2022, ALS and Plasma - Paramedicine Now

Thrombotic Thrombocytopenic Purpura (TTP)

Core EM

JANUARY 25, 2024

source: “Thrombotic Thrombocytopenic Purpura (TTP)”, 2022 , National Heart, Lung, and Blood Institute. Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. Scully, 2012) Citations: Balduini CL, et al.

Plasma

Plasma Frozen Plasma Emergency Department FFP

SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. sodium chloride), and balanced crystalloid solutions, meaning those with a chloride composition closer to plasma such as lactated ringer’s or Plasma Lyte 148. Reference: Finfer et al.

ICU

ICU Plasma Critical Care ALS

Trauma Resuscitation Updates

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1

E-9-1-1 Plasma ALS OR

SGEM#369: Romeo is Bleeding – Does He Need a RePHILL?

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. The Lancet Haematology 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anaesthesia and critical care. Date: June 18th, 2022 Reference: Crombie et al. Reference: Crombie et al. What do you advise him?

Plasma

Plasma Critical Care Paramedic ALS

SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: December 16th, 2022 Reference: Hohle et al. years ( 2 ).

Frozen Plasma

Frozen Plasma FFP Emergency Medical Services Plasma

Snake Bites and Children

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

Frozen Plasma

Frozen Plasma Plasma First Aid OR

ToxCard: Crotalid Envenomation Part 2 – CroFab vs. AnaVip: What’s the Difference?

EMDocs

AUGUST 31, 2023

Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. This size difference may lead to differences in the pharmacokinetic profiles of the two antibodies. 5 Figure 1. References: Ubani C, DeGelorm A, Sollee D.

Allergic Reaction

Allergic Reaction Plasma ALS EMS

ToxCard: Diethylene Glycol

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Metabolism of DEG adapted from Bessenhofer, et al. References: Abubukar et al. Nelson, et al. Accessed August 2022. FDA Consumer Magazine , June 1981, [link] Accessed August 2022.

E-9-1-1

E-9-1-1 ALS Plasma Emergency Department

Penetrating chest trauma

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. 2022 Dec;57(12):986-993. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

ToxCard: Local Anesthetic Systemic Toxicity

EMDocs

APRIL 10, 2024

Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] McGraw Hill; 2022. 2] This linking group can be either an amide (e.g.,

E-9-1-1

E-9-1-1 Plasma Epinephrine Life Support

Managing raised intracranial pressure in severe traumatic brain injury – the basics

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. Ben Abdeljelil A, Freire GC, Yanchar N, et al. Published 2022 Nov 20. Doi:10.1056/NEJMc2201761 Kochanek PM, Adelson PD, Rosario BL, et al. Published 2022 Mar 1. 2022.0891 Kochanek PM, Tasker RC, Carney N, et al.

ALS

ALS Emergency Department Plasma OR

Recognition and Treatment of Thrombotic Thrombocytopenic Purpura

ACEP Now

APRIL 5, 2024

Therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) is the first-line treatment, by simultaneously supplying fresh ADAMTS13 and removing anti-ADAMTS13 autoantibodies. References Sukumar S, Lämmle B, et al. Kessler CS, Khan BA, et al. Li XM, Mo XY, et al. 2021;46:556-9 Long B, Bridwell RE, et al.

Frozen Plasma

Frozen Plasma Plasma Emergency Department FFP

Spicy Bites - Snake Envenomation

FOAMfrat

SEPTEMBER 19, 2024

Along with inducing coagulopathy, venom toxins may contribute to local and/or systemic hemorrhage and plasma extravasation by means of basement membrane degradation within the vasculature. 2022, www.ncbi.nlm.nih.gov/books/NBK557565/. Other venom toxins carry a fibrinogenolytic effect which hinders coagulation (anticoagulation).

Emergency Department

Emergency Department Epinephrine OR Plasma

Emergency Department Evaluation of Cholestatic Labs

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. Published online October 31, 2022:97-117. doi:10.1016/B978-0-323-48109-0.00036-5 Todd Taylor A, Wheatley M, Chung AS, et al. doi:10.3109/00365529309098282 Newsome PN, Cramb R, Davison SM, et al.

Emergency Department

Emergency Department E-9-1-1 ALS OR

Andexxa Vs 4F-PCC in ICH: An Ongoing Debate

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. Crit Care 26, 180 (2022).

OR

OR Plasma ALS EMS

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

ACEP Now

FEBRUARY 11, 2024

One side effect of this medication is that it can reduce the absorption of antiepileptic medications such as valproate, vigabatrin, and lamotrigine and reduce their plasma concentration, thus putting patients taking these medications at higher risk of seizure. Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Bansal AB, Al Khalili Y.

Overdose

Overdose ACS Plasma ALS

A comatose patient with a carbon monoxide level over 50%

Dr. Smith's ECG Blog

FEBRUARY 18, 2022

In fact, there is laboratory evidence that CO toxicity increases Plateletneutrophil aggregates and plasma myeloperoxidase (MPO) concentration and thus may precipitate ACS (though this is by no means clinically proven). Yelken B et al. Intravascular Neutrophil Activation Due to Carbon Monoxide Poisoning What do you think of this ECG?

ACS

ACS Plasma OR STEMI

A guide to major haemorrhage management in paediatrics

Don't Forget the Bubbles

OCTOBER 28, 2024

Karageorgos S, Ren D, Ranaweera M, et al. Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Re ferences Al-Jeabory M, Gasecka A, Wieczorek W, Mayer-Szary J, Jaguszewski MJ, Szarpak L. 2021.02.009 George S, Wake E, Jansen M, et al.

Frozen Plasma

Frozen Plasma FFP Plasma ALS

SGEM#377: You Don’t Have to “AcT” that Way – TNK for Acute Ischemic Stroke?

The Skeptics' Guide to EM

SEPTEMBER 24, 2022

Date: September 20th, 2022 Reference: Menon et al. The Lancet 2022 Guest Skeptic: Professor Daniel Fatovich is an emergency physician and clinical researcher based at Royal Perth Hospital, Western Australia. Date: September 20th, 2022 Reference: Menon et al. Reference: Menon et al.

Plasma

Plasma ALS

Sepsis Updates Relevant to the Emergency Physician

EMDocs

DECEMBER 18, 2023

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. The first was the suggestion to use balanced crystalloid fluids, such as lactated ringers or plasma-lyte, instead of normal saline. References Evans L, Rhodes A, Alhazzani W, et al.

E-9-1-1

E-9-1-1 ALS Emergency Department Plasma

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

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. Glick Y, Knipe H, Hacking C, et al. Published November 8, 2022. Coccolini F, Stahel PF, Montori G, et al. Published April 22, 2022.

ED

ED Operating Room ALS Frozen Plasma

Case Report: Acute Kratom Withdrawal

ACEP Now

FEBRUARY 11, 2025

In 2022, the National Poison Data system reported 1,278 cases involving kratom; about 45 percent of those cases required health care facility management. Gummin DD, Mowry JB, Beuhler MC, et al. 2022 Annual Report of the National Poison Data System (NPDS) from Americas Poison Centers: 40th Annual Report. Clin Toxicol (Phila).

NARCAN

NARCAN Naloxone Overdose Mental Health Services

ToxCard: Naloxone – Pearls and Pitfalls

EMDocs

JANUARY 22, 2025

DOI: [link] O’Donnell J, Tanz LJ, Miller KD, et al. 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. PMID: 15651944] Robertson TM, Hendey GW, Stroh G, et al.

Naloxone

Naloxone E-9-1-1 Overdose NARCAN

Electrical instability in a healthy 50 year old. How to manage?

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. = 2022, September 2) [2] Ward, R. and Brugada syndrome. Van Zyl, M., &

Plasma

Plasma ACS OR Coronary

The Basics of Dexmedetomidine

Don't Forget the Bubbles

MARCH 24, 2025

Later phase : As plasma levels fall, vasoconstriction decreases. References Baserga M, DuPont TL, Ostrander B, et al. 2021.770511 Bayram A, Ulgey A, Baykan A, et al. Sahyoun C, Cantais A, Gervaix A, et al. doi:10.1007/s00431-021-03930-6 Smith HAB, Besunder JB, Betters KA, et al. 13526 Zhang Q, Zhou J, He Q, et al.

E-9-1-1

E-9-1-1 Emergency Department ALS Critical Care

Systemic Lupus Erythematosus: ED presentations, evaluation, and management

EMDocs

FEBRUARY 3, 2025

Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). Aringer M, Costenbader K, Daikh D, et al. Meier AL, Bodmer NS, Wirth C, et al. Tani C, Elefante E, Arnaud L, et al. Bartels CM, Buhr KA, Goldberg JW, et al. 2024;331(17):1480-1491.

ED

ED E-9-1-1 ALS OR

An EM Resident’s Guide to Basic Airway Management

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). et al (2022). Baker JB, et al.

E-9-1-1

E-9-1-1 EMS ALS OR

Cholera: ED presentation, evaluation, and management

EMDocs

MARCH 11, 2024

2 As of 2022 cholera was estimated to be responsible for over 4 million cases and 143,000 deaths each year, with a case fatality rate of 50% without timely and appropriate treatment. Published online November 14, 2022. Published online June 1, 2022. References Montero DA, Vidal RM, Velasco J, et al. Rehydration Therapy.

ED

ED ALS OR Plasma

EM@3AM: CSF Leak

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. 2022 Jun;45(3):1827-1845. 2022 Jun;45(3):2501. 2022 Jul;43(7):1068-1072. Epub 2022 Jun 23. 2022 Oct;74(Suppl 2):737-744. 2022 Aug;219(2):292-301.

EMS

EMS E-9-1-1 Plasma OR

EM@3AM: Neurosyphilis

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., Rosh Review Website Link References: Tudor ME, Al Aboud AM, Leslie SW, Gossman W. doi:10.1056/NEJMra1906228 Ha T, Tadi P, Leslie SW, et al. In: StatPearls. N Engl J Med.

EMS

EMS E-9-1-1 Plasma ALS

ED care of refugee populations from sub-Saharan Africa

EMDocs

JANUARY 6, 2025

Background: Refugees on the Rise As of 2022, it was estimated that there were 35.3 57 Adapted from: Long B, MacDonald A, Liang SY, et al. Global Trends Report 2022. link] Rother B, Pierre G, Lombardo D, et al. million refugees globally, with 80% of the refugee population located in Africa. 1 By the end of 2023, 117.3

ED

ED E-9-1-1 ALS Emergency Department

Paramedicine Now

Thrombotic Thrombocytopenic Purpura (TTP)

SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study

Trending Sources

Trauma Resuscitation Updates

SGEM#369: Romeo is Bleeding – Does He Need a RePHILL?

SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients

Snake Bites and Children

ToxCard: Crotalid Envenomation Part 2 – CroFab vs. AnaVip: What’s the Difference?

ToxCard: Diethylene Glycol

Penetrating chest trauma

ToxCard: Local Anesthetic Systemic Toxicity

Managing raised intracranial pressure in severe traumatic brain injury – the basics

Recognition and Treatment of Thrombotic Thrombocytopenic Purpura

Spicy Bites - Snake Envenomation

Emergency Department Evaluation of Cholestatic Labs

Andexxa Vs 4F-PCC in ICH: An Ongoing Debate

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

A comatose patient with a carbon monoxide level over 50%

A guide to major haemorrhage management in paediatrics

SGEM#377: You Don’t Have to “AcT” that Way – TNK for Acute Ischemic Stroke?

Sepsis Updates Relevant to the Emergency Physician

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

Case Report: Acute Kratom Withdrawal

ToxCard: Naloxone – Pearls and Pitfalls

Electrical instability in a healthy 50 year old. How to manage?

The Basics of Dexmedetomidine

Systemic Lupus Erythematosus: ED presentations, evaluation, and management

An EM Resident’s Guide to Basic Airway Management

Cholera: ED presentation, evaluation, and management

EM@3AM: CSF Leak

EM@3AM: Neurosyphilis

ED care of refugee populations from sub-Saharan Africa

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