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He is board certified […] The post SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study first appeared on The Skeptics Guide to Emergency Medicine. Case: A 62-year-old man is brought in by EMS from home with lethargy and hypotension. Date: June 12th, 2022 Reference: Finfer et al. Early work suggested potential harm from 0.9%
Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Clinical Question: Does administration of a balanced solution (Plasma-Lyte 148) during intensive care unit (ICU) stay, compared with saline solution, result in improved 90-day survival in critically ill patients? Reference: Zampieri et al.
Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 2] This linking group can be either an amide (e.g.,
Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. Boswell (EM and CCM) of the University of Maryland, perhaps the busiest center in the country for COVID-related ECMO. An overview of VV ECMO with a focus on COVID-19, with Dr. Kimberly A.
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. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P = 0.03.).
Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial. appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03
doi:10.1186/1757-1626-1-16 The post Snake Bites and Children appeared first on Pediatric EM Morsels. (Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. It’s expensive, so if you’re giving some of a vial, give it all. Pediatr Nephrol.
Today, she would not get out of bed, prompting the facility to call EMS. The first was the suggestion to use balanced crystalloid fluids, such as lactated ringers or plasma-lyte, instead of normal saline. The patient currently resides at a skilled nursing facility. She had a fever of 38.7 °C F) in the ambulance.
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.
8 Plasma butyrylcholinesterase (“pseudocholinesterase”) activity Easier to assay and is more widely available Red cell acetylcholinesterase (“true cholinesterase”) activity More accurate and specific Management: Patients require immediate intervention if there is concern for acute organophosphate poisoning.
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. She was initiated on deferoxamine and admitted to the ICU. 2 L/hr in adults. mg of elemental iron.
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. Figure 7: (modified from Tanoubi 2009).
84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). 66 ^^ = a form of polio that arises from the oral polio vaccine (OPV) in regions where there is system lack of vaccination or undervaccination. Severe malaria is typically caused by P. Severe malaria management. WHO Guidelines for Malaria.;
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