Intravenous Fluid Therapy in the Emergency Department and Critical Care Setting

Authors: Raymond Beyda, MD; Taylor Conrad, MD; Rithvik Balakrishnan, MD; Ted Segarra, MD; Taylor M. Douglas, MD

Editors: Kami Hu, MD FAAEM and Kelly Maurelus, MD FAAEM

Originally published: Common Sense
November/December 2018

Intravenous fluid (IVF) therapy is one of the most common therapies employed during the care and resuscitation of patients in the emergency, acute, and critical care settings. With several available IVF options such as balanced crystalloids, normal saline (NS), albumin, and other colloid solutions, it is clear that choosing the best solution, the optimal volume, and the appropriate rate of administration is an ever-present clinical challenge. In this review we attempt to address the following questions using recently published literature on the topic:

1. Does the use of balanced crystalloids (BC) in the resuscitation of patients confer a mortality/morbidity benefit when compared with NS?
2. Does the use of BC decrease the risk of acute kidney injury (AKI) in the acute setting?

D Annane, et al. Effects of Fluid Resuscitation With Colloids versus Crystalloids on Mortality in Critically Ill Patients Presenting With Hypovolemic Shock, The CRISTAL Randomized Trial. JAMA. 2013;310(17):1809-1817.
Crystalloids, including Lactated Ringers (LR), NS, and hypertonic saline, are thought to work based on the osmotic pressure of their contents. Colloids such as albumin, hydroxyethyl starch (HES), and gelatins, on the other hand, act on oncotic pressures to keep fluid in the intravascular space. The authors of the Colloids Versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial sought to compare the efficacy of these two large classes of fluids in acute hypovolemic shock without making specific comments on the above subtypes.

Geriatric Trauma: Not Just Older Adults, An Interview with Christopher Colwell, MD

This post was peer reviewed.
Click to learn more.

Christopher Colwell, MD FACEP

Author: M. Kaitlin Parks, MSIV
Medical Student
Oklahoma State University COM
AAEM/RSA Publications and Social Media Committee

Interviewee: Dr. Christopher Colwell, MD FACEP
Chief of Emergency Medicine
San Francisco General Hospital and Trauma Center, Professor, UCSF

Just as any pediatrician would tell you, “a child is not just a small adult”. The same goes for the geriatric population. There are many physiologic differences in the geriatric population that are important to understand in order to deliver the best and most tailored care. An area where this is especially pertinent to the emergency physician is in the setting of trauma. A lot of what we know about trauma has come from military medicine, which sees a strong bias towards the young and healthy. As our population ages, we are seeing an increasing number of geriatric trauma patients in the emergency department (ED).[1,2] Older patients have higher morbidity and mortality in the setting of trauma.[3] Our geriatric patients are also more likely to have comorbidities and medications that both worsen their response (such as anti-coagulation and clotting) or blunt their capacity to compensate (such as beta-blockers and heart rate).[4] Age has been integrated into Trauma Triage criteria but many criteria are based on vitals that may not adequately measure the severity of select trauma cases in the geriatric population.[5]

Tumor Lysis Syndrome

Image Credit: Pixabay

This post was peer reviewed.
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Author: Nick Pettit, DO PhD
Resident Physician, Indiana University
AAEM/RSA At-Large Board Member

Malignancy is the second leading cause of mortality, and scarily, retrospective studies have demonstrated that the projected five-year survival once someone receives a diagnosis of cancer is approximately 50%. The National Cancer Institute recently expanded its research agenda to better understand cancer care in the ED. Studies have shown that cancer patients make up about 3% of emergency department (ED) visits and Medicare data has demonstrated that in the last six months of life, cancer patients utilize the ED significantly more.[1]

Top 10 Most Read Posts of 2018

Image Source: Wikimedia

As December comes to a close, we look forward to recognizing the year’s top 10 articles! Join me in congratulating this amazing group of authors at all levels of training and from across the USA!

Additionally, I would like to thank each of the AAEM/RSA Modern Resident Blog authors, reviewers, mentors, and editorial staff members for their tireless contributions to the blog. Without all of them, the blog would not be what it is today. Thanks for a successful 2018!

We are currently accepting articles for 2019 and are always looking for additional faculty mentors as well. Feel free to contact us at info@aaemrsa.org with questions. Have a safe and happy holiday season!

Sincerely,

Jake Toy, DO
Editor-in-Chief
Modern Resident Blog