This is EMKases, EM Quick Hits podcast.

Quick. Let's get on with it.

EM cases is part of Shremie, the Schwartz-Riseman Emergency Medicine Institute.

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cases.

Ivy Fluid boluses. There was a time when the IV fluid bolus was central to emergency medicine, more important than ketamine or Pocis or even Cephtriaxone. It's possible that normal saline, one liter, IV bolus, is the most common order written in all of

emergency medicine history. But over the last decade, we've heard more and more about the harms

of IV fluids. Or if they aren't harmful, at least they don't seem to be doing what we hoped.

Sepsis is where we've seen the most research, and we have dramatically scaled back our use

of IV fluids when you compare the current practice to the many rivers era.

But what about other conditions?

Well, pancreatitis is actually a lot like sepsis.

There isn't necessarily a fluid deficit, but systemic inflammation can cause massive third spacing

and intravascular fluid deficits. So for a long time, IV fluids have been central

to pancreatitis management. But there's a big paper this year, the waterfall study published

in the New England Journal of Medicine, a randomized trial comparing aggressive ivy

fluids to moderate ivy fluids in patients with mild to moderate pancreatitis.

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