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. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality.

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E-9-1-1 FFP Plasma Emergency Department 139

EMDocs

JUNE 12, 2024

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. Ditzel RM, Anderson JL, Eisenhart WJ, et al. Emerg Med J.

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FFP ALS Plasma Emergency Department 105

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. 2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department.

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E-9-1-1 ALS Plasma Emergency Department 87

EMDocs

JULY 11, 2023

The patient’s plasma is mixed with normal pooled plasma (NPP) which adds sufficient clotting factors to overcome the deficiency. If an inhibitor is present, it will inhibit the clotting factors in patient plasma and the NPP, and the clotting time remains prolonged. Each unit of FVIII/kg raises the plasma FVIII level by 2%.

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Plasma ALS OR Emergency Department 75

Don't Forget the Bubbles

AUGUST 12, 2024

What neuroprotective measures can we undertake in the emergency department? Neuroprotective measures are undertaken in the emergency department and PICU to optimise intracerebral conditions, minimise secondary brain injury, and create optimal tissue healing conditions. Ben Abdeljelil A, Freire GC, Yanchar N, et al.

ALS 75

ALS Emergency Department Plasma OR 75

ACEP Now

APRIL 5, 2024

2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. It is thus imperative that emergency physicians be able to recognize and properly treat this disease, especially in the absence of its classical presentation. References Sukumar S, Lämmle B, et al.

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Frozen Plasma Plasma Emergency Department FFP 40

EMDocs

AUGUST 7, 2023

7 The American College of Emergency Physicians (ACEP) clinical policy supports the use of age-adjusted D-dimer testing when evaluating for VTE in older patients. doi:10.4103/1947-2714.143278 van der Pol LM, Tromeur C, Bistervels IM, et al. x Douma RA, le Gal G, Söhne M, et al. Ann Emerg Med. N Am J Med Sci. Circulation.

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E-9-1-1 ALS Plasma OR 91

FOAMfrat

AUGUST 15, 2024

Moreover, LTOWB also allows us to administer platelets and plasma, in addition to red cells, to promote clotting and homeostasis. If you don't have access to LTOWB and are administering component therapies such as PRBCs or plasma, this is still incredible and I highly encourage it! Minino AM, Heron MP, Murphy SL, et al.

Plasma 69

Plasma Ambulance ALS Emergency Department 69

ACEP Now

NOVEMBER 16, 2023

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.

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

ACEP Now

APRIL 2, 2024

An 18-year-old woman presented to the emergency department (ED) with symptoms of nausea, vomiting, diarrhea, and abdominal pain. References Katibi OS, Olaosebikan R, et al. Joskow R, Belson M, et al. Ajayi AM, Ayodele EO, et al. Ann Emerg Med. Sanford AA, Isenberg SL, et al. Am J Trop Med Hyg.

Plasma 40

Plasma ALS Emergency Department ED 40

Don't Forget the Bubbles

OCTOBER 28, 2024

Karageorgos S, Ren D, Ranaweera M, et al. doi: 10.1136/archdischild-2024-327224 Six-year-old Rhaenyra is brought into the emergency department after being hit by a car. Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Am J Emerg Med.

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Frozen Plasma FFP Plasma ALS 72

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. Rattlesnake Envenomation Treatment & Management: Prehospital Care, Emergency Department Care, Consultations.” Accessed 10 July 2024.

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Emergency Department Epinephrine OR Plasma 95

EMDocs

DECEMBER 18, 2023

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. Piccioni A, Saviano A, Cicchinelli S, et al. Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department.

E-9-1-1 86

E-9-1-1 ALS Emergency Department Plasma 86

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. Coccolini F, Stahel PF, Montori G, et al. World J Emerg Surg. Incagnoli P, Puidupin A, Ausset S, et al.

ED 61

ED Operating Room ALS Frozen Plasma 61

EMDocs

JUNE 7, 2023

8 Plasma butyrylcholinesterase (“pseudocholinesterase”) activity Easier to assay and is more widely available Red cell acetylcholinesterase (“true cholinesterase”) activity More accurate and specific Management: Patients require immediate intervention if there is concern for acute organophosphate poisoning. BMC Res Notes. 2013; 6:524.

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E-9-1-1 ICU Emergency Department ED 98

EMDocs

JUNE 14, 2023

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th Edition. Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. Parenteral organophosphorus poisoning in a rural emergency department: a case report. McGraw-Hill Education.

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

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. Macharia AW et al. Ware et al.

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E-9-1-1 ACS OR ICU 126

ACEP Now

FEBRUARY 11, 2025

A 33-year-old male with a history of drug use presented to the emergency department (ED) for extreme agitation after receiving two doses of 2 mg naloxone by EMS for respiratory depression. Gummin DD, Mowry JB, Beuhler MC, et al. Todd DA, Kellogg JJ, Wallace ED, et al. Obeng S, Kamble SH, Reeves ME, et al.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

EMDocs

JANUARY 22, 2025

Is there an ideal observation period in the emergency department after reversal with naloxone? DOI: [link] O’Donnell J, Tanz LJ, Miller KD, et al. Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. Available at: [link] October 19, 2023 Kelly A, Kerr D, Dietze P, et al. Ann Emerg Med.

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Naloxone E-9-1-1 Overdose NARCAN 93

EMDocs

FEBRUARY 3, 2025

Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). Aringer M, Costenbader K, Daikh D, et al. Meier AL, Bodmer NS, Wirth C, et al. Tani C, Elefante E, Arnaud L, et al. Bartels CM, Buhr KA, Goldberg JW, et al. 2024;331(17):1480-1491.

ED 66

ED E-9-1-1 ALS OR 66

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). Am J Emerg Med.

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EMS E-9-1-1 ALS OR 130

EMDocs

MARCH 11, 2024

Louis) // Reviewed by: Joshua Lowe, MD (EM Staff Physician, USAF); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 25-year-old woman presented to the emergency department (ED) in Uganda with acute encephalopathy. References Montero DA, Vidal RM, Velasco J, et al. 2023.1155751 Li X, Wu Y, Sun X, et al.

ED 109

ED ALS OR Plasma 109

EMDocs

JANUARY 6, 2025

57 Adapted from: Long B, MacDonald A, Liang SY, et al. Malaria: A focused review for the emergency medicine clinician. The American Journal of Emergency Medicine. link] Rother B, Pierre G, Lombardo D, et al. Burden of injury during the complex political emergency in northern Uganda. 57 Table 2. 2024;77:7-16.

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ED E-9-1-1 ALS Emergency Department 73