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 271

Plasma OR EMS ED 271

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Even with rapid treatment, the mortality rate is high. Vikhyat Bebarta, Bryan Judge, and Louise Kao. McGraw Hill.

Plasma 195

Plasma OR ED 195

Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. 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%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

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 101

Frozen Plasma Allergic Reaction FFP Plasma 101

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

The Skeptics' Guide to EM

OCTOBER 3, 2021

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. The SALT-ED trial was also a single-centre unblinded trial, but the primary outcome was hospital free days. Reference: Zampieri et al.

OR 130

OR Critical Care ICU Plasma 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. You’ll be working closely with providers of various levels while seeing a variety of medical illnesses and traumatic injuries depending on the hospital you work at.

EMT 130

EMT EMT Paramedic Plasma 130

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.

FFP 130

FFP Frozen Plasma Plasma ALS 130

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-9-1-1 111

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

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

Pediatric EM Morsels

AUGUST 9, 2024

Congenital Syphilis may still occur in patients presenting to your ED! 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. Causes fevers , hypotension , and can be life-threatening.

E-9-1-1 154

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

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

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 89

Plasma EMS ED OR 89

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. Most of the hyponatraemia we see admitted through the ED will be hypoosmotic hyponatraemia.

Critical Care 74

Critical Care Plasma OR ED 74

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. 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%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

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

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? How does this impact the prehospital environment? Prehospital blood product transfusion increases risk of hypoCa.

FFP 105

FFP ALS Plasma Emergency Department 105

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. Plasma cell endometritis is associated with Chlamydia trachomatis infection. We’ll keep it short, while you keep that EM brain sharp. What is the diagnosis? PMID: 9067792.

EMS 87

EMS E-9-1-1 Plasma OR 87

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 90

E-9-1-1 ALS Plasma Emergency Department 90

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? 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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. Her triage vitals are within normal limits.

Emergency Department 105

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

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

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

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. Internal potassium balance and the control of the plasma potassium concentration. Plasma potassium ([K] p ) was measured at 15-minute intervals during and after the infusion in 31 patients. Medics stated that he had not been taking his clopidogrel for 2 weeks.

STEMI 52

STEMI Plasma Defibrillator OR 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.

E-9-1-1 94

E-9-1-1 ALS Plasma OR 94

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

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. Internal potassium balance and the control of the plasma potassium concentration.

Plasma 40

Plasma STEMI Defibrillator Overdose 40

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! Linden JV, Bianco C, eds. Transfusion.

Plasma 69

Plasma Ambulance ALS Emergency Department 69

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

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

Dr. Smith's ECG Blog

FEBRUARY 18, 2022

In fact, there is laboratory evidence that CO toxicity increases Plateletneutrophil aggregates and plasma myeloperoxidase (MPO) concentration and thus may precipitate ACS (though this is by no means clinically proven). Figure-1: Comparison of the initial ECG in the ED ( = ECG #1 ) with the follow-up ECG done the next day ( = ECG #2 ).

ACS 52

ACS Plasma OR STEMI 52

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. Plasma glucose Beta-hydroxybutyrate (i.e.

ED 103

ED Plasma OR ALS 103

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 63

ED Operating Room ALS Frozen Plasma 63

EMDocs

DECEMBER 18, 2023

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. 8,9 Recently, monocyte distribution width (MDW) has shown promise in a large meta-analysis as a useful screening tool in the ED.

E-9-1-1 90

E-9-1-1 ALS Emergency Department Plasma 90

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

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 94

E-9-1-1 Emergency Department Plasma ACS 94