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

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 First Aid Plasma OR

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 Emergency Department Plasma

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 EMS

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

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

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

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

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

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 OR Plasma

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

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 OR ALS Plasma

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

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

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

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

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 ALS Plasma EMS

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

Paramedicine Now

Thrombotic Thrombocytopenic Purpura (TTP)

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

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Snake Bites and Children

ToxCard: Diethylene Glycol

ToxCard: Local Anesthetic Systemic Toxicity

Trauma Resuscitation Updates

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

Emergency Department Evaluation of Cholestatic Labs

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

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

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

Recognition and Treatment of Thrombotic Thrombocytopenic Purpura

Cholera: ED presentation, evaluation, and management

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

Penetrating chest trauma

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

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

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

Sepsis Updates Relevant to the Emergency Physician

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