IV fluid choice part 3: The SALT-ED trial

A review of the SALT-ED trial (Self 2018) comparing 0.9% saline to balanced IV fluids in an emergency department setting

So far, this week’s discussion of IV fluid choice has focused on ICU patients in our discussion of both the SPLIT and SMART trials. I work in the emergency department and really want to know how to manage emergency department patients. To close out IV fluids week, we will look at the SALT-ED trial, which was run by the same group and at the same hospital group as the SMART trial, but focused on patients in the emergency department.

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IV fluid choice part 2: The SMART trial

A review of the SMART trial (Semler 2018) comparing 0.9% saline to balanced crystalloid

Yesterday, I covered the SPLIT trial, comparing saline with Plasma-Lyte 148. Today we are going to look at SMART, the trial that provoked the numerous cringe-worthy popular headlines…

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IV fluid choice part 1: The SPLIT trial

A review of the SPLIT trial (Young 2015) comparing saline to Plasma-Lyte 148

“The saline used in IV bags could be killing you”, screams the New York Post. CNN seems to agree. Everyone in the world seems to know that saline is evil, but just yesterday I hung a bag of saline when treating a sick septic patient. Is that because I am a bad doctor? Because I haven’t read the studies? Because I don’t care? Or is this just another example of the general rule that headline news describing medical research is almost always wrong?

Those headlines were in response to two studies published in the New England Journal this year: SMART and SALT-ED. I will get to those papers in the next 2 days, but I think we should start with what was previously the largest, and still is the best trial available comparing saline to a balance IV solution. Welcome to IV fluids week…

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Prehospital plasma in trauma (PAMPer)

The PAMPer study (Sperry 2018) – Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock

Fluid resuscitation in trauma: a topic about which there are almost certainly more strong opinions than there are strong studies. We have moved away from crystalloid and towards using blood products, which makes some sense, given that is what the patient is losing. One question that remains is the role of plasma in resuscitating these patients, which leads us to this RCT.

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Femoral nerve blocks for hip fractures: the evidence

A deep dive into the evidence for providing femoral nerve blocks for patients with hip fractures

The most recent topic that Rory Spiegel, Anton Helman and I covered for the Emergency Medicine Cases Journal Jam is femoral nerve blocks for hip fractures. This is my summary of the evidence. Continue reading “Femoral nerve blocks for hip fractures: the evidence”

Adverse drug reactions in the emergency department (Hohl 2018)

Can a decision tool help us identify patients at risk for adverse drug reactions in the emergency department?

Adverse drug events might be responsible for as many as 1 in 9 emergency department visits.1,2,3 Physicians frequently miss the diagnosis of medication related adverse events.4,5,6 Pharmacists can be very helpful in assessing patients for adverse drug events, but are a scarce or non-existent resource in most emergency departments. This paper asks whether clinical decision tools can help us identify adverse drug reactions among emergency department patients.

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Massive Hemorrhage Post-Tonsillectomy

The initial emergency medicine management of post-tonsillectomy bleeding

Case

A ten year old boy presents with significant bleeding from his mouth and nose. He is learning forward, and although blood is rapidly pouring onto the stretcher, he is able to tell you his name. Two very anxious appearing parents are at the bedside, and are able to tell you that he had a routine tonsillectomy performed 5 days ago…

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