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Congenital Syphilis

Pediatric EM Morsels

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. Is this scalp swelling normal?

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Anticoagulation Reversal

Core EM

Published 2019 Jun 6. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. Background Around 6 million people in the U.S. Reversal of oral anticoagulation in patients with acute intracerebral hemorrhage. 2019;23(1):206.

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emDOCs Podcast – Episode 81: Hemophilia

EMDocs

The patient’s plasma is mixed with normal pooled plasma (NPP) which adds sufficient clotting factors to overcome the deficiency. If an inhibitor is present, it will inhibit the clotting factors in patient plasma and the NPP, and the clotting time remains prolonged. Each unit of FVIII/kg raises the plasma FVIII level by 2%.

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ToxCard: Diethylene Glycol

EMDocs

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. 2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. McGraw Hill, 2019. McGraw Hill, 2019.

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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.” 2019:94(4):697-703.

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ToxCard: Chronic Organophosphate Toxicity

EMDocs

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th Edition. Parenteral organophosphorus poisoning in a rural emergency department: a case report. He has been having difficulty walking and is having trouble manipulating tools he uses for work with his hands. Otherwise, provide supportive care. BMC Res Notes.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

8 Plasma butyrylcholinesterase (“pseudocholinesterase”) activity Easier to assay and is more widely available Red cell acetylcholinesterase (“true cholinesterase”) activity More accurate and specific Management: Patients require immediate intervention if there is concern for acute organophosphate poisoning. BMC Res Notes. 2013; 6:524.

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