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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. NEJM 2019 Guest Skeptic: Dr. Ryan Radecki is an Emergency Physician at Kaiser Permanente NW, co-host of the Annals of Emergency Medicine podcast and Journal Club section editor. Date: April 5th, 2019 Reference: Connolly et al.

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Anticoagulation Reversal

Core EM

Published 2019 Jun 6. Background Around 6 million people in the U.S. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Clin Med (Lond). 2018;18(4):314-319. doi:10.7861/clinmedicine.18-4-314

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Snake Bites and Children

Pediatric EM Morsels

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. It’s expensive, so if you’re giving some of a vial, give it all.

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

REBEL EM

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 2019. PMID: 36942533 Innerhofer P et al. Lancet Haematol 2017. PMID: 28457980 Jehan F et al.

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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: Iron

EMDocs

Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated. McGraw Hill; 2019. Can titrate up to maximum of 40 mg/kg/hr, although hypotension may limit dose of deferoxamine. 10 Maximum daily dose of 6-8g total of defuroxamine. Blood transfusion for clinically significant blood loss. Tenenbein M.

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Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

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. 2019 Dec;38(6):695-696]. 2010;376(9734):23-32. doi:10.1016/S0140-6736(10)60835-16. Incagnoli P, Puidupin A, Ausset S, et al. Anaesth Crit Care Pain Med.

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