This document summarizes guidelines for treatment of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) from the American Diabetes Association (ADA) and Joint British Diabetes Societies Inpatient (JBDS IP). Key points include:
1) Bedside beta-hydroxybutyrate testing is now the best way to monitor treatment response in DKA.
2) For DKA, guidelines recommend fixed rate insulin infusion of 0.1 unit/kg/hr without a priming dose and adjustments to meet metabolic targets.
3) For HHS, the goal of initial therapy is to expand intravascular volume and restore perfusion by replacing approximately 50
This document discusses simulation in medical education. It defines simulation as presenting problems authentically to allow trainees to respond as they would in real situations while receiving feedback. Simulation provides controlled, safe practice opportunities and helps develop clinical skills. Factors driving increased simulation use include problems with clinical teaching, new medical technologies, assessing competence, improving patient safety, and enabling deliberate practice. Effective simulation provides feedback, repetitive practice of varying difficulty, integration into the curriculum, and clearly defined learning outcomes.
This document discusses the use of point-of-care ultrasound in emergency and critical care settings. It provides an overview of using ultrasound to diagnose pneumothorax, pulmonary edema, and other conditions. Examples are given of ultrasound findings for a pneumothorax including the lack of lung sliding and presence of a lung point. Signs of pulmonary edema on ultrasound include A-lines and B-lines. The document emphasizes that ultrasound is a rapid, noninvasive tool that can help clinicians diagnose and treat patients, but should be used along with medical history, exams, and clinical judgment.
ACTEP2014: Therapeutic hypothermia for ACTEP 2014taem
This document discusses therapeutic hypothermia after cardiac arrest and suggests starting it in the emergency department. It defines therapeutic hypothermia and reviews studies showing improved neurological outcomes when mild hypothermia is induced after cardiac arrest. The benefits of therapeutic hypothermia are explained. Methods for inducing hypothermia in the emergency department are presented, including cold intravenous fluids and surface cooling techniques. The document recommends inducing therapeutic hypothermia for comatose cardiac arrest patients with initial rhythms of ventricular fibrillation or pulseless ventricular tachycardia.
This document discusses sepsis markers and their clinical use. It summarizes several biomarkers that show potential for diagnosing and monitoring sepsis, including procalcitonin (PCT), C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST). sCD14-ST shows diagnostic value in distinguishing infection from SIRS and sepsis from severe sepsis. Studies found sCD14-ST levels correlated with severity of illness and organ dysfunction in sepsis patients. The document reviews several clinical trials and studies that evaluated these biomarkers for diagnosing and predicting outcomes in sepsis, abdominal infections, febrile neutropenia, and burns.
ACTEP2014: Sepsis management has anything change taem
This document discusses sepsis management and what has changed. It begins with an introduction to the pathophysiology of sepsis, severe sepsis, and septic shock. It then discusses early goal directed therapy (EGDT) and landmark studies like Rivers 2001 that promoted protocolized resuscitation to targets like central venous pressure, mean arterial pressure, ScvO2, and transfusion thresholds. However, later large trials like ProCESS 2014 found no difference in mortality between EGDT, standard therapy, and usual care. Targets like CVP are not accurate predictors of fluid responsiveness. Studies also found no difference in outcomes between higher and lower blood pressure or hemoglobin transfusion thresholds. There remains uncertainty around optimal fluid type, vas
ACTEP2014: How to maximise resuscitation in trauma 2014taem
This document discusses various strategies for optimizing resuscitation of trauma patients, including permissive hypotension, bedside monitoring, and hemostatic resuscitation. It provides details on the Bickell study which found delayed fluid resuscitation improved outcomes for patients with penetrating torso injuries. Bedside monitoring techniques like focused assessment with sonography for trauma (FAST) and limited trauma ultrasound exam (LTTE) can help guide fluid management. Hemostatic resuscitation involving balanced use of blood products aims to address coagulopathy often seen in severe trauma. Target blood pressures of 60 mmHg may optimize outcomes with hypotensive resuscitation.
1) A medic responds to an IED explosion where his convoy was attacked. The person next to him has bilateral mid-thigh amputations with heavy bleeding from one leg. 2) The medic's top priority is to return fire and take cover since they are still under attack. 3) Once there is suppressive fire from the rest of the convoy, the medic applies a tourniquet to the leg with arterial bleeding to control the life-threatening hemorrhage.
This document discusses the use of hemodynamic ultrasound in critical care. It describes how ultrasound can be used to diagnose various types of shock such as hypovolemic, distributive, cardiogenic, and obstructive shock. Specific conditions that can be identified include tamponade, pulmonary embolism, and reduced left or right ventricular function. The document provides guidance on assessing volume responsiveness and fluid management in critically ill patients.
The document discusses the roles and responsibilities of an emergency department director. It covers topics such as developing leadership and communication skills, implementing effective peer review and physician profiling, dealing with problem physicians, improving customer relations and patient satisfaction, managing physician and hospital contracts, recruiting and orienting new physicians, measuring productivity and compensation, managing staffing and scheduling, conducting meetings, and managing risk. The emergency department director must balance both leadership and management functions to effectively run the emergency department.
