Welcome, everybody. Welcome to episode 572 of the Divine Intervention Podcasts.

Today's podcast, we're going to be saying some more things about emergency medicine.

Again, this podcast is going to be titled Quick and Dirty, Emergency Medicine, Part 2.

And again, EM is, this podcast, I will say for for sure is for people taking step two, step three, level two, level three, a surgery shelf, an emergency medicine shelf, an internal medicine shelf, actually.

So just something I want to keep in mind.

All right.

So let's continue from where we left off.

So what if they give you a question about a person that has any form of hemorrhage or some kind of GI bleed or whatever? What kind of volume resuscitation are you supposed to give first on your exams? Well, I'd really hope you're saying that, wait, I'm going to give you fluids first, right?

And typically on the USMLEs, they tend to want you to give normal sailing.

Again, I know some people get all around up about the fine details of normal saline versus lactated ringers.

But the thing is, in general, for purposes of the USMLA exams, they are not super

concerned about that. I would pretty much regard both of those things as being pretty much

interchangeable. But I will see the right answer like 95 plus percent of the time on your exams

is going to be normal ceiling, right? So just in general give normal sailing, right?

You want to give fluids first as your form of volume resuscitation before you give blood.

And just as a general principle of fluid management, you're generally going to be giving the person more fluid than you think that they have lost in terms of volume.

You know why?

Because it's only about a third of that fluid that you're giving that is going to stay within the vascular tree.

Time will fail me to start going into the details of the body compartments and how water and

fluids are distributed across the body. But remember, most of the body water is inside

your cell and interstitial, not really in the blood vessel. So if you're giving a person about

three liters of fluid, you actually may be resuscitating like a liter of volume. You're only

...