Critical Care Scenarios

OCTOBER 31, 2021

Plasma free hemoglobin levels may be a useful marker that changing your oxygenator could improve gas exchange.* Decannulate at the bedside when ready, watch them for 24 hours, then boot them out of the ICU; they’re ready.* Anticoagulate most patients on VV ECMO with heparin to a PTT of 45-55. Data remains slim,

Interfacility Transport 100

Interfacility Transport Plasma ICU EMS 100

Emergency Medicine Ireland

JUNE 7, 2021

In the plasma itself, 50% is ionised, 40% is plasma bound and 10% is chelated to various anions. There is a large gradient between the ionised calcium in the plasma and the tiny ionised fraction in the cells. Now let’s turn to hypercalcaemia, a fairly common diagnostic issue in the ICU.

Critical Care 52

Critical Care Plasma ICU OR 52

Critical Care Scenarios

JANUARY 10, 2021

Treat initially with steroids per the RECOVERY trial (dexamethasone 6 mg daily for 10 days); then, if needing ICU or especially if needing intubation, consider the DEXA-ARDS protocol (20 mg daily for 5 days, then 10 mg daily for another 5 days). Prone early, when the lungs are still recruitable and salvageable. .*

Critical Care 100

Critical Care Plasma ICU OR 100

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

Emergency Medicine Ireland

OCTOBER 28, 2020

TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. 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. Welcome back to the tasty morsels of critical care podcast.

Critical Care 40

Critical Care Plasma FFP ICU 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

Have a look to see how their osmolarity and tonicity across the cell membrane compare to plasma. Renal (= urine output) : anti-diuretic hormone (ADH) release from the posterior pituitary is stimulated by microchanges in plasma osmolarity. This water is held in either the intracellular compartment (i.e. everywhere outside the cells).

Plasma 80

Plasma ALS ICU Critical Care 80

Emergency Medicine Ireland

MARCH 4, 2021

GBS is a clinically important diagnosis for both the emergency department and the ICU. GBS is a clinically important diagnosis for both the emergency department and the ICU. In the ICU the diagnosis is usually fairly easy as they come with a label of possible GBS in the referral. Its rareish but common enough that you.

Critical Care 40

Critical Care ICU Plasma Emergency Department 40

EMDocs

JUNE 7, 2023

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. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

Emergency Medicine Ireland

OCTOBER 17, 2022

We talk a lot about cerebral protective measures in the ICU and hopefully this will give you a little of the basic physiological background. The brain apparently receives 15% of the cardiac output, though I imagine by the end of a typical ICU on call shift, that proportion will have dropped quite significantly.

Critical Care 40

Critical Care ICU Plasma OR 40

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 made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. We set the machine to synchronized cardioversion.

Defibrillator 52

Defibrillator ICU EMS Plasma 52

The Skeptics' Guide to EM

OCTOBER 3, 2021

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? Date: September 28th, 2021 Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 130

Don't Forget the Bubbles

JUNE 30, 2023

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. You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives.

E-9-1-1 139

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

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? in the 1:1:1 group vs. 17.0%

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

REBEL EM

JUNE 26, 2023

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 Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72

FFP 144

FFP Frozen Plasma ALS Plasma 144

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. In addition, free haem and haemoglobin contribute to the vascular damage. Blood film shows sickle cells and a further sample was sent for confirmation of diagnosis.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

EMDocs

DECEMBER 18, 2023

The first was the suggestion to use balanced crystalloid fluids, such as lactated ringers or plasma-lyte, instead of normal saline. This was based on studies that demonstrated qSOFA was more specific but less sensitive than its counterparts (Table 1). vs. 0.91), positive predictive value (0.27 vs. 0.38), and positive likelihood ratio (5.08

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65