Don't Forget the Bubbles

JUNE 30, 2023

In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. In 2021, Kulvatunyou, Bauman and colleagues compared the insertion of traditional 28-32Fr chest tubes with 14Fr pigtail catheters for drainage of traumatic haemothorax. Is he going to be OK?

E-9-1-1 139

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

EMDocs

JUNE 12, 2024

Two randomized controlled trials by Moore et al found that prehospital plasma administration in trauma patients is associated with hypoCa (53% vs 36%). 2021 Mar;41:104-109. 2021 Feb 1;90(2):396-402. How does this impact the prehospital environment? Prehospital blood product transfusion increases risk of hypoCa. Am J Emerg Med.

FFP 105

FFP ALS Plasma Emergency Department 105

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

AAEM RSA

APRIL 1, 2021

2,3 Here we examine some of the evidence behind the various components of MTPs, specifically calcium and factor VIIa, and the ratios in which the main products of red blood cells, plasma, and platelets should be administered. Accessed January 5, 2021. Holcomb JB, Tilley BC, Baraniuk S, et al. 248(3):447-58. CRASH-2 trial collaborators.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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. Ammar 2021, Pham 2022, Parsel 2022) However, Korebey et al. 2021 Aug;35(1):255-261. Epub 2021 Jan 6.

Plasma 52

Plasma OR ALS EMS 52

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

Don't Forget the Bubbles

OCTOBER 28, 2024

Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). doi:10.1136/bmjopen-2021-057780 Hibberd O, Price J, Thomas SH, Harris T, Barnard EBG. Published 2021 Apr 29. What blood product ratio should we use? Published 2022 May 4. 2024;19(5):e0303109.

Frozen Plasma 72

Frozen Plasma FFP Plasma ALS 72

EMDocs

AUGUST 31, 2023

In April 2021, after a post-hoc analysis of the original phase 3 study suggested non-inferiority of the F(ab’) 2 antivenin against copperhead envenomation, the FDA expanded approval of this antivenom to include copperhead and cottonmouth envenomations. Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5

Allergic Reaction 95

Allergic Reaction Plasma ALS EMS 95

EMDocs

DECEMBER 18, 2023

The most recent surviving sepsis campaign (SSC) guidelines were released in 2021, which provided 93 recommendations for evidence-based sepsis management. 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

E-9-1-1 88

E-9-1-1 ALS Emergency Department Plasma 88

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. 2021 Jul 26;:]. Several neurological mechanisms for CRPS have been suggested, including central sensitisation, alteration in the central nervous system (CNS), and small fibre changes. Clin J Pain.

MPD 98

MPD ALS Plasma OR 98

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. 2021 Aug 05;21:101558]. 2023;158(1):63-71. doi:10.1001/jamasurg.2022.5772 2022.5772 Perumal R, S DCR, P SS, Jayaramaraju D, Sen RK, Trikha V.

ED 62

ED Operating Room ALS Frozen Plasma 62

EMDocs

JANUARY 22, 2025

Drug Overdose Deaths with Evidence of Counterfeit Pill Use – United States, July 2019-December 2021. Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. J Med Toxicol.

Naloxone 94

Naloxone E-9-1-1 Overdose NARCAN 94

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

The minimum effective plasma concentration of flecainide is about 200 ng/mL. This plasma concentration leads to a QRS prolongation of about 10 msec. At plasma concentration peak ( after 90120 min. ) record another ECG and calculate the QRS duration. = The optimal range is between 200 ng/mL and 400 ng/mL. and Brugada syndrome.

Plasma 72

Plasma ACS OR Coronary 72

EMDocs

FEBRUARY 3, 2025

Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). Exploring macrophage activation syndrome secondary to systemic lupus erythematosus in adults: A systematic review of the literature.Published October 2021. Aziz A, Castaneda EE, Ahmad N, et al. doi:10.7759/cureus.18822.

ED 68

ED E-9-1-1 ALS OR 68

Core EM

JANUARY 16, 2025

This graph shows the gaseous equivalent volume of oxygen stored in the lungs, bound to hemoglobin, and dissolved in the plasma for people breathing room air (far left) vs the same people pre-oxygenated by breathing 100% O2 (far right), and then after they have desatted to 90% while apneic (center). Figure 7: (modified from Tanoubi 2009).

EMS 130

EMS E-9-1-1 ALS OR 130

EMDocs

MARCH 11, 2024

Published online October 20, 2021. Although IgA has limited systemic circulation (~6 months), the memory B cells that are responsible for preventing cholera infection persist and can quickly expand and differentiate into plasmablasts and eventually the plasma cells, which can reseed protective antibodies upon antigen-contact activation.

ED 110

ED ALS OR Plasma 110

EMDocs

FEBRUARY 22, 2025

Although the concentration of chloride in the CSF is slightly higher than in plasma, measuring chloride (B) is not an accurate way to detect the presence of CSF. Epub 2021 Sep 9. Glucose testing (C) may be done rapidly but is unreliable for detecting CSF due to the abundance of false-positive results. Neurosurg Rev. PMID: 34499261.

EMS 63

EMS E-9-1-1 Plasma OR 63

EMDocs

NOVEMBER 2, 2024

The development of an inflammatory process is largely due to the infiltration of lymphocytes and plasma cells which ultimately result in nerve damage (e.g., 27,4 (2021): 1018-1039. 2021 Aug;9(8):e1039-e1040. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.”

EMS 113

EMS E-9-1-1 Plasma ALS 113

EMDocs

JANUARY 6, 2025

2021-0784 Long B, MacDonald A, Liang SY, et al. Published online July 1, 2021. 66 ^^ = a form of polio that arises from the oral polio vaccine (OPV) in regions where there is system lack of vaccination or undervaccination. Severe malaria management. 84 Adapted from: World Health Organization (WHO). WHO Guidelines for Malaria.;

ED 74

ED E-9-1-1 ALS Emergency Department 74