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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.
This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Click here for Direct Download of the Podcast Paper: Bouzat P et al. High-quality studies are needed to determine the utility of this intervention. to 3.33; P = 0.72 to 2.10; P = 0.03
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
The absence of preeclampsia symptoms prior to the acute event makes eclampsia less likely. Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here. link] j.ajog.2016.03.012
A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al.
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.
Studies from the 1980s and 1990s found 5-14% of patients with hemoptysis had a life-threatening event (7,8). Warfarin: vitamin K 10 mg IV and PCC or FFP. Fibrinogen level < 150 mg/dL: cryoprecipitate or fibrinogen concentrate (not FFP). Ittrich H, Bockhorn M, Klose H, et al. Mondoni M, Carlucci P, Job S, et al.
When assessing a patient post non fatal strangulation, red flags include: History – Significant pressure to the neck, loss of consciousness, amnesia of event, incontinence during the event, ligature use. Traumatic Cardiac Arrest This is a high acuity, low occurrence event in the paediatric population with a high mortality rate.
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