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

Pediatric EM Morsels

MARCH 17, 2023

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.

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

EMDocs

JULY 11, 2023

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%.

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. McGraw Hill, 2019. McGraw Hill, 2019. Pharmacokinetics: 2 No minimal toxic dose has been established, however, doses up to 22 mg seem to be safe for adults from the available literature. Schier, Capt.

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.” 2019:94(4):697-703.

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

EMDocs

JUNE 14, 2023

Two assays available used to help confirm diagnosis, however, do not guide treatment Low levels of activity are consistent with organophosphate poisoning. These are send-out labs with turn-around times that make them unlikely to affect the ED course. 3 However, may be helpful in diagnosing the chronic toxicity forms. References: Tintinalli, J.

E-9-1-1 70

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

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

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. Br J Clin Pharmacol.

E-9-1-1 83

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

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. Romano JA Jr, Newmark J.

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

JUNE 30, 2023

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. 2019 Aug;31(4):683-687.

E-9-1-1 139

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

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. 2019 Apr;20(4):404]. Published 2019 Nov 27. The osmolarity is also increased in the kidneys, which leads to diuresis. Hence, it’s important to monitor blood pressure to avoid any episodes of hypotension after mannitol.

ALS 75

ALS Emergency Department OR Plasma 75

EMDocs

JULY 19, 2023

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. Secondary to its high volume of distribution, mercury is not readily dialyzable. Case Rep Crit Care. PMID: 30792928; PMCID: PMC6354150.

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. 2019 Dec;35(12):933-940. Several neurological mechanisms for CRPS have been suggested, including central sensitisation, alteration in the central nervous system (CNS), and small fibre changes.

MPD 98

MPD ALS Plasma OR 98

REBEL EM

JUNE 26, 2023

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.

FFP 144

FFP Frozen Plasma ALS Plasma 144

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. 2019, April 4). Conley, P. Verhamme, P., Schmidt, J., Middeldorp, S., Beyer-Westendorf, J.,

OR 52

OR ALS Plasma EMS 52

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. Non-O1/non-O139 Vibrio cholerae bacteraemia in mainland China from 2005 to 2019: clinical, epidemiological and genetic characteristics. 2023;10:1155751. doi:10.3389/fmed.2023.1155751 2020;148:e186.

ED 90

ED OR ALS Plasma 90

Pediatric EM Morsels

SEPTEMBER 6, 2024

Epub 2019 Oct 1. Arch Pathol Lab Med 1 November 2018; 142 (11): 1341–1346. doi: [link] Selvanathan SN, Suhumaran S, Sahu VK, Chong CY, Tan NWH, Thoon KC. Kikuchi-Fujimoto disease in children. J Paediatr Child Health. 2020 Mar;56(3):389-393. doi: 10.1111/jpc.14628. PMID: 31576642. Fusconi, M. and Zaccharelli, F.

Plasma 152

Plasma OR EMS 152

EMDocs

JUNE 3, 2023

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.

ED 54

ED Operating Room ALS Frozen Plasma 54

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. 2019, 3 rd edition. From: [link] Sickle Cell Disease in Childhood: Standards and Recommendations for Clinical Care.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126