ACEP Now

NOVEMBER 16, 2023

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.” 2019:94(4):697-703.

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. Occup Med (Lond).

E-9-1-1 83

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

EMDocs

MARCH 11, 2024

Louis) // Reviewed by: Joshua Lowe, MD (EM Staff Physician, USAF); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 25-year-old woman presented to the emergency department (ED) in Uganda with acute encephalopathy. How is this condition diagnosed and treated in the ED? Kirk M, ed. 2023;10:1155751. doi:10.3389/fmed.2023.1155751

ED 90

ED OR ALS Plasma 90

EMDocs

JUNE 14, 2023

These are send-out labs with turn-around times that make them unlikely to affect the ED course. This prevents ongoing exposure to the patient and ED staff. In: Mattu A and Swadron S, ed. 3 However, may be helpful in diagnosing the chronic toxicity forms. Treatment mainstay is avoidance of further exposure. McGraw-Hill Education.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. 2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463. Epub 2019 Jun 24. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Chemical terrorism.

Plasma 195

Plasma OR ED 195

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 54

ED Operating Room ALS Frozen Plasma 54

REBEL EM

MAY 25, 2023

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. The trauma call goes out. You will be running the show today, and you want to use your preparation time well. to −0.5%]; P  = 0.03.). to −0.5%]; P  = 0.03.).

E-9-1-1 139

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

EMDocs

JULY 19, 2023

This would be a send-out test and would be unlikely to help us acutely in the ED. However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. 2019 Jan 16;2019:4275918. doi: 10.1155/2019/4275918. Case Rep Crit Care. PMID: 30792928; PMCID: PMC6354150.

ACS 66

ACS Plasma OR ED 66

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. Haematology specialist clinics are key to manage the chronic side of the disease, while ED doctors should be able to act rapidly on the common acute emergencies.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126