Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock

Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock

In injured patients at risk for hemorrhagic shock, the prehospital administration of thawed plasma was safe and resulted in lower 30-day mortality and a lower median prothrombin-time ratio than standard-care resuscitation.... read more

Chest Compression Rates and Pediatric In-hospital Cardiac Arrest Survival Outcomes

Chest Compression Rates and Pediatric In-hospital Cardiac Arrest Survival Outcomes

Non-compliance with compression rate Guidelines was common in this multicenter cohort. Among ICU patients, slightly lower rates were associated with improved outcomes compared to Guidelines.Prospective observational study... read more

Thai cave rescue: The drug that allowed boys to survive rescue mission

Thai cave rescue: The drug that allowed boys to survive rescue mission

Thai schoolboys were rescued from the cave using dissociative ketamine plus positive-pressure facemask ventilation (to prevent water from leaking into their masks), so they basically used delayed sequence intubation strategy.... read more

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock

Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial... read more

Treatment of Acute Non-Anion Gap Metabolic Acidosis

Treatment of Acute Non-Anion Gap Metabolic Acidosis

Acute non-anion gap metabolic acidosis is now recognized to be as a common cause of metabolic acidosis, particularly in the ICU. Further examination of its impact on cellular function and clinical outcome are needed. Most... read more

Nine Reasons to Quit Using Normal Saline for Resuscitation

Nine Reasons to Quit Using Normal Saline for Resuscitation

Saline vs. balanced solutions has been a topic of ongoing debate. Two fresh studies will illuminate this: the SMART and SALT-ED trials. This post summarizes current knowledge, beginning with physiology and working our way... read more

The Fluid Debate: Balanced or Unbalanced

The Fluid Debate: Balanced or Unbalanced

Consider using balanced fluids in your ED unless you are treating a patient at risk for cerebral edema, or a patient with a chloride responsive metabolic alkalosis, e.g. from gastric losses. Although the superiority of balanced... read more

AKI and Mild Therapeutic Hypothermia in Patients After Cardiopulmonary Resuscitation

AKI and Mild Therapeutic Hypothermia in Patients After Cardiopulmonary Resuscitation

The aim of this study was to investigate the influence of mild therapeutic hypothermia (MTH) on the incidence of and recovery from acute kidney injury (AKI). Mild therapeutic hypothermia seems to have a protective effect... read more

Hemodynamic Support of Pediatric and Neonatal Septic Shock

Margaret Parker, MD, MCCM, speaks with Joseph A. Carcillo, MD, about the article, "American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock," published... read more

Haemostatic Resuscitation in Trauma: The Next Generation

Haemostatic Resuscitation in Trauma: The Next Generation

The next generation of haemostatic resuscitation aims at applying a ratio 1:1:1 driven strategy while using antifibrinolytics, haemostatic monitoring and avoiding critical fibrinogen deficiency by substitution. Mortality... read more

Patient Remains Awake for 90 Minutes of CPR

Patient Remains Awake for 90 Minutes of CPR

A man undergoing CPR, exhibited signs of conscious awareness for 90 minutes before the medical team stopped the life-sustaining procedure, according to a new case report. The 69-year-old man was admitted to a hospital in... read more

Strategies for Intravenous Fluid Resuscitation in Trauma Patients

Strategies for Intravenous Fluid Resuscitation in Trauma Patients

Fluids are drugs and should be managed as such. Appropriate early fluid resuscitation in trauma patients is a challenging task. Care should be taken in selecting both the type and volume to promote appropriate perfusion and... read more

Abnormal Saline and the History of Intravenous Fluids

Abnormal Saline and the History of Intravenous Fluids

Two new clinical trials together involving nearly 30,000 patients support previous observational evidence that the most common solution used for intravenous fluid therapy in the world is associated with kidney damage. Both... read more

Pushing Pressors in the Periphery

The mantra of the Broome Docs site is "bringing great care, out there." And today's topic goes right to the heart of that theme. It is one of my pet topics – so apologies in advance if the rant is too long or detailed.... read more

The Ten Pitfalls of Lactate Clearance in Sepsis

The Ten Pitfalls of Lactate Clearance in Sepsis

Clearance is the removal of a substance from blood, expressed as a volume (milliliters) over time (minutes). However, changes in lactate levels are the sum of ongoing production and removal from the blood by excretion (e.g.,... read more

Resuscitation Sequence Intubation – Hypoxemia Kills

Resuscitation Sequence Intubation – Hypoxemia Kills

This blog post is the second part of a series of 3, on a recent lecture I was asked to give on Critical Care Updates: Resuscitation Sequence Intubation. This talk was mostly derived from a podcast by Scott Weingart (Twitter:... read more

Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock

Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock

Children receiving fluid boluses over 5–10 minutes each had a higher risk of intubation than those receiving boluses over 15–20 minutes each. Notwithstanding the lack of difference in risk of mortality and the possibility... read more