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EM@3AM: Amniotic Fluid Embolism

EMDocs

We’ll keep it short, while you keep that EM brain sharp. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. The post EM@3AM: Amniotic Fluid Embolism appeared first on emDOCs.net - Emergency Medicine Education. link] j.ajog.2016.03.012

EMS 111
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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

REBEL EM

appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

FFP 139
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Penetrating chest trauma

Don't Forget the Bubbles

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. a) A balanced ratio of 1:1:1 (platelets: FFP: packed red cells) The PROPPR trial showed us that balanced ratios are important. And blood comes out. Quite quickly.

E-9-1-1 139
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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

REBEL EM

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Significant coagulopathy: INR > 1.8

FFP 52
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ToxCard: Iron

EMDocs

Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated. 6 Patients who receive deferoxamine, have significant metabolic abnormalities, or hypotension should be admitted to an intensive care unit (ICU). She was initiated on deferoxamine and admitted to the ICU.

E-9-1-1 97
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ED care of refugee populations from sub-Saharan Africa

EMDocs

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). Severe malaria is typically caused by P. Uncomplicated malaria patients who are able to access prescription medication can be discharged home. Severe malaria management. 84 Adapted from: World Health Organization (WHO).

ED 75