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

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

Pediatric EM Morsels

AUGUST 9, 2024

Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. 2022 Dec 27;14(12):e33009. Can identify T.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

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 130

Frozen Plasma Plasma First Aid OR 130

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

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

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-9-1-1 139

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] McGraw Hill; 2022. 2] This linking group can be either an amide (e.g.,

E-9-1-1 111

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

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

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Accessed August 2022. FDA Consumer Magazine , June 1981, [link] Accessed August 2022. Accessed August 2022. McGraw Hill, 2019. Besenhofer, Lauren M., Toxicological Sciences , vol. 1, 2010, pp.

E-9-1-1 92

E-9-1-1 ALS Plasma Emergency Department 92

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). Epub 2022 Sep 21. Am J Gastroenterol. PMID: 36735555.

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

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. Therapeutical plasma exchange for thrombotic thrombocytopenic purpura in the emergency department: A single center experience. 1 Dr. J Clin Med.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. Published 2022 Nov 20. Published 2022 Mar 1. 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 Plasma OR 75

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).

Plasma 52

Plasma OR ALS EMS 52

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. If ALP is elevated in conjunction with aminotransferases, the source may be assumed to be biliary, and further confirmation of the source is not required. doi:10.37349/edd.2022.00008

Emergency Department 105

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

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). 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

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. Updated December 11, 2022. Bansal AB, Al Khalili Y. Published January 2023.

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). Published 2022 May 4. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial.

Frozen Plasma 72

Frozen Plasma FFP Plasma ALS 72

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 96

Allergic Reaction Plasma ALS EMS 96

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 95

Emergency Department Epinephrine OR Plasma 95

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.

E-9-1-1 91

E-9-1-1 ALS Emergency Department Plasma 91

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. Published November 8, 2022. Published April 22, 2022. 2022 May 30;19(11):]. Published 2022 Jul 7. McGraw Hill; 2016. Radiopaedia.org.

ED 64

ED Operating Room ALS Frozen Plasma 64

EMDocs

JULY 19, 2023

However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. 2022, February 25). link] Accessed 21 November 2022 The post ToxCard: Organic Mercury Poisoning appeared first on emDOCs.net - Emergency Medicine Education. Resources: S. Food and Drug Administration.

ACS 92

ACS Plasma OR ED 92

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. first appeared on The Skeptics Guide to Emergency Medicine.

Plasma 100

Plasma ALS 100

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

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 72

Plasma ACS OR Coronary 72

EMDocs

JANUARY 22, 2025

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. References Spencer MR, Minio AM, Warner M. Drug overdose deaths in the United States, 20012021. NCHS Data Brief, no 457.

Naloxone 96

Naloxone E-9-1-1 Overdose NARCAN 96

Don't Forget the Bubbles

MARCH 24, 2025

Later phase : As plasma levels fall, vasoconstriction decreases. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. 2022 Jan;16(1):72.

E-9-1-1 59

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

EMDocs

FEBRUARY 3, 2025

Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). Published 2022 Feb 1. Catastrophic antiphospholipid syndrome (CAPS)is arapidly progressive thrombotic disorder, referred to as thrombotic storm,often triggered bytrauma, infection, or other stressors(27).

ED 70

ED E-9-1-1 ALS OR 70

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. Published online November 14, 2022. Published online November 14, 2022.

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. 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 65

EMS E-9-1-1 Plasma OR 65

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). Apfelbaum, J.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

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., 2022, doi:10.7759/cureus.32747 The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.” Am J Dermatopathol.

EMS 114

EMS E-9-1-1 Plasma ALS 114

EMDocs

JANUARY 6, 2025

Background: Refugees on the Rise As of 2022, it was estimated that there were 35.3 Global Trends Report 2022. Published online November 14, 2022. Published online November 14, 2022. Accessed May 25, 2022. million refugees globally, with 80% of the refugee population located in Africa. 1 By the end of 2023, 117.3

ED 75

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