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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)?

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REBEL Core Cast 108.0 – Angioedema

REBEL EM

Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. In: UptoDate, Feldweg AM (ed.) Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. N Engl J Med.

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Anticoagulation Reversal

Core EM

2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Background Around 6 million people in the U.S. Background Around 6 million people in the U.S. Background Around 6 million people in the U.S.

FFP 130
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Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚

ED 54
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Best Practices for Upper Gastrointestinal Hemorrhage

ACEP Now

Fresh frozen plasma, or FFP, should only be given to cirrhotic patients as part of the massive transfusion protocol in cases of profound hypotension, as “patients with cirrhosis rarely have true enzymatic hypocoagulability, and FFP may worsen bleeding due to over-resuscitation and dilution of coagulation factors.”