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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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SGEM#369: Romeo is Bleeding – Does He Need a RePHILL?

The Skeptics' Guide to EM

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
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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. 28,1 (2008): 105-20.

Plasma 141
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ACMT Toxicology Visual Pearls: On the Mark

ALiEM

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
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Congenital Syphilis

Pediatric EM Morsels

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Rates of congenital syphilis are increasing. Can identify T. pallidum before antibodies against it can be detected.

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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 ). The FDA granted accelerated approval for andexanet alfa (Andexxa) in May of 2018. Dabigatran is a direct thrombin inhibitor.

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Penetrating chest trauma

Don't Forget the Bubbles

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.).

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