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 20, 2023

Necrobiosis Lipoidica – This patient had a previous skin biopsy with histopathologic changes demonstrating a granulomatous dermatitis involving the dermis and subcutaneous tissues with necrobiosis of collagen and inflammatory infiltrates of lymphocytes and plasma cells consistent with a diagnosis of necrobiosis lipoidica.

Plasma 161

Plasma Coronary Emergency Department OR 161

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. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality.

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMDocs

AUGUST 31, 2023

Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 However, in 2015 crotalidae equine immune F(ab’) 2 (ANAVIP®) was approved by the FDA for rattlesnake envenomations, and distribution of this antivenom began in 2018. This size difference may lead to differences in the pharmacokinetic profiles of the two antibodies.

Allergic Reaction 97

Allergic Reaction Plasma ALS EMS 97

ESO

MARCH 15, 2024

Pulling data from the world’s largest de-identified medical database, the Index’s insights reflect over 968,538 hospital records from 596 hospital systems that took place between January 1 st and December 31 st of 2022. Balance resuscitation strategy, often in a 1:1:1 ratio of PRBCs with fresh frozen plasma and platelets.

Frozen Plasma 111

Frozen Plasma Plasma FFP OR 111

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

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] 2] This linking group can be either an amide (e.g., lidocaine) or an ester (e.g.,

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

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 94

E-9-1-1 ALS Plasma Emergency Department 94

The Overrun Podcast

MARCH 14, 2023

The gang gets back together and discusses new resuscitation data from 2022. Enrolled 789 patients RePHILL Study Question and Methods: Multicenter RCT out of the UK that investigated prehospital resuscitation using PRBCs and plasma versus normal saline to improve tissue perfusion or mortality in adult trauma patients with hemorrhagic shock.

Plasma 52

Plasma CPR OR 52

EMDocs

NOVEMBER 20, 2023

For patients on VKAs to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor prothrombin complex concentrate (PCC) is preferred to fresh frozen plasma (FFP) because of the rapidity of INR reduction (Conditional recommendation, very low-quality evidence). Conditional recommendation, low-quality evidence).

Frozen Plasma 104

Frozen Plasma FFP Plasma OR 104

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

FOAMfrat

SEPTEMBER 19, 2024

Background and Epidemiology In the United States, roughly 9,000 snake bites are reported annually, with approximately 3,000 being attributed to venomous species and less than 10 resulting in death. Many bites are associated with (human) consumption of alcohol. Fortunately, overall prognosis for snake envenomation within the U.S. Neither will the ER.

Emergency Department 95

Emergency Department Epinephrine OR Plasma 95

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 Plasma OR 75

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. Her medical history is significant for hypertension, hyperlipidemia, and hypothyroidism.

Emergency Department 105

Emergency Department E-9-1-1 ALS OR 105

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. 3 In TTP, patients undergo microangiopathic hemolytic anemia that leads to severe thrombocytopenia and, in severe cases, organ dysfunction.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

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 52

OR Plasma ALS EMS 52

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). This was his ECG. Intravascular Neutrophil Activation Due to Carbon Monoxide Poisoning What do you think of this ECG?

ACS 52

ACS Plasma OR STEMI 52

ACEP Now

FEBRUARY 11, 2024

Given the fact that he has not had these headaches before and has diffuse symptoms including weakness, lab work and head imaging are obtained. There were no acute findings on head CT. His lab values demonstrate no anemia, leukocytosis, or electrolyte abnormalities except for an elevated creatinine.

Overdose 52

Overdose ACS Plasma ALS 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). This makes comparing data across research trials challenging. As such, clinicians often activate the major haemorrhage protocol based on clinical suspicion, mechanism of injury and the clinical signs of shock.

Frozen Plasma 72

Frozen Plasma FFP Plasma ALS 72

EMDocs

DECEMBER 18, 2023

Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. Multiple studies published in 2022 have indicated that, despite disagreement surrounding prognostic accuracy, no such screening tool so far exists. vs. 8.52) when compared to MDW alone.

E-9-1-1 93

E-9-1-1 ALS Emergency Department Plasma 93

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 66

ED Operating Room ALS Frozen Plasma 66

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 94

ACS Plasma OR ED 94

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. 2022 Annual Report of the National Poison Data System (NPDS) from Americas Poison Centers: 40th Annual Report. It is illegal in six states and not regulated in 33 states. J Med Chem.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion. The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. Troponin T was negative on admission and on repeat blood draw.

Plasma 72

Plasma ACS OR Coronary 72

EMDocs

JANUARY 22, 2025

Naloxone reverses the analgesic, respiratory, sedative , and miotic e ffects of opioids. 6 Image 1: Structure of naloxone. Image courtesy of Wikimedia Commons. Naloxone Dosing Strategy: Start Low, Titrate Up In opioid-dependent or unknown patients, start with a lower dose (0.04 mg, 0.4mg, 2mg, and finally 10mg (rarely needed). 2mg* 2 5 0.5-1.5

Naloxone 97

Naloxone E-9-1-1 Overdose NARCAN 97

Don't Forget the Bubbles

MARCH 24, 2025

Later phase : As plasma levels fall, vasoconstriction decreases. Dexmedetomidine (Dexmed) is a highly selective alpha-adrenoreceptor agonist that can provide anxiolysis, sedation , and analgesia. Alpha-adrenoreceptors are found all over the body and reduce the fight-or-flight (sympathetic) response. How is Dexmedetomidine used in the ED?

E-9-1-1 59

E-9-1-1 Emergency Department ALS Critical Care 59

EMDocs

FEBRUARY 3, 2025

She also reports a fever (maximum 101F), photosensitivity, and mild abdominal discomfort radiating to both flanks, accompanied by some shortness of breath. However, she denies chest pain or any recent infections. Physical examination reveals a fatigued-appearing female with a malar rash across her face. What are common manifestations of SLE flares?

ED 71

ED E-9-1-1 ALS OR 71

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. Her facial features were flattened, and her eyes were sunken deep into their sockets. The patient’s breathing was labored, but breath sounds were normal.

ED 111

ED ALS OR Plasma 111

Core EM

JANUARY 16, 2025

Success at intubation likely takes more time and practice than other procedures, as shown in recent research on ED residents and their success rate at intubating, measured as a function of their total number of intubations (See Figure 1). Practice may not achieve perfection, but it will make you better. fiber optic through the nose).

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

FEBRUARY 22, 2025

A 37-year-old male comes in with facial trauma after his head slammed into the steering wheel during an MVC. He was able to walk away from the scene with no loss of consciousness, nausea, or vomiting. However, he has a headache that has become more painful. He was transported from the scene by EMS. VS include BP 120/80, HR 99, T 98.2,

EMS 67

EMS E-9-1-1 Plasma OR 67

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., Per the patient’s partner, he has not experienced any fevers, chills, cough, congestion, or recent illness and was not complaining of headaches or vision changes.

EMS 115

EMS E-9-1-1 Plasma ALS 115

EMDocs

JANUARY 6, 2025

Background: Refugees on the Rise As of 2022, it was estimated that there were 35.3 History of Present Illness The collateral history indicates that her symptoms began one week into her journey, but medical care was inaccessible at the time. The family reports no history of food allergies, insect bites, or contact with sick individuals.

ED 75

ED E-9-1-1 ALS Emergency Department 75