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Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al. Ann Emerg Med.
2017.09.1085 Gómez-Outes A, Alcubilla P, Calvo-Rojas G, et al. doi:10.1186/s13054-019-2492-8 Baugh CW, Levine M, Cornutt D, et al. 2019.09.001 Gilbert BW, Morton L, Huffman JB, et al. 2019.10.013 Patel IJ, Rahim S, Davidson JC, et al. Background Around 6 million people in the U.S. J Am Coll Cardiol. 2017;70(24):3042-3067.
Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).
Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al. N Engl J Med. 2015; 372(5):418-25. 2013;24:53-66.
Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Paper: Davenport R et al. References: Davenport R et al. Fibrinogen products may also be needed to stabilize clots and stem bleeding. Cryoprecipitate Group: 25.3% to 1.23; p = 0.74
FFP and platelets also contain citrate. Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Kyle et al demonstrated that transfusing a single unit of pRBCs can lead to significant decreases in Ca. grams of citrate per unit.
All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. a) A balanced ratio of 1:1:1 (platelets: FFP: packed red cells) The PROPPR trial showed us that balanced ratios are important. The trauma call goes out.
A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Electronic address, p. link] j.ajog.2016.03.012
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.” Am J Emerg Med.
2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. 1 Pregnant patients are particularly vulnerable to misdiagnosis of TTP in the ED. References Sukumar S, Lämmle B, et al. Kessler CS, Khan BA, et al. Li XM, Mo XY, et al. J Clin Med.
Ali, a 12-year-old male, is pre-alerted by ambulance to ED. How would you prepare for the patient’s arrival to ED? Do I have emergency blood available in the ED? Lee, a 14-year-old male, is brought into the ED by his friends, stating he has been in a fight. Which investigations would you consider?
ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI. 57 Table 2.
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