Pediatric EM Morsels

JUNE 14, 2024

References Absoud, Michael et al. 2019, doi:10.3390/children6050070 Wolf, Varina L et al. ALWAYS rule out a compressive lesion, this is a medical emergency! REMEMBER, ATM can come with other baggage (i.e. first sign of MS). These patients will require ongoing surveillance and management. Pediatric transverse myelitis.” Neurology vol.

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

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Clinical Question: Does administration of a balanced solution (Plasma-Lyte 148) during intensive care unit (ICU) stay, compared with saline solution, result in improved 90-day survival in critically ill patients?

OR 130

OR Critical Care ICU Plasma 130

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. References Sukumar S, Lämmle B, et al. Kessler CS, Khan BA, et al. Li XM, Mo XY, et al. 2021;46:556-9 Long B, Bridwell RE, et al.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

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. J Trauma Acute Care Surg.

ALS 89

ALS FFP Plasma Emergency Department 89

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

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%.

Plasma 62

Plasma ALS OR Emergency Department 62

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 145

FFP Frozen Plasma ALS Plasma 145

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. Cornelius B, Ferrell E, Kilgore P, et al. 2020;88(5):383-9.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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

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] doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al.

E-9-1-1 93

E-9-1-1 Plasma Epinephrine Life Support 93

The Overrun Podcast

NOVEMBER 23, 2020

Dr. Fisher’s Twitter feed: [link] Kotwal, et al. study on the 75th Ranger Regiment: [link] the PAMPER trial on prehospital plasma: [link] Fisher on ketamine: [link] Ketamine and PTSD: [link] Stop the Bleed information: [link] [link] [link] On this episode, Dan gets to sit down virtually with Dr.

EMT 52

EMT EMT Plasma Paramedic 52

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. Nelson, et al. Schier, Capt. McGraw Hill, 2019. 1, 2010, pp.

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. Ben Abdeljelil A, Freire GC, Yanchar N, et al. Doi:10.1056/NEJMc2201761 Kochanek PM, Adelson PD, Rosario BL, et al. 2022.0891 Kochanek PM, Tasker RC, Carney N, et al. 2019.00528 Rauchman SH, Zubair A, Jacob B, et al.

ALS 75

ALS Emergency Department Plasma OR 75

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. Crit Care Med.

Plasma 80

Plasma ALS ICU Critical Care 80

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. (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.

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

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

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

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

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

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. 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.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

ACEP Now

FEBRUARY 11, 2024

One side effect of this medication is that it can reduce the absorption of antiepileptic medications such as valproate, vigabatrin, and lamotrigine and reduce their plasma concentration, thus putting patients taking these medications at higher risk of seizure. Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Bansal AB, Al Khalili Y.

Overdose 52

Overdose ACS Plasma ALS 52

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 70

E-9-1-1 Emergency Department Plasma ACS 70

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. doi:10.1016/B978-0-323-48109-0.00036-5 Todd Taylor A, Wheatley M, Chung AS, et al. doi:10.3109/00365529309098282 Newsome PN, Cramb R, Davison SM, et al. 2012.05.002 Gurusamy KS, Giljaca V, Takwoingi Y, et al.

Emergency Department 87

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

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

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 83

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

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. doi:10.1186/s13017-017-0117-6 Anand T, El-Qawaqzeh K, Nelson A, et al.

ED 54

ED Operating Room ALS Frozen Plasma 54

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.

OR 52

OR Plasma ALS EMS 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. Macharia AW et al. Sinkin JC, Wood BC, Sauerhammer TM, et al. Ware et al. Acute Chest Syndrome in Children with Sickle Cell Disease.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

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. The estimated deficit associated with a serum decrease from 4.0 mEq/L is 100-200 mEq of total body K, and from 3.0 Medicine (Baltimore) 1981;60:339-54].

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., Rosh Review Website Link References: Tudor ME, Al Aboud AM, Leslie SW, Gossman W. doi:10.1056/NEJMra1906228 Ha T, Tadi P, Leslie SW, et al. In: StatPearls. N Engl J Med.

EMS 92

EMS E-9-1-1 Plasma ALS 92

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). Re ferences Al-Jeabory M, Gasecka A, Wieczorek W, Mayer-Szary J, Jaguszewski MJ, Szarpak L. 2021.02.009 George S, Wake E, Jansen M, et al.

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 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 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. A small, retrospective review by Brooke et al. More recently, Mesaroli et al. Taylor SS, Noor N, Urits I, et al.

MPD 98

MPD ALS Plasma OR 98

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. Fleischmann C, Scherag A, Adhikari NK, et al. Rhee C, Dantes R, Epstein L, et al.

E-9-1-1 65

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

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

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. Other venom toxins carry a fibrinogenolytic effect which hinders coagulation (anticoagulation). Communications Biology , vol. Accessed 17 July 2024.

Emergency Department 90

Emergency Department Epinephrine OR Plasma 90