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Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , CriticalCare , 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.
Takeaway lessons * In an ideal world, penetrating abdominal trauma in an unstable patient would proceed directly to the OR with no delay by the ED. Not too much role for TEG in the initial ED presentation. Continue to use a balanced ratio unless you can use TEG to guide FFP and platelets.* FFP is delayed or unavailable; 2.
A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. Treatment is supportive with respiratory therapy, criticalcare, inotropic therapy, and cardiac life support. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in.
Welcome back to the tasty morsels of criticalcare podcast. Read More » Welcome back to the tasty morsels of criticalcare podcast. Not so much for the patient but it’s one of those ones that is niche enough to not have been picked up via the usual filters of ED, medical team to the ward.
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.”
Airway: Key decision: base decision for intubation on clinical course, efficacy of airway clearance (coughing, mental status), ED/institutional resources, respiratory status (respiratory failure). Warfarin: vitamin K 10 mg IV and PCC or FFP. Fibrinogen level < 150 mg/dL: cryoprecipitate or fibrinogen concentrate (not FFP).
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