The Skeptics' Guide to EM

DECEMBER 17, 2022

Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. EMS have already splinted an obvious mid-shaft femoral fracture, but he continues to be tachycardic and hypotensive. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Emergency Medicine Cases

FEBRUARY 9, 2021

Why is serum calcium important to draw in the ED for the patient who is exsanguinating? If someone is on anti-platelets or anticoagulants what is the best strategy to ensure the docs in the ED know what to give and how much? What should be the lab resuscitation targets? How do we mitigate the risk of hypothermia? When and how much TXA?

Plasma 130

Plasma ED OR FFP 130

Chicago EMT Training

AUGUST 6, 2021

It's important to keep in mind that you are not functioning as an EMT when you're an ED Tech/Assistant. So when it comes time to renewing your certification or license, you'll have to directly correspond with the IDPH rather than an EMS Coordinator within a system. The biggest event they provide EMS for recently is Lollapalooza.

EMT 130

EMT EMT Paramedic Plasma 130

REBEL EM

SEPTEMBER 13, 2023

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.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

OCTOBER 3, 2021

Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Some bench work, observational studies, and now two large, unblinded, cluster-randomized single-center trials ( SMART and SALT-ED ) suggested a benefit to using balanced crystalloids (i.e. Lactated Ringer’s or Plasmalyte 148) over 0.9%

OR 130

OR Critical Care ICU Plasma 130

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. lidocaine) or an ester (e.g.,

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

Pediatric EM Morsels

AUGUST 9, 2024

Congenital Syphilis may still occur in patients presenting to your ED! The post Congenital Syphilis appeared first on Pediatric EM Morsels. Can identify T. pallidum before antibodies against it can be detected. > 4 weeks of age : Aqueous crystalline penicillin G 50,000 Units/kg IV every 6 hours Treat for 10-14 days. Emerg Radiol.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

EMDocs

MAY 23, 2024

3 Measured in analytical testing : Laboratories measure plasma concentration using osmometers which measures values as a function of kilograms of solvent. Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae. Validation of equations used to predict plasma osmolality in a healthy adult cohort.

Plasma 90

Plasma EMS ED OR 90

REBEL EM

MAY 25, 2023

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al. Ann Emerg Med.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. The trauma call goes out. You will be running the show today, and you want to use your preparation time well. to −0.5%]; P  = 0.03.). to −0.5%]; P  = 0.03.).

E-9-1-1 139

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

EMDocs

MARCH 4, 2024

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. Her triage vitals are within normal limits. How does cholestasis present?

Emergency Department 105

Emergency Department E-9-1-1 ALS OR 105

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. “Diethylene Glycol” in Goldfrank’s Toxicologic Emergencies , 11e Eds. “Fomepizole” in Goldfrank’s Toxicologic Emergencies , 11e Eds. Schier, Capt. Nelson, et al.

E-9-1-1 92

E-9-1-1 ALS Plasma Emergency Department 92

ACEP Now

APRIL 5, 2024

2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. 1 Pregnant patients are particularly vulnerable to misdiagnosis of TTP in the ED. Most of these deaths can be attributed to a delay in diagnosis. Thus, early management is essential for patient outcomes.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

EMDocs

AUGUST 7, 2023

Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain.

E-9-1-1 95

E-9-1-1 ALS Plasma OR 95

FOAMfrat

AUGUST 15, 2024

The midwives report that EMS is not needed for the baby. But, from a basic care perspective, I am not sure there is anything that the average EMS crew would do differently, despite this case being anything but basic. The midwives go on to explain that following the baby’s birth, the patient began to hemorrhage.

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

EMDocs

JUNE 3, 2023

What is the EM physician’s role in the stabilization of unstable pelvic injuries? The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚

ED 64

ED Operating Room ALS Frozen Plasma 64

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. She had a fever of 38.7 °C F) in the ambulance.

E-9-1-1 91

E-9-1-1 ALS Emergency Department Plasma 91

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Terbutaline and Albuterol for Lowering of Plasma Postassium Initial labs returned and confirmed critical hyperkalemia and new renal failure.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. CorePendium.

E-9-1-1 98

E-9-1-1 ICU Emergency Department ED 98

EMDocs

JUNE 14, 2023

These are send-out labs with turn-around times that make them unlikely to affect the ED course. This prevents ongoing exposure to the patient and ED staff. In: Mattu A and Swadron S, ed. 3 However, may be helpful in diagnosing the chronic toxicity forms. Iran Red Crescent Med J 16: e5072, 2014. Pesticides and Cholinergics.

E-9-1-1 95

E-9-1-1 Emergency Department Plasma ED 95

EMDocs

JULY 19, 2023

This would be a send-out test and would be unlikely to help us acutely in the ED. However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. 6 Urine heavy metals screens are not recommended for asymptomatic patients.

ACS 92

ACS Plasma OR ED 92

EMDocs

FEBRUARY 3, 2025

Collins, MD (EM Resident Physician, San Antonio, Texas); Michael J. Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). This leads to adiffuse hypercoagulable state and widespread vascular dysfunction. anticoagulation and blood pressure control). Ann Rheum Dis.

ED 70

ED E-9-1-1 ALS OR 70

ACEP Now

FEBRUARY 11, 2025

A 33-year-old male with a history of drug use presented to the emergency department (ED) for extreme agitation after receiving two doses of 2 mg naloxone by EMS for respiratory depression. If available, an in-house ED pharmacist is an incredible resource for guidance when there are questions regarding pharmacologic management.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

EMDocs

DECEMBER 6, 2024

On arrival to the ED the patient’s initial vital signs are temperature 38.5C, BP 102/48, HR 106, RR 20. Antidote : Deferoxamine is a chelating agent derived from Streptomyces pilosus ; binds free iron from plasma and iron inside of cells. Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated.

E-9-1-1 97

E-9-1-1 Frozen Plasma Plasma Overdose 97

EMDocs

MARCH 11, 2024

Authors: Gaston Omba, MD (EM Resident Physician, Makerere University); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. How is this condition diagnosed and treated in the ED? Kirk M, ed. Laboratory testing was not immediately available. Trop Med Infect Dis. 2023;8(3):169. 2013;8(1):e54395.

ED 110

ED ALS OR Plasma 110

Core EM

JANUARY 16, 2025

An EM Residents Guide to Basic Airway Management Authors: Justin Rice, MD Sagar Desai, MD Eunice Monge, MD William Chiang, MD Preface: Airway management is one of the most critical skills in emergency medicine, yet it can be one of the most challenging to master. Introduction Airway management is a critical ED skill to master.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. He was transported from the scene by EMS. Although the concentration of chloride in the CSF is slightly higher than in plasma, measuring chloride (B) is not an accurate way to detect the presence of CSF. However, he has a headache that has become more painful.

EMS 65

EMS E-9-1-1 Plasma OR 65

EMDocs

NOVEMBER 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 51-year-old male with a history of AIDS presents to the ED accompanied by his partner with complaints of cognitive decline and confusion over one month. ED Evaluation Neurosyphilis is known as a “great imitator” due to the extensive variability of nonspecific symptoms [11].

EMS 114

EMS E-9-1-1 Plasma ALS 114

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

ED 75

ED E-9-1-1 ALS Emergency Department 75