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Thrombotic Thrombocytopenic Purpura (TTP)

Core EM

Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. Decreases production of anti-ADAMTS13 antibodies by removing the B cells that mature into autoantibody-secreting plasma cells. 2018 Nov 30;2018(1):530-538.

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Acute Transverse Myelitis in Children

Pediatric EM Morsels

Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g. first sign of MS).

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SGEM#251: Nothing Compares to You…Because there was No Comparison Group

The Skeptics' Guide to EM

Date: April 5th, 2019 Reference: Connolly et al. Date: April 5th, 2019 Reference: Connolly et al. 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 ).

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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.” 2018:36(4):689-698.

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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. doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. 2018 Apr;44(4):409-417.

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Emergency Department Evaluation of Cholestatic Labs

EMDocs

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. doi:10.1016/B978-0-323-48109-0.00036-5 Todd Taylor A, Wheatley M, Chung AS, et al. doi:10.3109/00365529309098282 Newsome PN, Cramb R, Davison SM, et al. 2018:346-353.e2. Mayo Clin Proc. 2018;67(1):6-19.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

7 Check out ToxCard: Nerve Agents by Dr. Sahi & Dr. Santos from July 2018 Organophosphates exert their toxic effects by inhibiting acetylcholinesterase within the synaptic cleft, which leads to accumulation of acetylcholine, with subsequent overstimulation of postsynaptic nicotinic and muscarinic receptors, and a predominant cholinergic effect.

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