Emergency medicine clinics of North America
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Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. ⋯ Providers should have explicit plans for recovery after traumatic cases, including developing resilience and self-compassion. Experts in resuscitation can improve their performance (and that of their team) by consciously incorporating psychological skills into their armamentarium.
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Emerg. Med. Clin. North Am. · Nov 2020
Review Historical ArticleFluid Resuscitation: History, Physiology, and Modern Fluid Resuscitation Strategies.
Intravenous (IV) fluids are among the most common interventions performed in the emergency department. They are at times lifesaving, but if used recklessly can be harmful. Given their ubiquity, it is important to understand the history, physiology, and current strategies that govern the use of IV fluids during the resuscitation of the critically ill.
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Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. ⋯ Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited. As hemodynamic stability is restored, endpoints of resuscitation should be used to guide the resuscitation.
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Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal membrane oxygenation may improve outcomes, but remain primarily investigational.