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Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

AAEM RSA

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 ACS TQIP Best Practice Guidelines. 248(3):447-58.

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Penetrating chest trauma

Don't Forget the Bubbles

This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95.

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Sickle Cell Disease Module

Don't Forget the Bubbles

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Morphine sulphate is the commonest strong opioid to start with.

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ToxCard: Organic Mercury Poisoning

EMDocs

7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC. 2014 Jun 2;22(1):46. N Engl J Med.

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Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

ACEP Now

One side effect of this medication is that it can reduce the absorption of antiepileptic medications such as valproate, vigabatrin, and lamotrigine and reduce their plasma concentration, thus putting patients taking these medications at higher risk of seizure. Deerfield, Illinois: Takeda Pharmaceuticals America Inc; 2014. Steatorrhea.

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ToxCard: Chronic Organophosphate Toxicity

EMDocs

Iran Red Crescent Med J 16: e5072, 2014. doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Two assays available used to help confirm diagnosis, however, do not guide treatment Low levels of activity are consistent with organophosphate poisoning. Section 15: Toxicology: 1301-1303.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

8 Plasma butyrylcholinesterase (“pseudocholinesterase”) activity Easier to assay and is more widely available Red cell acetylcholinesterase (“true cholinesterase”) activity More accurate and specific Management: Patients require immediate intervention if there is concern for acute organophosphate poisoning. BMC Res Notes. 2013; 6:524.

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