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Extra-Corporeal Cardiopulmonary Resuscitation (ECPR) Introduction: What is ECPR? Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an advanced resuscitative technique that utilizes extracorporeal membrane oxygenation (ECMO) to provide circulatory and respiratory support in patients experiencing refractory cardiac arrest. Unlike conventional cardiopulmonary resuscitation (CPR), which relies on chest compressions and ventilation, ECPR involves the rapid establishment of veno-arterial ECMO to maintain perfusion to vital organs while treating the underlying cause of cardiac arrest. ECPR is primarily used in specialized centers with well-trained personnel and appropriate infrastructure, making it a resource-intensive intervention. Background and History of ECPR The concept of extracorporeal circulation has been evolving since the early 1950s, with Dr. John Gibbon’s development of the first successful heart-lung machine. In the 1970s, the use of ECMO for neonates with respiratory failur...

Introduction The Waterfall Trial is a landmark emergency medicine study investigating the optimal fluid resuscitation strategy for acute pancreatitis . Given the longstanding debate over whether aggressive or moderate fluid resuscitation leads to better outcomes, this trial provides essential clinical evidence. The study aims to determine whether a moderate fluid resuscitation approach is as effective as or superior to aggressive fluid administration , particularly in preventing complications such as fluid overload and organ failure . Background and Clinical Question Acute pancreatitis is an inflammatory condition that can range from mild, self-limiting disease to severe, life-threatening illness. Common causes include gallstones, chronic alcohol consumption, hypertriglyceridemia, and certain medications . The cornerstone of early management in emergency departments (EDs) is fluid resuscitation , aimed at maintaining perfusion and preventing complications such as systemic inflammator...

Acute Radiation Syndrome (ARS), also known as radiation sickness, is a severe illness that occurs following exposure to high doses of ionizing radiation over a short period. It is characterized by multisystem involvement and can result in significant morbidity and mortality if not properly managed. ARS is of particular concern in nuclear accidents, radiation therapy overdoses, and nuclear warfare scenarios. Etiology and Causes ARS results from high-dose exposure (>1 Gy) to ionizing radiation. The main sources include: Nuclear accidents (e.g. Chernobyl, Fukushima) Nuclear explosions (e.g. Atomic bomb detonations, e.g. Hiroshima and Nagasaki) Radiation therapy mishaps (e.g.  Accidental overexposure in Cancer treatment/ Research) Occupational exposure (e.g. Industrial accidents) Pathophysiology Ionizing radiation primarily harms biological tissues by creating free radicals and directly damaging DNA. The level of damage is influenced by the radiation dose, dose rate, type of rad...

Intravenous (IV) fluids are a cornerstone of modern medicine, used extensively in hospitals for resuscitation, maintenance, and replacement therapy. Normal saline (0.9% sodium chloride) has been the most commonly used IV fluid worldwide for decades. However, recent research has raised concerns about its potential adverse effects, particularly its high chloride content, which can lead to hyperchloremic acidosis and kidney injury.  In response, balanced crystalloid solutions, such as lactated Ringer's and Plasma-Lyte, have gained attention as potentially safer alternatives. This article explores the findings of recent trials comparing balanced crystalloids to conventional IV fluids.  While widely used the problem with Normal Saline is that it has a chloride concentration significantly higher than that of human plasma. This can disrupt the body's acid-base balance, leading to hyperchloremic metabolic acidosis, a condition associated with renal vasoconstriction, reduced glome...

  Shoulder joint dislocation can be reduced by a lot of explained maneuvers. Its better to learn them through some good videos from open source (YouTube and Vimeo) rather than memorizing  The various maneuvers for the reduction of a Dislocated Shoulder Joint are     1. Kochers Maneuver     2. FARES (Fast Reliable and Safe Technique)     3. Hennepin Technique (External Rotation Technique)     4. Milch Technique     5. Stimsons Technique (Gravitational Weight)     6. Hippodratic and Modified Hippocratic Technique     7. Cunningham Technique Kochers Maneuver Adduction-ExtRotation-Flexion-Internal Rotation The process must be very slow and its better to give some muscle relaxant and analgesic prior to the procedure. Cunningham Technique https://www.youtube.com/watch?v=HGIjEEg_PQQ FARES (FAst, REliable and Safe Technique) Small occilating movements while in extension and external rotation. Gradually this is incre...