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SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients

The Skeptics' Guide to EM

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).

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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. to −0.5%]; P  = 0.03.).

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ToxCard: Diethylene Glycol

EMDocs

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. 2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. 6, 1 June 2014, pp.

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ToxCard: Chronic Organophosphate Toxicity

EMDocs

Iran Red Crescent Med J 16: e5072, 2014. Parenteral organophosphorus poisoning in a rural emergency department: a case report. He has been having difficulty walking and is having trouble manipulating tools he uses for work with his hands. 3 However, may be helpful in diagnosing the chronic toxicity forms. CorePendium.

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Postpartum Hemorrhage: The Chapter We Skipped.

FOAMfrat

Moreover, LTOWB also allows us to administer platelets and plasma, in addition to red cells, to promote clotting and homeostasis. If you don't have access to LTOWB and are administering component therapies such as PRBCs or plasma, this is still incredible and I highly encourage it! Emergency Medicine: A Comprehensive Study Guide.

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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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Utility of D-dimer Testing in Special Populations

EMDocs

7 The American College of Emergency Physicians (ACEP) clinical policy supports the use of age-adjusted D-dimer testing when evaluating for VTE in older patients. 2014 Apr 23-30;311(16):1694]. Ann Emerg Med. 9 Additionally, a D-dimer level in the evaluation of AAD is most useful within 24 hours of symptom onset.

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