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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. EMS have already splinted an obvious mid-shaft femoral fracture, but he continues to be tachycardic and hypotensive. years ( 2 ).

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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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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. Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. N Engl J Med. 2015; 372(5):418-25. EBMedicine.net.

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

REBEL EM

Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial. Lancet Haematol 2017. appeared first on REBEL EM - Emergency Medicine Blog. PMID: 36942533 Innerhofer P et al. PMID: 28457980 Jehan F et al.

FFP 145
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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.”

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

EMDocs

What is the EM physician’s role in the stabilization of unstable pelvic injuries? For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. If a pelvic binder was placed by EMS, inquire whether this was placed empirically or if mechanical pelvic instability was already elicited.

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