Remove 2015 Remove OR Remove Plasma
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SGEM#251: Nothing Compares to You…Because there was No Comparison Group

The Skeptics' Guide to EM

In contrast, protamine could be used for heparin and LMWH reversal and vitamin K, fresh frozen plasma and prothrombinase complex concentrate could be used to reverse coumadin ( Hunt and Levi BMJ 2018 ). This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran.

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Whole Blood: Ready for Prime Time

The Overrun

Through the years, we see a change to plasma, then crystalloid, and then 1:1:1 therapy. Once compared, while 1:1:1 therapy or giving PRBCs or plasma alone is better than crystalloid, whole blood is preferable and may have more of a survival benefit for patients. In the First World War, the preferred resuscitation fluid was whole blood.

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Maintenance Fluids in Critical Illness

Don't Forget the Bubbles

Have a look to see how their osmolarity and tonicity across the cell membrane compare to plasma. Renal (= urine output) : anti-diuretic hormone (ADH) release from the posterior pituitary is stimulated by microchanges in plasma osmolarity. This water is held in either the intracellular compartment (i.e. everywhere outside the cells).

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Trauma Resuscitation Updates

REBEL EM

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al.

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REBEL Core Cast 108.0 – Angioedema

REBEL EM

Bradykinin Mediated Plasma globulins called kininogens release bradykinin and cause vascular permeability. Image: ( Morgan 2010 ) Features Absence of urticaria and pruritus Insidious onset (24-36 hours) ACE Inhibitors Inhibition of ACE hinders the degradation of bradykinin and can lead to idiosyncratic angioedema.

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Postpartum Hemorrhage: The Chapter We Skipped.

FOAMfrat

I can only speak for me, but I don’t ever remember anyone talking about that, and I would venture to guess most readers don’t either. I love this definition because it is simple and to the point: bleeding post birth accompanied by shock. Perfusion in your body is much the same. In the case of our patient, she is experiencing the latter.

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Penetrating chest trauma

Don't Forget the Bubbles

You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives. Ranulf is quite a sweet, round-faced boy, accompanied by his traumatised-looking mother as he is wheeled to your trauma bay.

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