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Podcast 185.0: Anticoagulation Reversal

Core EM

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.

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Thrombotic Thrombocytopenic Purpura (TTP)

Core EM

Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. Decreases production of anti-ADAMTS13 antibodies by removing the B cells that mature into autoantibody-secreting plasma cells. J Emerg Med.

Plasma 246
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Anticoagulation Reversal

Core EM

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. 2019.04.017 Connolly SJ, Milling TJ Jr, Eikelboom JW, et al. J Am Coll Cardiol.

FFP 130
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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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Snake Bites and Children

Pediatric EM Morsels

Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Sarkar S, Sinha R, Chaudhury AR, et al. (Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. It’s expensive, so if you’re giving some of a vial, give it all. Snake Toxicity.

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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.” Am J Emerg Med.

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REBEL Core Cast 108.0 – Angioedema

REBEL EM

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.