Podcasts about normal saline

In this episode of the Saving Lives Podcast, we review a 2025 study from Critical Care Medicine comparing lactated Ringer's and normal saline for initial fluid resuscitation in sepsis-induced hypotension. The findings suggest that LR may improve survival and increase hospital-free days compared to NS, supporting current guidelines favoring balanced crystalloids. Tune in for a deep dive into the study's results and clinical implications!The Vasopressor & Inotrope HandbookI have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: Gelbenegger G, Shapiro NI, Zeitlinger M, Jilma B, Douglas IS, Jorda A. Lactated Ringer's or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension. Crit Care Med. 2025 Feb 19. doi: 10.1097/CCM.0000000000006601. Epub ahead of print. PMID: 39969246.

13.00 เอกชนชี้ปี 2567 เป็นโอกาสทองผู้ซื้อบ้านมือสอง หลังความต้องการขายเพิ่มต่อเนื่อง //อย.เตือนกรณีเผยแพร่ข้อมูลน้ำเกลือ Normal Saline ใช้แช่คอนแทคเลนส์ได้ไม่เป็นความจริง

This week on Journal Club we wrap up 2023 several interesting articles. From the POPART trial's insights into noninvasive surfactant delivery to the controversial use of saline boluses in preterm infants, this episode promises to give you things to think about during the holiday season. As we bid farewell to 2023, join us for a journey through the latest advancements that have challenged and enlightened us. We scrutinize the outcomes of administering oropharyngeal surfactant and examine the physiological effects of normal saline boluses on the tiniest patients. Each segment unveils critical takeaways, urging a reevaluation of established practices and spotlighting the synergy of interdisciplinary collaboration for enhancing neonatal health care.Looking ahead, we're excited to share a glimpse of the upcoming podcast series that will further our mission of education and support for both practitioners and families. From "At the Bench" with its focus on the nitty-gritty of basic science research to the NICU Family Podcast aimed at deciphering medical jargon for parents, we're expanding our network to bring diverse perspectives under one roof. Stay tuned as we recharge during our brief hiatus, and prepare to return with more episodes that promise to inspire, challenge, and evolve the world of neonatology. As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

When fluid resuscitating a hypotensive patients, how do you know when to continue with IV fluids and when to initiate vasopressors? In this episode, critical care teaching legend Nicole Kupchik, RN MSN CNS, shares evidence-based practices for determining the best course of action. Explore the significance of noninvasive measurements in assessing fluid responsiveness and learn how incorrect decisions can lead to adverse patient outcomes. Nicole Kupchik's latest book, The Critical Care Survival Guide, is a concise bedside reference book with easy-to-access resources for anyone working in critical care regardless of experience level.Studies that support the use of balanced crystalloids in fluid resuscitation versus normal saline:Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-AnalysisLactated Ringer's Solution Reduces Systemic Inflammation Compared With Saline in Patients With Acute Pancreatitis

Theme: Critical Care.Participants: Dr Alex Yartsev (intensivist at Westmead Hospital), Dr Mark Salter (emergency physician at Westmead Hospital), Maddy Jegatheeswaran (intensive care Fellow at Westmead Hospital), Gladis Kabil (registered nurse at Westmead Hospital), Kristian Adams, Pramod Chandru, Caroline Tyers, Amanda De Silva, Shreyas Iyer, and Samoda Wilegoda. Discussion:Kabil, G., Liang, S., Delaney, A., Macdonald, S., Thompson, K., Saavedra, A., Suster, C., Moscova, M., McNally, S., Frost, S., Hatcher, D., & Shetty, A. (2021). Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study. Emergency Medicine Australasia, 34(3), 361–369. https://doi.org/10.1111/1742-6723.13893. Presenter: Gladis Kabil - registered nurse at Westmead Hospital and PhD candidate. Music/Sound Effects: Lagoon by LiQWYD & Luke Bergs | https://www.liqwydmusic.com, https://soundcloud.com/bergscloud, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. My Old East Coast by Vendredi feat. Melanie | https://soundcloud.com/vendrediduo, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Slipz (audio logo) by tubebackr | https://soundcloud.com/tubebackr, Music promoted by https://www.free-stock-music.com. Trick Or Treat by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. When The Lights Go On by Vlad Gluschenko | https://soundcloud.com/vgl9, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Disclaimer:Please be advised that the individual views and opinions expressed in this recording strive to improve clinical practice, are our own, and do not represent the views of any organization or affiliated body. Therapies discussed are general and should not be a substitute for an individualized assessment from a medical professional.Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time!~

In episode 60 of the pharmaceutical calculations podcast, you will learn how to calculate the volume of normal saline needed to provide the correct concentration of Na+ for an infusion. Key equations and pertinent concepts such as percentage strength and millimoles are also reviewed. This episode was originally broadcast as a video on our YouTube channel: www.youtube.com/pharmaceuticalcalculationseasyAdditional Resources for Practice:Pharmaceutical Calculations: 1001 Questions with Answers: https://www.rxcalculations.com/shop/uncategorized/pharmaceutical-calculations-1001-questions-answers/NAPLEX Question Bank: https://www.rxcalculations.com/shop/uncategorized/gold-membership/Join Our Social Media Community:Website: http://www.rxcalculations.comForum: https://forum.rxcalculations.com/Facebook: https://www.facebook.com/pharmaceuticalcalculationsTwitter: https://twitter.com/RxCalculationsInstagram: https://www.instagram.com/rxcalculationsYouTube: www.youtube.com/pharmaceuticalcalculationseasyAbout RxCalculations: RxCalculations helps you master pharmaceutical calculations. We make it so you never have to worry about failing an exam or compromising patient safety because of a calculations error. RxCalculations is a leading global educational service platform focused on developing top quality pharmaceutical calculations products to help prospective pharmacists and health care professionals all over the world resolve one of the biggest challenges related to their profession.Our top quality products include affordable courses, personal consults, books, video tutorials, timed quizzes and apps designed to make you an expert in solving any pharmaceutical calculations question. We also have the largest pharmaceutical calculations online question bank which has over 1000 questions covering every important calculations topic as well as step-by-step video solutions. With all these resources at your disposal we have all you need to not only master pharmacy calculations but ace every test as well as passing your board exams.

Date: June 12th, 2022 Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. NEJM 2022. Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in the Department of Critical Care Medicine at Mayo Clinic Arizona.  He is board certified […]

CKC February 2022 Dispatch: In this edition we review a studying using fuzzy regression discontinuity design to answer a question about the risk of contrast induced nephropathy. We even take a brief detour to talk about what the heck fuzzy RDD is. In the latter half we discuss a subject that still keeps a lot of people salty, NS v plastma lyte or LR. 00:00 - Intro 00:55 - IV Contrast and Kidney Function - Association of Intravenous Radiocontrast With Kidney Function: A Regression Discontinuity Analysis 03:54 - Balanced Electrolyte Solutions vs Normal Saline in the ICU - Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults | NEJM | Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis | NEJM Evidence 05:22 - Outro

Contributor: Aaron Lessen, MD Educational Pearls: Normal saline is thought to interfere with renal function and cause an acidosis and balanced fluids (like lactated ringers) are a better option The SALT-ED trial and SMART trial showed a small benefit with renal injury and need for dialysis using balanced fluid in critically ill patients Recent multicenter RCT in Brazil evaluated balanced fluids versus normal saline and looked at 90-day mortality Found no difference in 90-day mortality or secondary outcomes like renal function PLUS trial is currently being done in Australia and New Zealand to further evaluate fluid choice Larger trials don't show a major difference at this point, keep an eye out for future trials References Semler MW, Wanderer JP, Ehrenfeld JM, et al. Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial. Am J Respir Crit Care Med. 2017;195(10):1362-1372. doi:10.1164/rccm.201607-1345OC   Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584 Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial [published online ahead of print, 2021 Aug 10]. JAMA. 2021;326(9):1-12. doi:10.1001/jama.2021.11684 https://clinicaltrials.gov/ct2/show/NCT02721654 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!  

Today we are joined by Dr. Brian Locke to talk about the newest big trial on IV fluids in critically ill patients and a meta-analysis that looks at all the similar trials. Is this question finally settled?We also look at PICC lines vs midlines, IV L-ornithine L-aspartate in acute treatment of hepatic encephalopathy, a new ward-based program for delirium prevention in older inpatients, post-discharge thromboprophylaxis for high risk COVID patients, and whether mindfulness training can help burnout in residents.Balanced Multielectrolyte Solution vs Normal Saline in Critically Ill Patients (PLUS)Balanced Crystalloid vs Normal Saline Meta-analysisPICC lines vs MidlinesApixaban vs Rivaroxaban for Recurrent VTE LOLA for Hepatic EncephalopathyEat-Walk-Engage in Older Inpatients (CHERISH)Rivaroxaban for Post-discharge Prophylaxis in High Risk COVID patients (MICHELLE)Mindfulness Training and BurnoutMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Commentary by Dr. Usha Tedrow

Contributor: Ricky Dhaliwal, MD Educational Pearls: Multiple RCTs and a Cochrane Review found there is no difference in wound infection rates when irrigating with tap water  Pressure of the water and how extensively the wound is irrigated were the most important factors affecting infection rates Quantity and type of water were independently not as important References Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2012;(2):CD003861. Published 2012 Feb 15. doi:10.1002/14651858.CD003861.pub3 Lewis K, Pay JL. Wound Irrigation. [Updated 2021 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538522/ Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Welcome to October's papers of the month! Should patients who gain a ROSC following an out of hospital cardiac arrest go for an immediate angiogram if their ECG does not show an STEMI or Left Bundle Branch Block? We've looked at this before with the COACT trial which only looked at those patients with a shockable rhythm but this months paper looks at all ROSCs from all rhythms. Next up we take a look at a paper that investigates senior paramedics decision making in cessation of cardiac arrests and think further about the decision making that goes into these complex decisions. Finally we take a look at a huge trial assessing the use of balanced fluids versus Normal Saline in critically ill patients and gain more information about the strategy we should employ. Once again we'd love to hear any thoughts or feedback either on the website or via twitter @TheResusRoom. Enjoy! Simon & Rob

We're back after a nice relaxing summer taking care of a surge of COVID-19 patients.  To start off season 3 we decided to do a rapid review of some of the best articles over the last three months.  Dr. Brian Locke returns to help us break down some critical care papers, we talk about the miracle of SGLT-2 inhibitors, the treatment of UTIs in men, and the latest in COVID-19 literature. Hypothermia vs Normothermia after Cardiac ArrestEmpagliflozin for Heart Failure with Preserved EFAntibiotic Duration for Afebrile UTIs in MenNormal Saline vs Balanced Solution in ICU patients Baricitinib for COVID-19Therapeutic Anticoagulation for COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Well done Katherine on a great viva session with us.You present very well with great technique for answering questions, getting to the point, and thinking on your feet.All the best with your exam!Please support us on our patreonhttps://www.patreon.com/anaesthesiaAll proceeds will go to Fund a Fellow, to help train anaesthetists in developing countries.Please rate, post a review and subscribe!Check out https://anaesthesiacollective.com/education/first-part-exam/ for general information and a collection of model answersand sign up to the ABCs of Anaesthesia facebook group https://www.facebook.com/groups/2082807131964430and check out the ABCs of Anaesthesia YouTube channel for more contenthttps://www.youtube.com/c/ABCsofAnaesthesiaIf you have any questions, please email Lahiruandstan@gmail.com  Disclaimer:The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this episode. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode'Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These podcasts are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com. 

One of the fundamentals of therapy for severe Diabetic Ketoacidosis (DKA) is fluids.  However, it is well known that aggressive fluid replacement with Normal Saline commonly results in a non-anion gap metabolic acidosis as the underlying condition improves. Does this acidosis cause harm?  Can it be avoided? In this edition of the podcast, Todd chats to intensivist Dr Mahesh Ramanan about his recently completed study, SCOPE, which compared the effects of buffered solution Plasmalyte 148 with normal saline in these patients. This is another great podcast interview from the 2021ANZICS Clinical Trials Group meeting in Noosa See omnystudio.com/listener for privacy information.

Show notes at pharmacyjoe.com/episode568. In this episode, I’ll discuss whether balanced crystalloid therapy could lead to faster resolution of DKA than normal saline. The post 568: Could balanced crystalloid therapy lead to faster resolution of DKA than normal saline? appeared first on Pharmacy Joe.

Drs. Young, Blaine and Ambruso explore a case of SIADH, why we DON'T use normal saline in SIADH and how to correct symptomatic hyponatremia.

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Urgent Care RAP show. Earn CME on your commute while getting the latest practice-changing urgent care information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/UCRAPPOD Ilene Claudius, MD, Matthieu DeClerck, MD, Lisa Patel, MD, and Mizuho Morrison, DO walk us through the classification of burns in pediatric patients and how this affects management. Criteria and referral to a burn center is discussed as well as the treatment of burns for outpatient vs. inpatient management. Pearls: When calculating the total body surface area burned, only include areas of partial or full thickness injury.  A good burn area estimation tool is that a child’s hand is ~1% of their total BSA.  Any partial and/or full thickness burn involving >15% of the total BSA requires immediate burn center referral. Topical antibiotic ointment is now preferred over silver sulfadiazine for superficial partial thickness burns. All full thickness burns and partial thickness burns to the hands, face, genitals, or over joints should be seen within several days by a pediatric burn specialist.  When considering burns in children, it is useful to classify them into 3 categories: life threatening, common, and negligible burns. Superficial burns (ie: those with erythema only) are of no clinical consequence.  When using a burn formula to calculate the total body surface area (BSA) involved, only the areas of partial and full thickness areas of burn count (ie: with blistering and/or loss of skin).  Partial thickness burns involve the papillary (superficial partial) or reticular (deep partial) layers of the dermis. These are generally very painful. Full thickness burns involve any tissue below the dermis (e.g. fat, muscle, bone etc). These are commonly less painful because the nerves have been destroyed. Overestimation of burned surface area is common, especially in children. Most pediatric burns have a small area of partial thickness surrounded by extensive superficial burn.   A common pitfall is to count the entire area of injury in the estimate of the percent of total BSA burned.  When estimating the percent of total BSA affected in children, the “rule of 9’s” (commonly used in adults) does not work because the proportional anatomy of children is different. The Lund Browder Chart (see references) is useful for estimating total BSA burned in children.  1% of a child’s BSA is also roughly the size of the palm and fingers on one of their hands.  Serious burns may require immediate burn center referral or outpatient follow-up depending on anatomic areas affected and the percent of total BSA burned. Burns involving >15% of the total BSA require immediate burn center referral because of the risk of significant fluid losses.  Lactated Ringer’s is preferred over Normal Saline because of the risk of acidosis. In an ED/ICU setting, fluid management is guided by monitoring urine output.  If possible, it is reasonable to begin IV fluids from UC while arranging an emergent burn center referral.  Heat loss and risk of hypothermia can be significant for children with large burns and covering children with a warm, dry sheet can help mitigate this while arranging transfer. Burns are very painful, so the liberal use of topical and oral analgesia for severe burns is critical. Smaller areas partial thickness burns involving the hands, face, genitals, or extending over a joint or complete circumference of an extremity can cause serious cosmetic and functional impairment and are best managed with close burn center follow-up.  All full thickness burns will require non-urgent burn center follow-up (ie: within several days) because skin grafting will usually be required to allow for healing. Recommended topical wound/burn care depends on the depth of the burn. Superficial burns require no wound care but aloe products or Vaseline™ can soothe discomfort.  Superficial partial thickness burns with intact blisters seem to become infected less often and heal faster if the blister is drained and debrided, but this remains controversial. It is appropriate to NOT debride blisters that are thick walled or

Lecture 1 on my IV Fluid Series. In this podcast, I discuss how much fluid we keep intravascularly after resuscitation, as well as the history behind the creation of Normal Saline, Ringer's lactate/lactated ringers, Plasma-lyte and Normosol. Show Notes: https://eddyjoemd.com/ Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.

The Curious Clinicians dive into the history and physiologic effects of IV fluids and why saline is definitely not "normal". Show notes: https://curiousclinicians.com/?p=824 CE/MOC: https://vcu.cloud-cme.com/course/search?p=4000&curriculum=Curious%20Clinicians

Dr. Wambold, Attending Anesthesiologist at the University of Kentucky, goes over the difference between Volume expansion acidosis and contraction alkalosis. He also discusses the use of Normal Saline vs Lactated Ringer fluid use in the OR.

The Battle Royale between two common crystalloids- NS vs LR. We bring you the rundown and why we belong to the House of Ringers. Website: www.emboardbombs.com

Normal Saline, or 0.9% saline, is a crystalloid solution used ubiquitously for dehydration and hypovolemia. It is compatible with blood product transfusion and most medications. It is classified as an isotonic fluid, however, the concentration of NaCl is higher than found in humans at 154mEq/L of both Na+ and Cl-. There are concerns about the deleterious effects of solutions with supraphysiologic chloride concentrations. It is typically the first-line fluid used in trauma resuscitations, head injuries, acute neurologic conditions where hyponatremia should be avoided, and the treatment of mild hyponatremia.

In this episode, we discuss IV fluids for hospitalized patients, including normal saline (0.9% NaCl) and lactated ringer’s. In addition, we review the newest literature supporting the use of balanced crystalloids over normal saline from the SMART and SALT-ED trials.

David Farcy, MD FAAEM FCCM, Chairman of the Department of Emergency Medicine at Mount Sinai Medical Center - Miami Beach and President of AAEM, speaks with Michael Winters, MD MBA FAAEM, Associate Professor of Emergency Medicine and Medicine, Program Director of the Combined EM/IM Program, and Founder and Co-Director of the Combined EM/IM/Crit Care Program at the University of Maryland School of Medicine in Baltimore, MD. Drs. Farcy and Winters discuss balanced crystalliods versus normal saline in critically ill adult patients. Intro music by NICOCO, 'Quiberon,' from the album 'Nicoco,' powered by JAMENDO.

David Farcy, MD FAAEM FCCM, Chairman of the Department of Emergency Medicine at Mount Sinai Medical Center - Miami Beach and President of AAEM, speaks with Michael Winters, MD MBA FAAEM, Associate Professor of Emergency Medicine and Medicine, Program Director of the Combined EM/IM Program, and Founder and Co-Director of the Combined EM/IM/Crit Care Program at the University of Maryland School of Medicine in Baltimore, MD. Drs. Farcy and Winters discuss balanced crystalliods versus normal saline in critically ill adult patients. Intro music by NICOCO, 'Quiberon,' from the album 'Nicoco,' powered by JAMENDO.

Hot Off the Press! In this podcast, we dive into the 2018 Surviving Sepsis Update and look at the new recommendations, evaluate the evidence and take a look at how this does or does not fit with other high-level evidence. We dive into the fluid debate, with a focus on Normal Saline vs. Lactated Ringers, whether 30mL/kg is based on the best evidence, whether fluid should be given based on true body weight or ideal body weight, and lastly, the hot topic of EtCO2 guided fluid resuscitation when coupled with passive leg raising. This is always a hot topic! Take a journey with me on this often disagreed on subject! Lastly, we couldn’t make this podcast without. Please rate, and review wherever you download the podcast. Thanks for listening!

Hot Off the Press! In this podcast, we dive into the 2018 Surviving Sepsis Update and look at the new recommendations, evaluate the evidence and take a look at how this does or does not fit with other high-level evidence. We dive into the fluid debate, with a focus on Normal Saline vs. Lactated Ringers, whether 30mL/kg is based on the best evidence, whether fluid should be given based on true body weight or ideal body weight, and lastly, the hot topic of EtCO2 guided fluid resuscitation when coupled with passive leg raising. This is always a hot topic! Take a journey with me on this often disagreed on subject! Lastly, we couldn't make this podcast without. Please rate, and review wherever you download the podcast. Thanks for listening!See omnystudio.com/listener for privacy information.

This week on The Rounds Table Kieran Quinn and Paxton Bach take listeners through articles covering new evidence on prescribing fluids to critically and non-critically ill patients as well as new evidence on increasing the dose of inhaled corticosteroids for asthma exacerbations. IV fluids are a staple of hospital medicine, almost all patients will receive ...The post Feeling Salty? Normal Saline vs. Balanced Crystalloids & Quadrupling Asthma Medications appeared first on Healthy Debate.

This week on The Rounds Table Kieran Quinn and Paxton Bach take listeners through articles covering new evidence on prescribing fluids to critically and non-critically ill patients as well as new evidence on increasing the dose of inhaled corticosteroids for asthma exacerbations. IV fluids are a staple of hospital medicine, almost all patients will receive ... The post Feeling Salty? Normal Saline vs. Balanced Crystalloids & Quadrupling Asthma Medications appeared first on Healthy Debate.

Reuben Strayer, MD Courtesy of Reuben Strayer, MD Emergency Medicine Physician who works in New York City Author of emupdates.com One of the authors of painandspa.org Twitter @emupdates Created the phrase "ketamine brain continuum" No financial disclosure     Ready to continue your Special K Trip? Today's episode is Part 2 out of a 3-part series and will cover the use of ketamine for procedural sedation and intubations in the ED with Reuben Strayer, MD. If you didn't listen to Reuben talk about ketamine, the safety measures of ketamine, or confused by this graphic with different dosing - go back and listen to Episode 7 for Part 1 where this is explained in detail.   Ketamine for Procedural Sedation and Analgesia (PSA) Prep Your Patient Therapeutic Communication - let your patient have whatever fantasy they want and encourage it! Any fantasy can be a reality with ketamine...seriously. If they are in so much pain that they are already freaking out and you're not doing your procedure you can give opioids to help calm them down - but remember, ketamine is a powerful analgesia as well...you can always keep them dissociative for a longer duration of time. Situation dependent. Administer your ketamine dosage diluted in Normal Saline and give it slow...best method to prevent psychiatric disturbance. Prep Yourself Place patient on continuous telemonitoring and pulse oximetry Bonus points: CO2 monitoring Airway capable Doctor Watch respirations and breathing closely May have periods of apnea Prevent apnea by administering ketamine slowly (approx. 2 minutes diluted or diluted in Normal Saline 50/100mL over a longer period of time) Expect apnea if you administer ketamine as a fast IV push bolus (1-2 seconds) Patient may still have apnea - MD must know maneuvers to open airway (head position, jaw thrust, BVM, intubation) Nasal Cannula on patient - turn on oxygen as needed I like to have everything connected even if the oxygen is turned off NRM on standby Airway Cart, BVM, and Intubation Kit on standby Suction on standby Nurse who is dedicated to monitor sedation - lots of paperwork and frequent monitoring including watching those respirations! Consent PSA Ketamine Dose Reuben gives a dissociative dose (Ketamine 1-1.5mg/kg). You can get away with giving an analgesic dose but if a patient comes in with a bad fracture - give the dissociative dose and have propofol on hand to counter ketamine's side effects. Ketamine can be used as monotherapy for PSA. Propofol - to counter ketamine's effects (HTN, muscle rigidity, psychiatric emergence, etc.) Draw up in separate syringe. Administer in 20/30/40mg IV pushes as needed Ketofol - Effective but you are not dosing propofol separately. What is it? Ketamine and propofol drawn up in single syringe and administered at the same time. Always Treat Psychiatric Disturbance As your patient metabolizes the ketamine, your patient may "freak out" or have a psychiatric emergence and you must always treat it. It's inhumane to not ignore it and let the patient "ride it out." Use conventional medications to treat: propofol, midazolam, haloperidol, droperidol (if you can get your hands on it) Post PSA Ketamine Pearls NPO until fully alert. Don't stimulate patient prematurely. Minimal noise and minimal physical contact. Nurse with patient entire time monitoring patient until fully alert. Ketamine for Rapid Sequence Intubation (RSI) Okay to use for polytrauma or head trauma (ICP) patients. Has neuroprotective properties - good for ICP/head trauma patients. Induction agent independent from paralytic - doesn't matter if you use rocuronium or succinylcholine - but we are fans of rocuronium for RSIs in the ED. Roc Rocks vs. Sux Sucks -LITFL Extra Ketamine in your syringe? Can use like a push dose pressor while setting up post intubation drips.

Why Use Push Dose Pressors? To buy yourself some time with your super hypotensive patients!! Ensure your patient's perfusion status while you are trying to: intubate managing transient hypotension preparing a drip preparing a central line Know which medication to use based on clinical presentation of patient. Dr. Scott Weingart's Easy Push Dose Printout (It has photos!) Epinephrine alpha 1&2, beta 1&2 agonist = inopressor (Increase in myocardial contraction, heart rate, and peripheral vascular resistance) Epinephrine Push Dose Concentration 10mcg/mL (1:100,000) vs. cardiac dose (1:10,000) Onset Immediate - 1 minute Duration 5-10 minutes Dose 5-20mcg every 2-5 minutes (0.5-2mL)   Preparation Draw up 9mL of Normal Saline in an empty 10mL syringe (updated - see below) Attach a syringe and draw up 1mL of epinephrine from the pre-filled cardiac dose amp (Epinephrine 100mcg/mL) Shake a little, Place a label: Epinephrine 10mcg/mL Phenylephrine alpha 1 agonist = increase in peripheral vascular resistance Heart rate remains the same. Watch out for reflex bradycardia.   Phenyelphrine Push Dose Concentration 100mcg/mL   Onset Immediate - 1 minute Duration 10-20 minutes Dose 50-200mcg every 2-5 minutes (0.5-2mL)   Preparation Draw up 1mL of phenylephrine (10mg/mL concentration vial) Inject into NS 100mL bag Shake a little, Place a label: Phenylephrine 100mcg/mL Use as a drip or draw up in a syringe. Super Nerdy Receptor Information Beta Receptors Tissue Receptor Subtype Heart beta1 Adipose Tissue beta1, beta3? Vascular Smooth Muscle beta2 Airway Smooth Muscle beta2 Beta1 Agonist Increases contractile force & HR. Activation of beta1 receptors in the atria and ventricles but the ventricles are really effected - thus increasing myocardial contraction. HR increases because SA node, AV node and the His-Purkinjie system are activated.   Beta 2 Agonist Relaxes smooth muscles   Alpha1 & Alpha 2 Agonist Constriction of vascular smooth muscle. Myocardial Alpha 1 may have a positive inotropic effect. No clear understanding on Alpha 2 receptors at this moment. Epinephrine & NE has equal affinity to both alpha 1 and alpha 2 receptors.  However, Epinephrine has a higher affinity to beta 2 receptors. So effects are dose dependent. Initially will activate beta 2 receptors so relaxes vascular smooth muscle and decrease peripheral resistance, but at higher doses, epinephrine will also bind to alpha 1 receptors which is a potent vasoconstrictor and will dominate as epinephrine concentrations are higher.   Phenylephrine is a pure alpha 1 agonist. Vasoconstriction of both arterial and venous vessels. Great for someone who has tachycardia/tachyarrhythmia but also hypotensive. Can cause reflex bradycardia. Update 8/6/2017 "Concentration" used to differentiate final concentration versus dosing, to have clear language. Update 8/8/2017 Brought to my attention by Craig Button, RN - There have been reported cases of serious medication errors due to mixing medications using pre-filled saline flushes and not labeling them. Therefore, I am going to change the recommended preparation of mixing epinephrine push dose concentrations. The LAST thing I want is to hear about unlabeled saline flushes with epinephrine lying around, and/or causing harm to patients. These medications should be respected so PLEASE LABEL ALL PREPARATIONS!! Original text is here. Blog post has been updated above. Original Text: Epinephrine Push Dose Concentration Preparation Take a NS 10mL flush and squeeze out air bubbles and saline so 9mL remains Attach a syringe and draw up 1mL of epinephrine from the pre-filled cardiac dose amp (Epinephrine 100mcg/mL) Shake a little, Place a label: Epinephrine 10mcg/mL Now listen to the episode.... References: Scott Weingart. EMCrit Podcast 6 – Push-Dose Pressors. EMCrit Blog. Published on July 10, 2009. Accessed on August 3rd 2017. Available at [https://emcrit.

Todd Fraser, MD, speaks with Paul Young, FCICM, about the article, Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial.

Todd Fraser, MD, speaks with Paul Young, FCICM, about the article, Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial.

Fluids in Critical Care: Time to SPLIT With Normal Saline? Summary by: Paul Young Intravenous fluid therapy is a ubiquitous treatment for critically ill patients and has been used in clinical practice for over 175 years. Despite this long history, the majority of intravenous fluids have not been subjected to the same level of scrutiny as other drugs. That said, large-scale fluid trials evaluating albumin and starch solutions compared to 0.9% saline have been conducted and their results have changed clinical practice around the world so that crystalloid fluid therapy is now predominant in many parts of the world. While 0.9% saline is the world’s most commonly prescribed crystalloid fluid, increasingly clinicians are turning to buffered or balanced crystalloid solutions as an alternative to 0.9% saline. This practice change from 0.9% saline towards balanced crystalloids is not based on high quality evidence but is supported by observational data suggesting that saline may be associated with an increased risk of renal toxicity and mortality compared to buffered crystalloids. This talk gives an overview of the data comparing the comparative effectiveness of 0.9% saline and buffered crystalloids, provides an overview of the historical context of intravenous fluid therapy (and proctoclysis), and describes the design of the Saline vs. Plasma-Lyte 148® for Intravenous fluid Therapy (SPLIT) trial which has now been completed and was recently published in the Journal of the American Medical Association. External Links• [The Bottom line] SPLIT trial reviewed• [article] Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit The SPLIT Randomized Clinical Trial• [editorial] Editorial accompanying paper• [videocast] Presentation of SPLIT trial at ESICM by Dr Paul Young• [Further reading] Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults• [St Emlyn's] SPLIT trial published. Saline or Plasmalyte on the ICU?

In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss the recent 3-building blaze in NYC, the nature of fires, and how to survive one. Also, Dr. Bones tells you how to make normal saline solution for irrigation of wounds, and Nurse Amy tells you went to close a wound and when to leave it open. Finally, Dr. Bones goes out on a limb with his recommendation to replace the standard handshake with fist bumps?! Hear him out, there's hard data supporting it!  

In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy discuss the recent 3-building blaze in NYC, the nature of fires, and how to survive one. Also, Dr. Bones tells you how to make normal saline solution for irrigation of wounds, and Nurse Amy tells you went to close a wound and when to leave it open. Finally, Dr. Bones goes out on a limb with his recommendation to replace the standard handshake with fist bumps?! Hear him out, there's hard data supporting it!  

In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss earthquake safety, making your own sterile saline for wound care, the plight of pollinators like Monarch butterflies, ebola updates including a new country to report cases, and a captured laptop with a jihadist plan for bioterrorism....

In this episode of the Doom and Bloom(tm) Survival Medicine Hour, Joe and Amy Alton, aka Dr. Bones and Nurse Amy, discuss earthquake safety, making your own sterile saline for wound care, the plight of pollinators like Monarch butterflies, ebola updates including a new country to report cases, and a captured laptop with a jihadist plan for bioterrorism....

David Farcy, MD FAAEM FCCM, Chairman, Department of Emergency Medicine at Mount Sinai Medical in Miami Beach, Florida, speaks with Peter DeBlieux, MD FAAEM, Professor of Medicine at Louisiana State University Health & Science Center in New Orleans. In this episode, Drs. Farcy and DeBlieux discuss the fluids used in fluid resuscitation including isotonic crystalloids and albumin. Intro music by SaReGaMa, "Sky is the Limit," from the album "Sky is the Limit," powered by JAMENDO.

We review the FOAM from SMACC GOLD, Dr. David Story's "Is Chloride A Poison?" for a great primer on the Stewart method to acid-base.  The Strong Ion Difference (SID) is essentially Sodium minus Chloride (Na - Cl). Normal = 38; a higher SID indicates metabolic alkalosis and a lower SID indicates a metabolic acidosis.  "Normal Saline" has a whopping amount of chloride, which decreases the SID and has been associated with acidosis, renal insufficiency in critically ill patients, and, perhaps, mortality. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Key Texts: Tintinalli (7e) Chapters 19,21 ; Rosen's (8e) Chapters 124, 125 FOAM Resources: Acid-Base ala EMCrit I/II/III/IV, Hyponatremia - EMBasic, Hyponatremia-ERCast, Hyponatremia - EMCrit Thanks y'all! -Jeremy Faust and Lauren Westafer