The Skeptics' Guide to EM

JUNE 18, 2022

The paramedic asks you, “we have saline, and we also have red-cells and this fancy new lyophilised plasma. Should we give our shocked patient saline or plasma / red cells en route to the ED?” The Control of Major Bleeding After Trauma ( COMBAT ) Trial was published in the Lancet in 2018. What do you advise him?

Plasma 100

Plasma Critical Care Paramedic ALS 100

EMDocs

JUNE 7, 2023

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.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. 2018 Jan 5;359(6371):23. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Even with rapid treatment, the mortality rate is high. Neurol Clin Pract.

Plasma 195

Plasma OR ED 195

Don't Forget the Bubbles

MAY 15, 2023

This response varies between individuals, age groups and developmental stages, so a single plasma concentration cannot be defined. If there is clinical concern for hypoglycaemia, plasma glucose concentration should be measured. Learning point: Take a plasma glucose sample and ask the lab to run it urgently – time is sugar!

ED 101

ED Plasma OR ALS 101

Dr. Smith's ECG Blog

APRIL 6, 2018

Terbutaline and Albuterol for Lowering of Plasma Postassium Initial labs returned and confirmed critical hyperkalemia and new renal failure. In 2018 there is generally a delay to onset of dialysis in most EDs. We should also have given 0.25mg intramuscular terbutaline, but we did not.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

Don't Forget the Bubbles

AUGUST 2, 2023

Pro-inflammatory states may also play a role, as patients with CRPS have significantly higher levels of plasma cytokines and chemokines. in 2018, 16% of patients diagnosed with CRPS had comorbid depression, and two-thirds had at least one psychiatric diagnosis, significantly higher than in the general population. Pain Res Manag.

MPD 98

MPD ALS Plasma OR 98

Don't Forget the Bubbles

JUNE 30, 2023

This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. to −0.5%]; P  = 0.03.).

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

EMDocs

AUGUST 31, 2023

However, in 2015 crotalidae equine immune F(ab’) 2 (ANAVIP®) was approved by the FDA for rattlesnake envenomations, and distribution of this antivenom began in 2018. Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 Published online January 2018. 5 Figure 1. Crotalidae Immune F(ab’)2 (Equine).

Allergic Reaction 72

Allergic Reaction Plasma ALS EMS 72

REBEL EM

JUNE 26, 2023

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. J Trauma Acute Care Surg 2018. Lancet Haematol 2017. PMID: 28457980 Jehan F et al. PMID: 29664892 Zeeshan M et al.

FFP 144

FFP Frozen Plasma ALS Plasma 144

EMDocs

JULY 19, 2023

However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. 2018, February 1). Chelation is generally indicated in cases where patients are experiencing symptoms of toxicity (even the vague, non-specific ones) or there are elevated concentrations of mercury in blood.

ACS 66

ACS Plasma OR ED 66

Pediatric EM Morsels

SEPTEMBER 6, 2024

Kikuchi-Fujimoto Disease: Basics Non-malignant condition of lymph nodes Also known as Histiocytic Necrotizing Lymphadenitis [Perry 2018, Selvanathan 2020, Fusconi 2023, Boone 2023] First described in 1972 by Kikuchi and Fujimoto independently [Perry 2018, Boone 2023] Seen worldwide, but higher prevalence in Japanese and other Asian populations [Perry (..)

Plasma 152

Plasma OR EMS 152

EMDocs

MARCH 11, 2024

2018 Nov;38(sup1):S16-S31. Although IgA has limited systemic circulation (~6 months), the memory B cells that are responsible for preventing cholera infection persist and can quickly expand and differentiate into plasmablasts and eventually the plasma cells, which can reseed protective antibodies upon antigen-contact activation.

ED 90

ED OR ALS Plasma 90

EMDocs

JUNE 3, 2023

Institutional protocols should be utilized, keeping in mind that either whole blood or a 1:1:1 ratio of packed red blood cells, platelets, and fresh frozen plasma are optimal. Published October 9, 2018. Int J Environ Res Public Health. 2017;14(10):1217. Published 2017 Oct 12. doi:10.3390/ijerph14101217 Heilman, J. Wikimedia Commons.

ED 54

ED Operating Room ALS Frozen Plasma 54

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. J Hematol 2018; 93: 363-370 Rubin LG, Schaffner W. Acute Chest Syndrome in Children with Sickle Cell Disease. Macharia AW et al. Care of the Asplenic Patient.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126