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REBEL Core Cast 108.0 – Angioedema

REBEL EM

Stable patients with isolated anterior tongue edema should undergo fiberoptic laryngoscopy in the ED ( McCormick 2011 ) Avoid unnecessary airway manipulation (can exacerbate edema) Edema may obscure the neck anatomy Airway Management Early intubation often indicated as swelling may progress and supraglottic rescue devices may be ineffective Consider (..)

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Guideline Update: Acute Lower GI Bleeding

EMDocs

For patients on VKAs to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor prothrombin complex concentrate (PCC) is preferred to fresh frozen plasma (FFP) because of the rapidity of INR reduction (Conditional recommendation, very low-quality evidence). Conditional recommendation, low-quality evidence).

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Tasty Morsels of Critical Care 001 | Thrombotic Thrombocytopaenic Purpura

Emergency Medicine Ireland

Theoretically giving them FFP while waiting on PLEX seems like it might be sensible but in reality probably does nothing when the autoantibodies are still around. UPDATE: Caplacizumab is a new drug with now 2 RCTs supporting its use and is finding an increasing role, early in the role of TTP, even immediately after PLEX is started.

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

REBEL EM

This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. to 3.33; P = 0.72 to 2.10; P = 0.03

FFP 145
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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

REBEL EM

Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Fibrinogen and fibrin are often depleted during major trauma as a result of consumption, breakdown, and dilution. Fibrinogen products may also be needed to stabilize clots and stem bleeding.

FFP 127
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EM@3AM: Amniotic Fluid Embolism

EMDocs

The absence of preeclampsia symptoms prior to the acute event makes eclampsia less likely. Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here.

EMS 111
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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