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Podcast 185.0: Anticoagulation Reversal

Core EM

Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al. 2015 Dec 22;132(25):2412-22.

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EM@3AM: Amniotic Fluid Embolism

EMDocs

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. 2015 May;28(7):793-8. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain.

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REBEL Core Cast 108.0 – Angioedema

REBEL EM

2015; 372(5):418-25. In: UptoDate, Feldweg AM (ed.) Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. A randomized trial of icatibant in ACE-inhibitor-induced angioedema. N Engl J Med. PMID 25629740 Hassen GW et al. J Emerg Med 2013; 44 (4): 764-772. EBMedicine.net.

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Penetrating chest trauma

Don't Forget the Bubbles

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. a) A balanced ratio of 1:1:1 (platelets: FFP: packed red cells) The PROPPR trial showed us that balanced ratios are important. The trauma call goes out.

E-9-1-1 139
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emDOCs Podcast – Episode 102: Hypocalcemia in Trauma and the Diamond of Death

EMDocs

FFP and platelets also contain citrate. How does this impact what you do in the ED? Blood products, including both packed red blood cells and whole blood, are stored with the anticoagulant citrate, with can bind Ca and lower ionized Ca levels. grams of citrate per unit. Any transfused blood product can reduce active Ca in the serum.

ALS 89
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SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients

The Skeptics' Guide to EM

Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. The transfusion tech calls to remind you that your protocol is currently under review, and asks if would you like the 1:1 or the 1:3 version of fresh-frozen plasma (FFP) to packed red blood cells (pRBC)?