (38.7%). The patients’ charts, complete of all data and therefore, valid for this research, resulted to be 120 (64%). In the presence of a symptomatic ureteral stone, the correct approach must first of all, focalize on the dimension of the calculus itself; less importance instead, is given to the location, as reported in other studies, the presence of hydroureteronephrosis, sex and the side. Conclusion: In the cases when the pain symptoms cannot be solved by means of the administration of analgesics, it is then reasonable to take into consideration an immediate endourological treatment. If the pain symptoms are promptly solved, an attentive wait of 4 weeks should be considered reasonable in order to allow spontaneous expulsion of the calculus.

Clinical Management Protocol for Dental Implants Inserted in Patients with Active Lichen Planus. Part II 4‐Year Follow‐Up

2018 ◽  
Vol 28 (5) ◽  
pp. 519-525 ◽  
Author(s):  
Aya Khamis Khamis ◽  
Moustafa Nabil Aboushelib ◽  
Mohamed Hamdy Helal
Keyword(s):  
Dental Implants ◽  
Lichen Planus ◽  
Clinical Management ◽  
Management Protocol

scholarly journals Factors affecting prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt: A cross-sectional study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252044
Author(s):  
Doaa Mahmoud Khalil ◽  
Elmorsy Elmorsy ◽  
Ahmed Arafa ◽  
Hesham Ahmed Nafady ◽  
Lamiaa Saleh
Keyword(s):  
Emergency Department ◽  
Time Delay ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Consciousness Level ◽  
Injured Patients ◽  
Prehospital Time

Purpose This study aimed to assess the factors affecting the prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Upper Egypt. Materials and methods In this cross-sectional study, the following data were retrieved from the hospital records of 632 injured patients between 1/1/2018 and 31/3/2018: age, sex, residence, means of transportation to the hospital, prehospital time delay, consciousness level on admission, source of injury, and type of worst injury. Results The prehospital time delay (>one hour) of the injured patients was positively associated with age >60 years and rural residence but inversely associated with consciousness level with odds ratios (95% confidence intervals) of 5.14 (2.26–11.68), 3.49 (2.22–5.48), and 0.56 (0.32–0.96), respectively. Conclusion The prehospital time delay of the injured patients arriving at the Emergency Department of Beni-Suef University Hospital in Egypt was associated with old age, rural residence, and consciousness level.

scholarly journals Fluid resuscitation in trauma: what are the best strategies and fluids?

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
G. H. Ramesh ◽  
J. C. Uma ◽  
Sheerin Farhath
Keyword(s):  
Fluid Resuscitation ◽  
Trauma Care ◽  
Fluid Management ◽  
Main Body ◽  
Transport Time ◽  
Low Resource ◽  
Prehospital Trauma Care ◽  
Special Groups ◽  
Resuscitation Fluid ◽  
Care Systems

Abstract Background Traumatic injuries pose a global health problem and account for about 10% global burden of disease. Among injured patients, the major cause of potentially preventable death is uncontrolled post-traumatic hemorrhage. Main body This review discusses the role of prehospital trauma care in low-resource/remote settings, goals, principles and evolving strategies of fluid resuscitation, ideal resuscitation fluid, and post-resuscitation fluid management. Management of fluid resuscitation in few special groups is also discussed. Conclusions Prehospital trauma care systems reduce mortality in low-resource/remote settings. Delayed resuscitation seems a better option when transport time to definitive care is shorter whereas goal-directed resuscitation with low-volume crystalloid seems a better option if transport time is longer. Few general recommendations regarding the choice of fluid are provided. Adhering to evidence-based clinical practice guidelines and local modifications based on patient population, available resources, and expertise will improve patient outcomes.

Establishment of a multidisciplinary concussion program: impact of standardization on patient care and resource utilization

2014 ◽  
Vol 13 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Sara Anne Wilkins ◽  
Chevis N. Shannon ◽  
Steven T. Brown ◽  
E. Haley Vance ◽  
Drew Ferguson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Resource Utilization ◽  
Media Coverage ◽  
Public Awareness ◽  
Return To Play ◽  
Management Protocol ◽  
Before And After ◽  
Multiple Variables ◽  
The Impact

Object Recent legislation and media coverage have heightened awareness of concussion in youth sports. Previous work by the authors' group defined significant variation of care in management of children with concussion. To address this variation, a multidisciplinary concussion program was established based on a uniform management protocol, with emphasis on community outreach via traditional media sources and the Internet. This retrospective study evaluates the impact of standardization of concussion care and resource utilization before and after standardization in a large regional pediatric hospital center. Methods This retrospective study included all patients younger than 18 years of age evaluated for sports-related concussion between January 1, 2007, and December 31, 2011. Emergency department, sports medicine, and neurosurgery records were reviewed. Data collected included demographics, injury details, clinical course, Sports Concussion Assessment Tool-2 (SCAT2) scores, imaging, discharge instructions, and referral for specialty care. The cohort was analyzed comparing patients evaluated before and after standardization of care. Results Five hundred eighty-nine patients were identified, including 270 before standardization (2007–2011) and 319 after standardization (2011–2012). Statistically significant differences (p < 0.0001) were observed between the 2 groups for multiple variables: there were more girls, more first-time concussions, fewer initial presentations to the emergency department, more consistent administration of the SCAT2, and more consistent supervision of return to play and return to think after adoption of the protocol. Conclusions A combination of increased public awareness and legislation has led to a 5-fold increase in the number of youth athletes presenting for concussion evaluation at the authors' center. Establishment of a multidisciplinary clinic with a standardized protocol resulted in significantly decreased institutional resource utilization and more consistent concussion care for this growing patient population.

Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis

2020 ◽  
pp. 088506662091790
Author(s):  
Jeremy K. Lessing ◽  
William J. H. Ford ◽  
Peter A. Steel ◽  
Sunday Clark ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation ◽  
Fluid Therapy ◽  
Intravenous Fluid ◽  
Medical Providers ◽  
Suspected Sepsis ◽  
Intravenous Fluid Therapy ◽  
Multiple Levels ◽  
Emergency Department Patients ◽  
Elevated Lactate

Background: Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information. Objectives: This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis. Methods: Adult patients presenting with a suspected diagnosis of severe sepsis to a large, urban, academic emergency department had either physician-estimated or patient self-reported weights recorded on presentation. All patients had subsequent inpatient bed/stretcher scale weights recorded on the first day of hospitalization. Results: Physician-estimated and patient self-reported weights linearly correlated ( P < .001) with inpatient bed/stretcher scale weights. Median accuracy error for physicians (5.4% [2.0-10.1]) and patients (3.9% [1.6-6.4]) was not significantly different ( P = .28). Physician-estimated and patient self-reported weights accuracy was determined at multiple levels: within 5% (46%, 57%, respectively), 10% (75%, 90%), 15% (90%, 95%), and 20% (100%, 95%) error tolerances, as well accurate estimates within 5 kg (69.2%, 70.0%). Conclusions: Both physician-estimated and patient self-reported weights are reliable when calculating initial protocol-based intravenous fluid resuscitation for emergency department patients with sepsis.

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