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The Search for the Holy Grail: Assessment of Fluid Responsiveness
Last week our residents and faculty met for journal club in search of the holy grail.. err.. I mean, to talk about ways to assess volume responsiveness. A couple of weeks back the PGY-1 and 2 residents met and discussed a number of questions they had about the care and management of patients with sepsis. The discussion hit on a number of key topics: empiric antibiotic selection, timing of antibiotics, choice of vasopressors, etc. Ultimately the group decided they wanted to take a closer look at non-invasive ways to assess volume responsiveness and guide resuscitation in septic patients.
Procedural Sedation Cage Match
It's a typical busy post-Thanksgiving shift in the ED. It seems like patients with acute decompensated heart failure, sepsis, NSTEMI's and a whole host of other ailments are tucked in every corner and crevice of the ED. Just as you finish putting in orders on the last patient you saw, your next patient rolls by on an EMS stretcher. You see from your computer that the patient is on a backboard and in a c-collar after what clearly was some form of traumatic event. He's screaming in pain and holding his left leg flexed at the hip and internally rotated. "Jeez, I bet that hip is dislocated," you say to yourself.
You know you're going to need to reduce this dislocation, to not do so would risk avascular necrosis. Tammy, one of the nurses you are working with that day is already 2 steps ahead of you. "Doc, we're getting everything set up for the sedation, you're going to need for that hip that's out. What drugs do you want us to pull up?"
Transfusion in Trauma: One Ratio to Rule them All??
A couple weeks back we met for the first journal club of the year in our residency. For this first session, we tackled the clinical conundrum of transfusion ratios in trauma. The question came from a brainstorming session with the PGY-1 and 2 residents, where the following PICO question was derived:
Patients: Victims of both blunt and penetrating trauma in need of blood transfusion as a part of the their initial resuscitation
Intervention: high plasma and platelet to PRBC ratio transfusion
Comparison: low plasma and platelet to PRBC ratio transfusion
Outcome: Mortality (in patient and 30 day mortality)