Pediatric EM Morsels

JUNE 14, 2024

References Absoud, Michael et al. 2019, doi:10.3390/children6050070 Wolf, Varina L et al. CSF Studies Findings: elevation of cell count and differential, protein, and glucose analysis. CSF is abnormal in 50% of transverse myelitis cases, glucose typically normal. ALWAYS rule out a compressive lesion, this is a medical emergency!

Plasma 141

Plasma ALS OR EMS 141

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. The transfusion tech calls to remind you that your protocol is currently under review, and asks if would you like the 1:1 or the 1:3 version of fresh-frozen plasma (FFP) to packed red blood cells (pRBC)? years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

EMDocs

JULY 11, 2023

Today on the emDOCs cast, Brit Long, MD ( @long_brit) covers hemophilia, including background, severity, evaluation, and management. Episode 81: Hemophilia What is hemophilia? Bleeding disorder due to a deficiency in one or more of the proteins (factors) involved in the coagulation pathway. Most common site is hemarthrosis (70-80% of cases).

Plasma 62

Plasma ALS OR Emergency Department 62

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. 3 In TTP, patients undergo microangiopathic hemolytic anemia that leads to severe thrombocytopenia and, in severe cases, organ dysfunction.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

REBEL EM

JUNE 26, 2023

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. REBEL Cast Ep118: The PROCOAG Trial – 4F-PCC in Trauma Patients? Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 to 3.33; P = 0.72 to 2.10; P = 0.03

FFP 145

FFP Frozen Plasma ALS Plasma 145

The Skeptics' Guide to EM

APRIL 6, 2019

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 ).

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130

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. mmol/L to 1.3 doi:10.1097/TA.0000000000002570

ALS 89

ALS FFP Plasma Emergency Department 89

Don't Forget the Bubbles

JUNE 30, 2023

You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives. Ranulf is quite a sweet, round-faced boy, accompanied by his traumatised-looking mother as he is wheeled to your trauma bay.

E-9-1-1 139

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

EMDocs

APRIL 10, 2024

Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] 2] This linking group can be either an amide (e.g., lidocaine) or an ester (e.g.,

E-9-1-1 92

E-9-1-1 Plasma Epinephrine Life Support 92

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

Don't Forget the Bubbles

AUGUST 12, 2024

This can be from the brain hitting the skull, shear forces from sudden acceleration and deceleration, or direct injury at the point of impact. The severity of head injuries can be classified according to the GCS. TBI occurs in two stages: a primary brain injury and a secondary brain injury. This insult to the brain is often irreversible.

ALS 75

ALS Emergency Department Plasma OR 75

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. Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

AAEM RSA

APRIL 1, 2021

2,3 Here we examine some of the evidence behind the various components of MTPs, specifically calcium and factor VIIa, and the ratios in which the main products of red blood cells, plasma, and platelets should be administered. Holcomb JB, Tilley BC, Baraniuk S, et al. in the 1:1:1 group vs. 17.0% vs. 26.1%, respectively, p=0.26).

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

FOAMfrat

AUGUST 15, 2024

I can only speak for me, but I don’t ever remember anyone talking about that, and I would venture to guess most readers don’t either. I love this definition because it is simple and to the point: bleeding post birth accompanied by shock. Perfusion in your body is much the same. In the case of our patient, she is experiencing the latter.

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.” 6 Balloon tamponade (i.e.,

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

The Overrun Podcast

NOVEMBER 23, 2020

Dr. Fisher’s Twitter feed: [link] Kotwal, et al. This is long episode, but there’s a TON of information…everything from tourniquets, pain management, blood vs. crystalloid, “scoop and run”, and much, much more. We also talk about education, and how The Church is looking to educate while still having a laugh or two.

EMT 52

EMT EMT Plasma Paramedic 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

Have a look to see how their osmolarity and tonicity across the cell membrane compare to plasma. Renal (= urine output) : anti-diuretic hormone (ADH) release from the posterior pituitary is stimulated by microchanges in plasma osmolarity. doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. Step 3 Less is more.

Plasma 80

Plasma ALS ICU Critical Care 80

ACEP Now

APRIL 2, 2024

References Katibi OS, Olaosebikan R, et al. Joskow R, Belson M, et al. Ajayi AM, Ayodele EO, et al. Sanford AA, Isenberg SL, et al. Quantification of hypoglycin A and methylenecyclopropylglycine in human plasma by HPLC-MS/MS. Ackee fruit poisoning in eight siblings: implications for public health awareness.

Plasma 40

Plasma ALS Emergency Department ED 40

EMDocs

AUGUST 7, 2023

Acute Aortic Dissection (AAD) A meta-analysis found that plasma D-dimer level <500 ng/mL is useful for identifying patients who are unlikely to have an AAD and do not require further aortic imaging. The chest pain started suddenly today while at rest, is located on the right side, and radiates to her back.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

ACEP Now

FEBRUARY 6, 2024

2 Parsa, et al. 3 Casavant, et al. 3 Casavant, et al. Parsa, et al. Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Al Aboud DM, Gossman W. Hack’s recommendation for examining urine under ultraviolet (UV) light for suspected ethylene glycol ingestions.

ALS 52

ALS Plasma Critical Care OR 52

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. Her medical history is significant for hypertension, hyperlipidemia, and hypothyroidism.

Emergency Department 86

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

EMDocs

JUNE 14, 2023

He has a glove and stocking pattern of numbness to his extremities. Motor and sensory findings are symmetrical. Patellar reflexes are 1+. He has no saddle anesthesia or back pain and denies any difficulty urinating or issues with defecation. Paraquat Influenza vaccine Methanol Organophosphate Are his symptoms reversible?

E-9-1-1 69

E-9-1-1 Emergency Department Plasma ACS 69

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. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

ACEP Now

FEBRUARY 11, 2024

Given the fact that he has not had these headaches before and has diffuse symptoms including weakness, lab work and head imaging are obtained. There were no acute findings on head CT. His lab values demonstrate no anemia, leukocytosis, or electrolyte abnormalities except for an elevated creatinine.

Overdose 52

Overdose ACS Plasma ALS 52

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. In addition, free haem and haemoglobin contribute to the vascular damage. Blood film shows sickle cells and a further sample was sent for confirmation of diagnosis.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

JUNE 3, 2023

Introduction The pelvic ring is made up of the bony ilium, ischium, pubis, and sacrum, which are held together with ligaments. Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently.

ED 54

ED Operating Room ALS Frozen Plasma 54

Dr. Smith's ECG Blog

JULY 27, 2023

Peak plasma concentration of amphetamines is rapid ( within minutes ) following inhalation or injection. PEARL #3: The pathophysiologic mechanism for producing amphetamine-induced acute MI is unclear ( Bazmi et al — SQUMJ 17(10); e31-37, 2017 — and — Sinha et al — Case Rep Cardiol, 2016 ).

Coronary 52

Coronary ACS Naloxone 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. Article : Costa O.S. Crit Care 26, 180 (2022).

OR 52

OR Plasma ALS EMS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Internal potassium balance and the control of the plasma potassium concentration. This is pathognomonic of hyperkalemia (I suppose it could be due to a massive overdose of a sodium channel blocking drug, maybe). mEq/L is 100-200 mEq of total body K, and from 3.0

Plasma 52

Plasma STEMI Defibrillator Overdose 52

EMDocs

NOVEMBER 2, 2024

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., Per the patient’s partner, he has not experienced any fevers, chills, cough, congestion, or recent illness and was not complaining of headaches or vision changes.

EMS 91

EMS E-9-1-1 Plasma ALS 91

Don't Forget the Bubbles

OCTOBER 28, 2024

Karageorgos S, Ren D, Ranaweera M, et al. Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Fifteen-minute consultation: a guide to paediatric major haemorrhage Archives of Disease in Childhood – Education and Practice.

Frozen Plasma 72

Frozen Plasma FFP Plasma ALS 72

EMDocs

AUGUST 31, 2023

Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 However, in 2015 crotalidae equine immune F(ab’) 2 (ANAVIP®) was approved by the FDA for rattlesnake envenomations, and distribution of this antivenom began in 2018. This size difference may lead to differences in the pharmacokinetic profiles of the two antibodies.

Allergic Reaction 72

Allergic Reaction Plasma ALS EMS 72

Don't Forget the Bubbles

AUGUST 2, 2023

Pro-inflammatory states may also play a role, as patients with CRPS have significantly higher levels of plasma cytokines and chemokines. Cognitive behavioural therapy (CBT) In a study by Brinkers et al. What is Complex Regional Pain Syndrome? Making the diagnosis relies on observable signs and reported symptoms.

MPD 98

MPD ALS Plasma OR 98

Don't Forget the Bubbles

MAY 15, 2023

This response varies between individuals, age groups and developmental stages, so a single plasma concentration cannot be defined. If there is clinical concern for hypoglycaemia, plasma glucose concentration should be measured. Learning point: Take a plasma glucose sample and ask the lab to run it urgently – time is sugar!

ED 103

ED Plasma OR ALS 103

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. This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). vs. 0.91), positive predictive value (0.27 vs. 0.38), and positive likelihood ratio (5.08

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

FOAMfrat

SEPTEMBER 19, 2024

Background and Epidemiology In the United States, roughly 9,000 snake bites are reported annually, with approximately 3,000 being attributed to venomous species and less than 10 resulting in death. Many bites are associated with (human) consumption of alcohol. Fortunately, overall prognosis for snake envenomation within the U.S. Neither will the ER.

Emergency Department 90

Emergency Department Epinephrine OR Plasma 90

EMDocs

MARCH 11, 2024

Her facial features were flattened, and her eyes were sunken deep into their sockets. The patient’s breathing was labored, but breath sounds were normal. The abdomen was soft with mild periumbilical tenderness, normoactive bowel sounds, and no rebound or guarding. The extremities were cold with no peripheral edema. cholerae bacteria.

ED 89

ED OR ALS Plasma 89