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SGEM#251: Nothing Compares to You…Because there was No Comparison Group

The Skeptics' Guide to EM

Date: April 5th, 2019 Reference: Connolly et al. Date: April 5th, 2019 Reference: Connolly et al. In contrast, protamine could be used for heparin and LMWH reversal and vitamin K, fresh frozen plasma and prothrombinase complex concentrate could be used to reverse coumadin ( Hunt and Levi BMJ 2018 ).

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Point/Counterpoint: Antifreeze Poisoning Tests

ACEP Now

2 Parsa, et al. 3 Casavant, et al. 3 Casavant, et al. Parsa, et al. If uncertainty remains while awaiting definitive testing, a POC lactate is a better clue. Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Al Aboud DM, Gossman W. 2023;43(10):20-21.

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Trauma Resuscitation Updates

REBEL EM

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]

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Penetrating chest trauma

Don't Forget the Bubbles

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. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control.

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Emergency Department Evaluation of Cholestatic Labs

EMDocs

5 Identification of obstructive physiology in the emergency department (ED) and referral for definitive management can spare patients from these damaging downstream consequences. 1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. How does cholestasis present?

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Best Practices for Upper Gastrointestinal Hemorrhage

ACEP Now

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.,

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Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

AAEM RSA

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. Holcomb JB, Tilley BC, Baraniuk S, et al. Cornelius B, Ferrell E, Kilgore P, et al. 2020;88(5):383-9.

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