Resuscitation: Which IV Fluids to Choose

[@eddyjoemd]

Thanks for watching my talk and all the feedback. I'm working to improve this channel constantly. Please share with your friends and colleagues. Click the thumbs up button and subscribe! -EJ www.eddyjoemd.com

[@sam-cz9if]

eddyjoemd hi i am RN working in Surgical ward . Was wondering if you can provide me the data or study about the increased in cl level leading to decrease renal perfusion pls . Love wartching your videos on my days off I’m also waiting on my gamsat result to hopefully get in to meds hood this September

[@JS-ox6pn]

You elaborate well... Thank u. Please go on without getting distracted by small uneventful things that happen during the video. I think no one among the watchlist minds it. U r simply great....thank u.... From critical care medicine student.

[@eddyjoemd]

Thank you for your words ☺️

[@blue_cynic]

Medic in the army thanks explanation far better then my instructors

[@eddyjoemd]

Glad I was able to help!

[@Mariabecerra9587]

Can listen to you all day

[@eddyjoemd]

☺️☺️☺️

[@kimberlyanderson5773]

Oh my gosh, you are so real. Love it. It's nice that you aren't perfect in front of the camera. The information is very helpful and it makes sense. Thank you! Signed, a future nurse

[@eddyjoemd]

Thanks, Kimberly

[@AhmedGamalMedicine_gets_easy]

One subscriber added, the best explanation I ever heard about IV solutions, and the clinical experience and studies you talking about are what making the video THE BEST. Thank you ❤️🙏

[@margaretprawl313]

Awesome. Thank you. From Junior New grad RN

[@shan-shanchristensen9604]

I'm a new ICU nurse with 3 years of Tele experience. I find your videos very informative and helpful. Thank you so much for taking the time out of your busy schedule to teach others. You're AWESOME! 👍

[@eddyjoemd]

Thanks! Glad to help. Let me know what else you think may be helpful. Currently recording a batch of videos to release next month.

[@Anomerik]

Current resident. Wish I could have you in the doc bubble when my attendings tell me to bolus patients who don't need it. Love the content, doc.

[@mehaktaufiq5287]

Thanks alot. Really helpful. Kindly keep posting. I m from a resource limited country and it’s so much help to know how medicine is practiced in high resource places. U save lives on rounds but a-lot more of them by posting such videos as we try to reciprocate ur expertise, as per our circumstances. Thank u again

[@princessjazz5767]

pre PA here taking anatomy class... ended up here and loving it THANK YOU SO MUCH

[@eddyjoemd]

My pleasure! Good luck!

[@tmkhan1206]

great cme update on iv fluids keep up cme stay blessed nice teaching

[@eddyjoemd]

💪🏼💪🏼💪🏼

[@jillian5667]

Loved this video! I am a new ER nurse at a level 1 trauma center and we only use LR in those patients. This was really helpful in understanding why LR can prevent the trauma triad of death!

[@eddyjoemd]

Glad the video helped, Jillian! Keep working hard to understand the in's and out's of everything you do and you'll become one of those rockstar nurses in no time!

[@MsHt1960]

I really appreciate your explanation and tying the system together😊. Great explanation of AKI

[@ninasantos261]

Thank you so much, how I wish my senior residents could explain like you

[@eddyjoemd]

My pleasure!

[@varsharani1666]

Thank you.. It's one of the best explanation on IV fluids.. As I have completed my residency. It will be of great use..

[@allisonhigginbotham4182]

I am in nursing school & I learned so much watching this thank you!!!

[@eddyjoemd]

Very happy I can help, Allison! Share it with your classmates. Best of luck in school and thanks for choosing nursing. We NEED more people like you.

[@eddyjoemd]

CITATIONS: www.eddyjoemd.com/2019/04/citations-for-my-choosing-ivf-in.htm Thank you for checking out my video. Follow me on Twitter and Instagram @eddyjoemd Twitter: twitter.com/eddyjoemd Instagram: instagram.com/eddyjoemd Books I recommend for ICU Beginners. Marino's The ICU Book: amzn.to/2M2oFVm The Washington Manual of Critical Care: amzn.to/2MfmDR4 The Ventilator Book: Second Edition: amzn.to/2BYbyhK The Advanced Ventilator Book: amzn.to/2nhvyTY Essentials of Mechanical Ventilation: amzn.to/2vqQAnF @eddyjoemd is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com I haven't been making as many videos as of late because I've been using my time to learn more about how to invest my money myself. I have found the following books very helpful along the way. These are affiliate links and I will make a small commission if you buy something from Amazon after you click on a link listed below. Rule #1: The Simple Strategy for Successful Investing in Only 15 Minutes a Week! by Phil Town amzn.to/2Ql27kW Invested: How Warren Buffett and Charlie Munger Taught Me to Master My Mind, My Emotions, and My Money (with a Little Help from My Dad) by Danielle Town amzn.to/2Usevy9 Payback Time: Eight Steps to Outsmarting the System That Failed You and Getting Your Investments Back on Track by Phil Town amzn.to/2UvGb56 The Dhandho Investor: The Low-Risk Value Method to High Returns by Mohnish Pabrai amzn.to/2EoYRi2 The Education of a Value Investor: My Transformative Quest for Wealth, Wisdom, and Enlightenment by Guy Spier amzn.to/2EoYSCC The Little Book That Still Beats the Market by Joel Greenblatt amzn.to/2QtLaVO One Up on Wall Street by Peter Lynch amzn.to/2XsqNrA Invest Like a Guru: How to Generate Higher Returns At Reduced Risk With Value Investing by Charlie Tian amzn.to/2ED7dBu

[@lucasbeven4941]

Great information. Helped me during my rotations. No need to make to apologize for every imperfect detail.

[@eddyjoemd]

+Lucas Beven glad you enjoyed the video!

[@heshamalonizan413]

I am a paramedic and Your videos are very informative ❤️keep up

[@eddyjoemd]

Thanks for taking care of all those people you help daily!

[@airstreamvagabond]

Nice presentation... good refresher for me. Your right, we should know the contents in our IVF.

[@eddyjoemd]

Glad it was helpful!

[@sportcrazed125]

Is there any change in data found now, 4 years later? If so, could you please do an updated video? If not, thank you for this information!

[@eddyjoemd]

I’ve posted a couple posts on Instagram reviewing the newest data. I haven’t gotten around to creating a new video, though. You can follow me on IG @eddyjoemd.

[@gilbertkiprono4189]

Thank you Dr. Eddy. Jug kwa bill yangu🤜🏿

[@brunovale6335]

thanks for your video, its great. But the reason for hyperK+ in DKA its another than acidosis itself, since organic metabolic acidosis dont cause per se hyperK+.

[@monsterozgur]

I learned a lot about this video and know I’m more aware of what I give to my patients and give better suggestion for MD when I run rapid response role. I wish lytes fluid is more commonly used at everywhere

[@eddyjoemd]

Thanks for having checked it out!

[@charmainedixon4262]

Hi Dr Eddy Joe, new Acute Care Nurse Practitioner- thanks for this video😁

[@eddyjoemd]

My pleasure!

[@Motivarbeing6]

This is my 1st video .... And seriously I was enjoying ur video and also don't know when I am able to make notes of this (Iv fluids) topic Thank u for making these video .... And keep making these video for us 😊

[@eddyjoemd]

My pleasure!

[@Motivarbeing6]

@@eddyjoemd 😊😊

[@sitinursharida8728]

Thanks sir for iv fluids talk

[@thysonsacclaim]

Awesome awesome awesome! As a med student I REALLLLLLLY appreciate this info.

[@eddyjoemd]

Glad you gained something from it. Share with your class 👍🏼. Best of luck!

[@nygeek6471]

Nurses must know, especially in ICU and step down units, so if an intern just does NS they can request a more optimal fluid!

[@eddyjoemd]

exactly!

[@drowzeeRN]

Very interesting info regarding the difference in the fluids. I'm a nurse and I work in a small rural hospital in a small ICU. (Also have only been out of school for 3 years). We are ALWAYS using 0.9% saline for our patients. I feel like the only time I see LR being used is on our surgical patients, ordered by the surgeons. I also feel sometimes like our docs aren't up to date with current practices/information unfortunately. Just discovered your channel, looking forward to checking out more of your videos. Thanks!

[@Guillaume98100]

Thank you this is not only for doctors but for nurses that are refreshing the ICU . Great job !

[@eddyjoemd]

Thanks for watching! Share it with your colleagues. My wife is a CCRN and she motivated me to do this.

[@truongl5733]

Mate your info is just so easy to absorb! Thanks for the free lecture, will sure help with my paramedic career! Please keep it up :)

[@eddyjoemd]

My pleasure! Glad you got something out of it. Many new videos in the works!

[@trc214]

I agree, his videos are so easy to focus on and understand

[@jasOn1291]

"And then I wipe it off with my socks coz i'm smart.." hahaha sooo good

[@eddyjoemd]

🤣🤣

[@BigPoppa171990]

Awesome videos. Could you please do one on assessment and plan breakdown. What you are looking for and this applies for all of medicine not just ICU if thats ok with you? such as imaging? labs? contacting social worker? Telemetry? so we have a template on what we should be going because I always suck in my A/P

[@fatimasuleman1980]

Thank you so much! Wonderful lecture

[@abdulrabb1616]

You are a great teacher..i love your work. Feeling proud to have subscribed your channel 👌👌👌

[@crystalumar9423]

Thank you for the very informative lecture...been trying to understand this topic for a while and your video really helped simplify it :) would really appreciate you providing your sources and studies mentioned. Thanks again and look forward to more of your lectures!

[@bigworldddd9566]

Thank you for your effort and your time!

[@eddyjoemd]

+Bigworld DDD my pleasure!

[@jibranhaider6938]

Absolutely amazing explanation. Keep em coming!

[@cristinavasta8014]

Thank you!!!!! I loved this lecture

[@eddyjoemd]

My pleasure!

[@beyondbeautyandbrainbbb3191]

hi nice presentation ...thanks for summing up

[@eddyjoemd]

My pleasure!

[@cesaroscar8036]

Thank You Eddy

[@eddyjoemd]

My pleasure, Cesar!

[@ahmedmaamoon6117]

Valuable information and explanation thx

[@eddyjoemd]

My pleasure!

[@maristelamelo9640]

Great video!! As a vet it was very useful to me as well! Thanks for all the valuable information and keep up with the awesome work!

[@eddyjoemd]

So glad it was helpful! Thanks for watching!

[@nateloo]

Wow, you should definitely continue making alike videos. Very helpful!

[@eddyjoemd]

+Michal Cesek trying to! It's just challenging with my work/life schedule. Thanks for watching!

[@dianainboulder]

New subscriber. You have explained so clearly. Thank you!

[@eddyjoemd]

My pleasure!

[@reynolds1231]

I’m an obgyn resident. I’m memorizing this lecture as best as I can, our field doesn’t deal with these medical issues too often so it’s always an argument when someone says you can’t give LR to a septic patient or that a Na of 130 should be corrected with a liter of hypertonic saline (@_@)

[@eddyjoemd]

Oh wow! When someone tells you that LR can’t be given to a septic patient show them the SMART trial from NEJM. OBGYN residents should never have to use 3% saline to my knowledge.

[@user-dj4fx8nn8n]

So informative thanks

[@lmeb8518]

Hi. You said that the sodium lactate in LR is not the same as lactic acid. I am a new physician and it's embarrassing that I only learned this now. Anyway, can you please provide me with the literature? I would really love to read on it further.

[@eddyjoemd]

Hey there! Better yet, let me link you to a post by my colleague and badass, Josh Farkas: emcrit.org/pulmcrit/understanding-lactate-in-sepsis-using-it-to-our-advantage/

[@lmeb8518]

Thanks!

[@chemaha1]

do you have an update on these studies?

[@lm8podtunes324]

Thank you for your well explained video. And looks like I am watching myself! I also drop things, talk fast, funny interruptions, and sigh all the times whenever I try to teach someone medical stuffs. (Can be very anxious some times too) ^^

[@eddyjoemd]

It was one of my first videos. I have grown more comfortable in front of the camera over the last couple years. 😉

[@MedSurvival]

Thanks for sharing this topic.. The choice of IV Fluids isn't easy one. A new friend here to support you. Stay Safe and Connected

[@eddyjoemd]

Thanks for the support!

[@alexdooley6710]

Great video, finally fluids explained!! I'm on a TICU rotation so this is super helpful. A video on vent modes/settings would be amazing!

[@eddyjoemd]

Alex, I'm glad you enjoyed the video. I have a vent talk sort of prepared that I just need to film. Hopefully soon! Thanks for watching. Best of luck on your TICU rotation, those are a lot of fun!

[@br5145-v3m]

why don't you ask your Respiratory Therapist who went to school (just as long as you did) for that.

[@eddyjoemd]

Ask my RT for what, Brian? I obtain the opinions of my RT's all the time. They're part of my team.

[@trc214]

Hi Dr. Eddyjoe, can you make a video on resuscitation in septic patients for PGY-1s?

[@eddyjoemd]

Yep. I’m actually working on this right now. It’s not going to be out for a few months simply bc if the amount of data I am going through, though.

[@sitinursharida8728]

Hi may i ask. How dr decide to put 2 pint 0.9% nacl or 3 pint or 4 pint per day?

[@jfu2011]

Thank you for the presentation!

[@eddyjoemd]

You're welcome!

[@zrehman]

Hey boss, great video! Quick question, I am a new attending, just finished residency. I work as an Oncology Hospitalist and all the patients we admit are very sick and always require fluids. Especially for Febrile Neutropenia. Would you recommend it being appropriate to place these patients on LR or Plasma-Lite? Thank you!

[@eddyjoemd]

Congrats on the new attending life! Don’t party too much now. Lifestyle creep is real! I’d choose depending on their current sodium and electrolyte numbers. Are they hypo or hypernatremic? Do they have SIADH from their lung cancer? It also depends on how accessible the Plasma-Lyte actually is. Is it on the par wall or do they have to send it up from pharmacy? How long is it going to take for the nurses to hang it? Those types of variables. I mostly use them interchangeably. As long as it’s safe for your patients and you’re keeping a close eye on their labs, they should be fine. Just glad you’re not using saline for everyone.

[@alejovm98]

Great video. How do you explain a senior doctor that his approach is wrong?. I don't wanna sound like a gunner :/ thank you for your video amazing explaining

[@Missmethinksalot1]

Honestly have been subbed since eons but usually avidly follow you on IG instead. Been missing a lot more than I imagined on your YT. I'll read your posts in your actual voice from now lol.

[@matthewburnham4933]

what is most commonly used in your opinion for rapid fluid infusion for cases of rhabdomyolysis?

[@eddyjoemd]

Depends on their electrolyte situation. I usually reach for LR though.

[@TheMattBurnham]

eddyjoemd thanks for the reply!

[@deanopha4653]

Whilst there is a school of thought that using balanced solutions is beneficial for resus, the clinical trials aren't super conclusive and normal saline remains the current treatment preference in most healthcare systems (see UK and Australian guidelines..... Far superior systems with better outcomes than US). Plasmalyte and even Hartmanns is expensive also.

[@hometownrocker1]

Great Job on video. I wish you would do more. How about DKA, hypernatremia,hyponatremia,or an instructional video on peep, fio2, pressure support / control...(when to go up on peep vs ps/pc to increase sats/ volume/ or decrease CO2) ....thanks again

[@eddyjoemd]

+hometownrocker1 I intend on doing more. I appreciate your suggestions! DKA would be a cool one to tackle. I am writing a vent lecture so that one should be out within the next couple months. I won't touch hyponatremia with a 10 foot pole. It's the most looked up topic on uptodate for a reason and I don't think I do a good job explaining it. The most important thing I do for hyponatremia is get a very very good history including ALL medications. That will get you your etiology 80% of the time and then your next steps should be 1. Don't break the patient 2. Don't break the patient 3. Be patient. Good luck!

[@eshrakobaid3546]

Thank you doctor

[@eddyjoemd]

My pleasure!

[@atskykhan4663]

Lovely video...need more...can we hav a video on abg approach.pleasse @eddyjoe

[@eddyjoemd]

Noted. I'll work on one. Thanks for following along!

[@zulqarnainyounas9360]

Very well explained can be plz properly explain intravenous fluids in kids

[@eddyjoemd]

I do not know how to manage fluids in kids. They terrify me. Hope you can find a good resource!

[@fern2485]

Thank you so much for your presentation ❤️❤️❤️❤️🙏

[@eddyjoemd]

My pleasure! Thanks for checking out my video 👍🏼

[@soufiaalshawagfeh5336]

Thank you very much for this clear explanation!

[@eddyjoemd]

My pleasure!

[@bre1136]

Very informative.. I would appreciate the sources you mentioned. Thank you

[@eddyjoemd]

Here you go, bud. www.eddyjoemd.com/2019/04/citations-for-my-choosing-ivf-in.html. Hope this helps. There will be updated version of this video coming soon so I hope you subscribed!

[@maryem8263]

eddyjoemd I hope she saw this!! You are amazing! You follow up in almost every area of your social media. Im AMAZED by you. When do you ever sleep!! Lmao.

[@erikjohansson8221]

Which fluid would you recommend that has Postural Orthostatic Tachycardia Syndrome (POTS) which means they struggle with low blood volume?

[@nalakajayasinghe1481]

Great explanation

[@eddyjoemd]

Thanks for the feedback!

[@mohmandafg]

Thank you

[@tariqjaber9497]

This is a really good video!

[@eddyjoemd]

Appreciate the feedback! Thanks for watching!

[@hashimsailon8331]

Thank you very much Dr EJ, your teaching is real helpful. Keep going Dr!

[@eddyjoemd]

My pleasure! Glad to hear it's helpful. I've got a lot of talks in mind and time is my rate limiting factor. Hopefully I'll be able to get some more knocked out soon.

[@akanecortich8197]

I'm thinking for pancreatitis 5-10mL /kg/hour LRingers , higher volumes in first 48 hours = worse outcome. Saline also has worse outcomes.

[@eddyjoemd]

Pancreatitis is a challenging pathology to manage. No two cases that end up in the ICU are the same. I haven’t seen the data where saline is worse in pancreatitis bc I don’t think it exists. Please send me a link if I’m wrong 👍🏼. Ultimately I do agree with you that saline is likely worse than balanced salt solutions. Thanks for checking out my video!

[@shellwilliams6306]

Can't or shouldn't use LR with IV Zosyn.

[@stethoscopembrn2658]

Wow! Excellent information

[@eddyjoemd]

Thanks for watching! Share it with your follow nurses. I routinely share this type of information with my staff. Let me know if you want me to teach other things.

[@cozygamingandvideos3914]

I'm in nursing school and I'm writing my final paper regarding the dangers of normal saline. Is LR always safer than NS (except some neuro patients) ? What about LR for maintenance on a medsurg floor?

[@eddyjoemd]

I responded to you on twitter. email me at [e-mail].

[@androidangel787]

Great video. However, I would like to point out, and it is my understanding, at 13:25, you mentioned that lactate is converted to bicarbonate. But, isn't it converted to glucose through the Cori Cycle? I understand that lactate, after being converted to glucose, undergoes glycolysis, TCA and oxidative phosphorylation. CO2 is produced and it is converted to HCO3 by carbonic anhydrase. Is that what you were referring to? Thank you!

[@fatoumattasissoho28]

Thank you...loving it. I am preparing to start an ICU rotation and so excited to stumble upon this.

[@eddyjoemd]

You're welcome! Best of luck on your rotation. Critical Care is amazing but I'm completely biased!

[@sheralikhan3796]

Thank you so much,,, it was awesome,,, one of my weak points,,, fluids

[@eddyjoemd]

+Sher Ali Khan it was a weak part in my knowledge base when I was in your shoes, too.

[@govindrajmane196]

Video is most useful but which company provides best quality of iv fludes

[@eddyjoemd]

I have no idea how I could find that data. Can you try to find it and share it here?

[@govindrajmane196]

@@eddyjoemd I think aculife healthcare pvt ltd provide best i fludes U know thise company

[@eddyjoemd]

I do not know of that company. Why do you think they provide the best quality? Trying to learn. Thank you!!

[@edwar123]

Great video,best one helped me to understand it

[@eddyjoemd]

+Edward Habib glad it helped!

[@ants5824]

I like to know if anyone can tell me which is the best fluid to use for vitamins infusion i bern using 9% sodium chloride?

[@Kedda486]

The 0.9% saline section of this video would you say that regular healthy ppl cant have saline not cant but shouldn't ???

[@armughankhan6077]

Why does having low anion difference have decreased risk for acidosis?

[@ulfathassan3652]

Thnku... Really helpful

[@makeitaleapyear6062]

you are funny ,yet amazing with your teaching! expecting more of videos from you :)

[@eddyjoemd]

Thanks! I'm still working on getting better at this journey of lifelong learning, but I'm glad that I can reach out to people in this format. Thanks for watching.

[@smriti3245]

Sir plasmasol/ normosol not available in my set up

[@eddyjoemd]

Wish I could help you my friend 💪🏼

[@ddd778]

Would you give 0.9% saline or LR for DKA? My textbooks say 0.9%saline but I see many sources that are conflicting.

[@eddyjoemd]

9 times out of 10 I'd give LR.

[@eddyjoemd]

Also, don't forget to correct the sodium for the hyperglycemia. You may find that you're iatrogenically making the pt hypernatremic by giving them NS therefore causing harm.

[@naif8052]

Thanks . I just subscribed.

[@fidelmiranda2915]

Hello Doc. This video has been awesome. I've been trying to teach out firefighters the difference between NS/LR. Apparently, our private EMS system only utilizes NS. This Video has been very helpful. Can you send me the study regarding LR vs Plamalight/

[@eddyjoemd]

+Fidel Miranda I'm glad you found the video helpful. There's no study comparing PL to LR but the feasibility study comparing PL to NS is called the SPLIT trial. The main author is Paul Young. You can google it or try the link below. You're definitely a huge piece of the life saving process and we appreciate all the people you bring us but for a system type change, I wouldn't recommend pushing a change to use LR. There's no data, at least from what I've seen, that would warrant a change in practice. Thanks again for watching! Let me know if you have any other questions. www.hrc.govt.nz/sites/default/files/Young%20et%20al.%20JAMA%202015.pdf

[@Ζαμανφού]

Why doctors keep administer N/S 0,9 to treat dehydrated patients? RL has way more electrolytes, wouldn't it be better?

[@lankadisanayaka5623]

Indication for NS Indication of RL....?

[@DeepakSharma-ow5pj]

excellent!

[@eddyjoemd]

Thanks!

[@Dangerous0Fairy]

Thank you so much , this is informative and simple to understand .. new subscriber here ❤

[@eddyjoemd]

Thanks for subscribing! Glad you got something out of my video! 💪🏼

[@woo9194]

The only reason why I hesitate using LRs is because of the potential medication interactions/reactions

[@eddyjoemd]

two IV's could help. I understand the concern, though.

[@seifmany]

thank you for your valuable information and i need to contact you for your opinions in other polyionic electrolyte solutions,

[@EwitzAmanda]

Amazing!!! Are you left handed?

[@eddyjoemd]

Thanks! Yeah, I am. No one is perfect 🤣

[@EwitzAmanda]

@@eddyjoemd I'm left-handed too! Lefties in healthcare!

[@eddyjoemd]

Ohhhh yeah! In my graduating class from med school I think we were 45% lefties!

[@mercedesrodriguez4704]

Awesome!!!

[@eddyjoemd]

Thanks!!