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?

Plasma 130

Plasma ED OR FFP 130

Pediatric EM Morsels

JANUARY 19, 2024

Now, let’s discuss another complication of “The Great Mimicker” which may throw us for a loop in the ED – Pseudoparalysis of Parrot : Pseudoparalysis of Parrot – Basics First described by Jules Marie Parrot in 1871. We have touched on the treatment for older children with syphilis with Bicillin CR vs LA.

Plasma 269

Plasma OR EMS ED 269

Core EM

JANUARY 24, 2024

Background Around 6 million people in the U.S. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. Background Around 6 million people in the U.S. Background Around 6 million people in the U.S.

FFP 130

FFP Frozen Plasma Plasma ALS 130

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome. What are nerve agents? [1-3]

Plasma 195

Plasma OR ED 195

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Pediatric EM Morsels

AUGUST 9, 2024

Congenital Syphilis may still occur in patients presenting to your ED! Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? May be on soles of feet !

E-9-1-1 152

E-9-1-1 Plasma Emergency Department OR 152

EMDocs

JUNE 3, 2023

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˚ C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. of pelvic fractures to be open.

ED 54

ED Operating Room ALS Frozen Plasma 54

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. 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)?

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Emergency Medicine Ireland

APRIL 16, 2024

Most of the hyponatraemia we see admitted through the ED will be hypoosmotic hyponatraemia. This time the tonicity is high from something else such as high glucose or mannitol drawing water from cells into plasma. Today we cover an incredibly common inpatient issue – hypnatraemia. Caveat emptor and all that. There is indeed.

Critical Care 74

Critical Care Plasma OR ED 74

EMDocs

APRIL 10, 2024

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. Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] lidocaine) or an ester (e.g.,

E-9-1-1 92

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

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. The majority of our students come from a premedical background but there are a few with other career choices such as firefighter, paramedic, law enforcement, etc. It opens many doors in various industries.

EMT 130

EMT EMT Paramedic Ambulance 130

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.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Emergency Medicine Ireland

APRIL 29, 2024

Older person presents to the ED after being unwell for several weeks. If it’s rising too quick it’s often because the patient is losing lots of water through the kidneys which concentrates the plasma raising the Na in the blood. Older person presents to the ED after being unwell for several weeks.

Critical Care 75

Critical Care Plasma OR ED 75

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. The priority is the drain and blood replacement.

E-9-1-1 139

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

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 64

Plasma EMS ED OR 64

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. 1 Pregnant patients are particularly vulnerable to misdiagnosis of TTP in the ED. creatinine less than 2.0

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

EMDocs

JULY 13, 2024

A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. We’ll keep it short, while you keep that EM brain sharp. She has significant tenderness to the lower abdomen on palpation. What is the diagnosis?

EMS 63

EMS E-9-1-1 Plasma OR 63

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. What is the ideal blood component ratio for massive transfusion in traumatic hemorrhage? in the 1:1:1 group vs. 17.0%

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 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.

E-9-1-1 83

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

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication. 1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity?

E-9-1-1 65

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

EMDocs

MARCH 4, 2024

Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. 5 Identification of obstructive physiology in the emergency department (ED) and referral for definitive management can spare patients from these damaging downstream consequences. How does cholestasis present?

Emergency Department 86

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

ACEP Now

APRIL 2, 2024

An 18-year-old woman presented to the emergency department (ED) with symptoms of nausea, vomiting, diarrhea, and abdominal pain. Before arriving at our ED, the patient sought care at an urgent care clinic, where she was prescribed ondansetron without improvement. Jamaican vomiting sickness in Toledo, Ohio. Ann Emerg Med.

Plasma 40

Plasma ALS Emergency Department ED 40

EMDocs

JUNE 14, 2023

These are send-out labs with turn-around times that make them unlikely to affect the ED course. 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. He has a glove and stocking pattern of numbness to his extremities.

E-9-1-1 69

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

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

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 65

ACS Plasma OR ED 65

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. Haematology specialist clinics are key to manage the chronic side of the disease, while ED doctors should be able to act rapidly on the common acute emergencies.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Emergency Medicine Ireland

OCTOBER 28, 2020

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. Treatment consists of: * PLEX – actual proper PLEX with plasma replacement as opposed to just washing out all the good stuff and giving albumin as replacement.

Critical Care 40

Critical Care Plasma FFP ICU 40

EMDocs

JUNE 12, 2024

Two randomized controlled trials by Moore et al found that prehospital plasma administration in trauma patients is associated with hypoCa (53% vs 36%). How does this impact what you do in the ED? Why is calcium important in trauma or critical illness? The normal concentration of ionized Ca is between 1.1 mmol/L to 1.3

ALS 89

ALS FFP Plasma Emergency Department 89

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

Emergency Medicine Ireland

MARCH 4, 2021

Its rareish but common enough that you will at least suspect it often enough in the ED and many ICUs will have one long stay ICU patient with GBS every few years and a short stay one more often. The ED diagnosis is much more of a challenge as they present often before the textbook findings are there.

Critical Care 40

Critical Care ICU Plasma Emergency Department 40

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. How do I measure hypoglycaemia in the ED? If there is clinical concern for hypoglycaemia, plasma glucose concentration should be measured. What is hypoglycaemia? Again, this is a general guide only.

ED 103

ED Plasma OR ALS 103

Dr. Smith's ECG Blog

JULY 27, 2023

On arrival to the ED, the patient was diaphoretic, tachycardic. I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? Peak plasma concentration of amphetamines is rapid ( within minutes ) following inhalation or injection. and had dilated pupils. He was alert and oriented.

Coronary 52

Coronary ACS Naloxone Plasma 52

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. Her lungs are clear to auscultation.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

They transported to the ED. The history, obtained subsequently, is interesting: The patient had been seen at an outside ED 2 days prior and the K was 2.5 Hospital admission had been recommended, but she left that ED against medical advice. I don't think that it is possible to say for certain, and it does not matter.

Plasma 52

Plasma STEMI Defibrillator Overdose 52

Dr. Smith's ECG Blog

APRIL 6, 2018

Terbutaline and Albuterol for Lowering of Plasma Postassium Initial labs returned and confirmed critical hyperkalemia and new renal failure. He ended up requiring a total of 13 grams of CaCl in the ED to maintain rhythm and hemodynamics until our dialysis colleagues could start dialysis in the ED.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

EMDocs

MARCH 11, 2024

Louis) // Reviewed by: Joshua Lowe, MD (EM Staff Physician, USAF); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 25-year-old woman presented to the emergency department (ED) in Uganda with acute encephalopathy. How is this condition diagnosed and treated in the ED? The extremities were cold with no peripheral edema.

ED 89

ED OR ALS Plasma 89

EMDocs

NOVEMBER 2, 2024

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. 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.,

EMS 91

EMS E-9-1-1 Plasma ALS 91