509 #FOAMed users were polled over 24h as to their preference of fluid regime in the septic patient with normal sodium, potassium and chloride levels.
The results are above with CSL coming first, just ahead of NS (0.9%).
Obviously nothing particularly robust about the survey, merely an interesting snapshot of users as to their preference.
Interesting to note, that much of the 8% who stated another fluid preference, cited Plasmalyte (or similar balanced solutions) as their choice of fluid.
The question often gets raised on whether there is a demonstrable difference in outcome between a lot of the balanced crystalloids themselves, or versus NS. There would need to be larger trials performed to ascertain this.
Here are some interesting reads on the topic:
Avila et al - The Use of Fluids in Sepsis
Lavesque et al - Fluid Choice in Sepsis, Does it Matter?
Chang et al 2016 - Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock.
How to Master BVM Ventilation
Bag mask ventilation is the cornerstone of airway management.
It’s often considered a basic procedure, but there is nothing “basic” about BVM ventilation. Skill acquisition requires extensive training and experience. It’s not pretty, sexy, or glamorous. Most people perform it poorly even though it’s an essential part of good airway management.
In this tutorial article, ACLS medical go through some great tips and advice on becoming a BVM master.
Great work guys!
- BVM ventilation is a difficult skill for providers at all levels and specialties.
- The traditional CE method is not very effective, and sometimes totally ineffective.
- Use ETCO2 as an objective measurement.
- Adopt the “two thumbs down” technique
- Deliver breaths slowly
- Only compress 1/3 of the bag
- Give breaths quickly during cardiac arrest, but allow full release of BVM
Defining the learning curve for endotracheal intubation using direct laryngoscopy: A systematic review
Journal Article - Resuscitation Journal, Europe, Metanalysis
"Patients with OHCA who receive ETI by EMS are more likely to obtain ROSC, survive to hospital admission, and survive neurologically intact when compared to SGA."
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