REBEL EM

SEPTEMBER 13, 2023

Bradykinin Mediated Plasma globulins called kininogens release bradykinin and cause vascular permeability. Image: ( Morgan 2010 ) Features Absence of urticaria and pruritus Insidious onset (24-36 hours) ACE Inhibitors Inhibition of ACE hinders the degradation of bradykinin and can lead to idiosyncratic angioedema.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

Pediatric EM Morsels

JUNE 14, 2024

References Absoud, Michael et al. 2019, doi:10.3390/children6050070 Wolf, Varina L et al. doi:10.1177/0883073812452916 The post Acute Transverse Myelitis in Children appeared first on Pediatric EM Morsels. ALWAYS rule out a compressive lesion, this is a medical emergency! REMEMBER, ATM can come with other baggage (i.e.

Plasma 143

Plasma ALS OR EMS 143

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 130

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial.

FFP 143

FFP Frozen Plasma ALS Plasma 143

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 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

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. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. to −0.5%]; P  = 0.03.).

E-9-1-1 139

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

Pediatric EM Morsels

MARCH 17, 2023

Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Sarkar S, Sinha R, Chaudhury AR, et al. doi:10.1186/1757-1626-1-16 The post Snake Bites and Children appeared first on Pediatric EM Morsels. It’s expensive, so if you’re giving some of a vial, give it all. Snake Toxicity. Updated 2022 Sep 19]. J Pediatr Surg.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

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. References: Abubukar et al. Nelson, et al. Conklin, Laura, et al. ADH: alcohol dehydrogenase; ALDH: aldehyde dehydrogenase. Schier, Capt.

E-9-1-1 92

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

EMDocs

AUGUST 7, 2023

Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain. N Am J Med Sci. Circulation.

E-9-1-1 95

E-9-1-1 ALS Plasma OR 95

EMDocs

MARCH 4, 2024

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. 1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. 2012.05.002 Gurusamy KS, Giljaca V, Takwoingi Y, et al.

Emergency Department 105

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

FOAMfrat

AUGUST 15, 2024

The midwives report that EMS is not needed for the baby. But, from a basic care perspective, I am not sure there is anything that the average EMS crew would do differently, despite this case being anything but basic. The midwives go on to explain that following the baby’s birth, the patient began to hemorrhage.

Plasma 69

Plasma Ambulance ALS Emergency Department 69

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. 1 Dr. Turner originally trained at the Medical University of South Carolina, is an EM intern at Hershey Medical Center in Hershey, PA. J Clin Med.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

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.” 6 Balloon tamponade (i.e.,

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

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. References: Xian Y, Zhang S, Inohara T, et al.

Plasma 52

Plasma OR ALS EMS 52

EMDocs

AUGUST 31, 2023

Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 Bush SP, Ruha AM, Seifert SA, et al. link] Kanaan NC, Ray J, Stewart M, et al. F(ab) is smaller, consisting of a single antigen binding site, while F(ab’) 2 consists of two antigen-binding sites linked together by an antibody “hinge” region. 5 Figure 1.

Allergic Reaction 96

Allergic Reaction Plasma ALS EMS 96

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. 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. F) in the ambulance.

E-9-1-1 91

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

EMDocs

JUNE 3, 2023

What is the EM physician’s role in the stabilization of unstable pelvic injuries? If a pelvic binder was placed by EMS, inquire whether this was placed empirically or if mechanical pelvic instability was already elicited. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚

ED 64

ED Operating Room ALS Frozen Plasma 64

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. Otherwise, provide supportive care.

E-9-1-1 98

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

EMDocs

JUNE 14, 2023

Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. PMID: 23163581] Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. These are send-out labs with turn-around times that make them unlikely to affect the ED course. McGraw-Hill Education. Pesticides and Cholinergics.

E-9-1-1 95

E-9-1-1 Emergency Department Plasma ED 95

FirstWatch

MARCH 18, 2025

The efficacy of whole-blood and plasma transfusions became clear during the World War II. A Process for Deployment In Montgomery County, 4 EMS supervisors maintain a supply of 6 units of whole blood under normal circumstances. All of our ALS providers are trained to an awareness level as well. Or ask around.

EMS 52

EMS Public Safety First Responder Plasma 52

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. 2022;23(1):4-9.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

EMDocs

FEBRUARY 3, 2025

Collins, MD (EM Resident Physician, San Antonio, Texas); Michael J. 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.

ED 70

ED E-9-1-1 ALS OR 70

Core EM

JANUARY 16, 2025

An EM Residents Guide to Basic Airway Management Authors: Justin Rice, MD Sagar Desai, MD Eunice Monge, MD William Chiang, MD Preface: Airway management is one of the most critical skills in emergency medicine, yet it can be one of the most challenging to master. et al (2022). Baker JB, et al. Blunt, MC, et al.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. He was transported from the scene by EMS. 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. However, he has a headache that has become more painful.

EMS 65

EMS E-9-1-1 Plasma OR 65

EMDocs

MARCH 11, 2024

Authors: Gaston Omba, MD (EM Resident Physician, Makerere University); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. References Montero DA, Vidal RM, Velasco J, et al. 2023.1155751 Li X, Wu Y, Sun X, et al. 0054395 Qureshi K, Molbak K, Sandstrom A, et al. 2023;10:1155751. Kirk M, ed.

ED 110

ED ALS OR Plasma 110

EMDocs

NOVEMBER 2, 2024

We’ll keep it short, while you keep that EM brain sharp. 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., demyelination as in tabes dorsalis) and subsequent death [10]. Laboratory testing protocols vary.

EMS 114

EMS E-9-1-1 Plasma ALS 114

EMDocs

JANUARY 6, 2025

57 Adapted from: Long B, MacDonald A, Liang SY, et al. link] Rother B, Pierre G, Lombardo D, et al. link] Franco JR, Cecchi G, Priotto G, et al. 66 ^^ = a form of polio that arises from the oral polio vaccine (OPV) in regions where there is system lack of vaccination or undervaccination. 57 Table 2. Malaria treatment options.

ED 75

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