The Skeptics' Guide to EM

DECEMBER 17, 2022

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)? Noting with some relief that at least he isn’t anticoagulated, you activate the hospital massive transfusion protocol. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Critical Care Scenarios

DECEMBER 13, 2020

Continue to use a balanced ratio unless you can use TEG to guide FFP and platelets.* FFP is delayed or unavailable; 2. During the most acute period, mostly transfuse to target vitals (MAP >65 or so). As they begin to achieve hemostasis, things slow down, and it start to become possible to follow labs.

FFP 100

FFP Critical Care ED OR 100

Don't Forget the Bubbles

JUNE 30, 2023

a) A balanced ratio of 1:1:1 (platelets: FFP: packed red cells) The PROPPR trial showed us that balanced ratios are important. b) A balanced ratio of 1: 1:2 (platelets: FFP: packed red cells) The PROPPR trial showed us that balanced ratios are important. And blood comes out. Quite quickly. Time to get a transfusion started.

E-9-1-1 139

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

ESO

MARCH 15, 2024

They received fewer PRBCs, fresh frozen plasma (FFP), and platelets across their LOS, while total units and volumes were similar. Patients who received low titer O+ whole blood in transfusions showed significant improvements in shock index (SI), length of stay (LOS), and in mortality rates.

Frozen Plasma 111

Frozen Plasma Plasma FFP OR 111

REBEL EM

SEPTEMBER 26, 2022

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 Furthermore, 14.3%

FFP 52

FFP E-9-1-1 ICU ALS 52

EMDocs

JUNE 22, 2024

Answer : Amniotic fluid embolism Epidemiology: Incidence of 1:15,200 to 1:53,400 1 7% occur during labor Causes approximately 14% of all maternal peripartum death in United States Current fatality rate 13-60% 1-4 Risk factors: Advanced maternal age, amniocentesis, cesarean delivery, eclampsia, medical induction of labor, placental pathology, diabetes, (..)

EMS 96

EMS Ambulance FFP ICU 96

EMDocs

JUNE 12, 2024

FFP and platelets also contain citrate. Blood products, including both packed red blood cells and whole blood, are stored with the anticoagulant citrate, with can bind Ca and lower ionized Ca levels. Packed red blood cells (pRBCs) are stored with 3 grams of citrate per unit, while whole blood is stored with 1.66 grams of citrate per unit.

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.”

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

EMDocs

NOVEMBER 20, 2023

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).

Frozen Plasma 80

Frozen Plasma FFP Plasma OR 80

Emergency Medicine Ireland

OCTOBER 28, 2020

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.

Critical Care 40

Critical Care Plasma FFP ICU 40

Broome Docs

NOVEMBER 17, 2023

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient.

FFP 138

FFP OR 138

Emergency Medicine Cases

FEBRUARY 9, 2021

Jeannie Callum, Dr. Andrew Petrosoniak and Dr. Barbara Haas join Anton in answering the questions: How do you decide when to activate the MHP? How do you know when it is safe to terminate the MHP? What lab tests need to be done, how often, and how should the results be shared with the clinical team?

Plasma 130

Plasma ED OR FFP 130

ACEP Now

APRIL 5, 2024

Therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) is the first-line treatment, by simultaneously supplying fresh ADAMTS13 and removing anti-ADAMTS13 autoantibodies. Thus, early management is essential for patient outcomes. 4 Early hematology consultation should be obtained when TTP is suspected.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

EMDocs

DECEMBER 6, 2024

Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated. Can titrate up to maximum of 40 mg/kg/hr, although hypotension may limit dose of deferoxamine. 10 Maximum daily dose of 6-8g total of defuroxamine. Blood transfusion for clinically significant blood loss.

E-9-1-1 76

E-9-1-1 Frozen Plasma Plasma Overdose 76

Don't Forget the Bubbles

OCTOBER 28, 2024

Major haemorrhage protocols typically include a mixture of packed red blood cells (pRBCs), platelets, and fresh frozen plasma (FFP). Platelets and FFP replace lost platelets and coagulation factors, which help with clotting and also provide some volume expansion. Rhaenyra continues to receive blood products in a 1:1:1 ratio.

Frozen Plasma 72

Frozen Plasma FFP Plasma ALS 72