ACEP 2015 Pearls Part 1

I'm starting a series of practice-improving information that I learned at ACEP 2015.
The first few in the series are from David Pearson, MD, FACEP, Associate Residency Director, Carolinas Medical Center and his "Critical Care Pearls" session.
*Shock Index: A better predictor of shock than SBP alone. According to Dr. Pearson, a SBP< 90 is actually a late and insensitive finding.
The shock index is HR/SBP. A value > 0.9 indicates tissue hypoperfusion.
4% of intubated patients have peri-intubation cardiac arrest and the shock index can predict risk of peri-intubation arrest
A preintubation shock index of 0.8 or higher predicts post-intubation hypotension and peri-intubation cardiac arrest
Other predictors include intubation for acute respiratory failure, chronic renal insufficiency, and advanced age
*Fluids: A balanced electrolyte solution is more physiologic than either LR or NS.
pH of NS= 5.5
pH of LR= 6.5
Balanced electrolyte solution, eg. Plasmalyte: pH= 7.4
With NS, chloride is exchanged for HCO3- in serum which can lead to acidosis and hyperchloremia
In severely ill acidotic patients, NS can further drop pH
In absence of BES such as Plasmalyte, LR has higher pH and is more physiologic

More pearls from Dr. Pearson's session coming soon!
Feedback is appreciated! Hope this is helpful.

**CORRECTION: The original post incorrectly attributed this session to Dr. Scott Weingart. The author apologizes for any inconvenience/misunderstanding.