The Overrun

JUNE 3, 2023

Through the years, we see a change to plasma, then crystalloid, and then 1:1:1 therapy. Once compared, while 1:1:1 therapy or giving PRBCs or plasma alone is better than crystalloid, whole blood is preferable and may have more of a survival benefit for patients. In the First World War, the preferred resuscitation fluid was whole blood.

Plasma 52

Plasma Paramedicine Paramedicine EMS 52

EMDocs

MAY 23, 2024

3 Measured in analytical testing : Laboratories measure plasma concentration using osmometers which measures values as a function of kilograms of solvent. New York Mcgraw-Hill Education; 2019. Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae. Goldfrank’s Toxicologic Emergencies.

Plasma 65

Plasma EMS ED OR 65

EMDocs

JULY 11, 2023

Today on the emDOCs cast, Brit Long, MD ( @long_brit) covers hemophilia, including background, severity, evaluation, and management. Episode 81: Hemophilia What is hemophilia? Bleeding disorder due to a deficiency in one or more of the proteins (factors) involved in the coagulation pathway. Most common site is hemarthrosis (70-80% of cases).

Plasma 62

Plasma ALS OR Emergency Department 62

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication. 1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity?

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

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.” 6 Balloon tamponade (i.e.,

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

EMDocs

JUNE 14, 2023

He has a glove and stocking pattern of numbness to his extremities. Motor and sensory findings are symmetrical. Patellar reflexes are 1+. He has no saddle anesthesia or back pain and denies any difficulty urinating or issues with defecation. Paraquat Influenza vaccine Methanol Organophosphate Are his symptoms reversible?

E-9-1-1 70

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

EMDocs

JUNE 7, 2023

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. 7 May lead to respiratory failure.

E-9-1-1 83

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

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

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. What are nerve agents? [1-3] 1-3] Nerve agents inhibit acetylcholinesterase (AChE) and lead to a cholinergic crisis. Provide supportive care. McGraw Hill.

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

Don't Forget the Bubbles

AUGUST 12, 2024

This can be from the brain hitting the skull, shear forces from sudden acceleration and deceleration, or direct injury at the point of impact. The severity of head injuries can be classified according to the GCS. TBI occurs in two stages: a primary brain injury and a secondary brain injury. This insult to the brain is often irreversible.

ALS 75

ALS Emergency Department OR Plasma 75

Don't Forget the Bubbles

JUNE 30, 2023

You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives. Ranulf is quite a sweet, round-faced boy, accompanied by his traumatised-looking mother as he is wheeled to your trauma bay.

E-9-1-1 139

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

EMDocs

MARCH 11, 2024

3 Between 1990 and 2019, there were approximately 3 million deaths due to cholera globally, indicating a significant public health issue. 3 Between 1990 and 2019, there were approximately 3 million deaths due to cholera globally, indicating a significant public health issue. The extremities were cold with no peripheral edema.

ED 90

ED OR ALS Plasma 90

EMDocs

JULY 19, 2023

However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. She first noticed herself bumping into walls but attributed it to being absent-minded or not paying enough attention to where she was going.

ACS 66

ACS Plasma OR ED 66

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. What is Complex Regional Pain Syndrome? CRPS is distinguished from other chronic pain conditions by the presence of signs indicating prominent autonomic and inflammatory changes in the region of pain.

MPD 98

MPD ALS Plasma OR 98

REBEL EM

JUNE 26, 2023

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72

FFP 145

FFP Frozen Plasma ALS Plasma 145

REBEL EM

NOVEMBER 28, 2022

Xian 2019) 4-Factor Prothrombin Complex Concentrates (4F-PCC), or K-Centra, is a derivative of human plasma and is explicitly used to reverse vitamin K antagonists such as warfarin and non-specifically in the reversal of DOACs. The question remains—Which reversal agent is ideal in anticoagulant-associated intracranial bleeding (ICB)?

OR 52

OR ALS Plasma EMS 52

EMDocs

JUNE 3, 2023

Introduction The pelvic ring is made up of the bony ilium, ischium, pubis, and sacrum, which are held together with ligaments. Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently.

ED 54

ED Operating Room ALS Frozen Plasma 54

Pediatric EM Morsels

SEPTEMBER 6, 2024

We talk about a lot of common, not-to-miss diagnoses here at the Morsel Bakery, but we also talk about remaining vigilant for more subtle or uncommon diagnoses. We have spoken about causes to consider when working up a Fever of Unknown Origin including Myocarditis , Osteomyelitis , Acute Rheumatic Fever , and Lemierres syndrome.

Plasma 152

Plasma OR EMS 152

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. In addition, free haem and haemoglobin contribute to the vascular damage. Blood film shows sickle cells and a further sample was sent for confirmation of diagnosis.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126