Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? Fortunately, we have addressed many neonatal issues in the PedEMMorsels. May be on soles of feet !

E-9-1-1 152

E-9-1-1 Emergency Department Plasma OR 152

ESO

MARCH 15, 2024

Balance resuscitation strategy, often in a 1:1:1 ratio of PRBCs with fresh frozen plasma and platelets. The 2023 Trauma Index revisits the metric surrounding whole blood and packed red blood cell (PRBC) transfusions for trauma patients with an Early Blood Transfusion Needs Score (EBTNS) greater than five.

Frozen Plasma 111

Frozen Plasma Plasma FFP OR 111

Pediatric EM Morsels

JUNE 14, 2024

(Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g.

Plasma 141

Plasma ALS OR EMS 141

Emergency Medicine Cases

FEBRUARY 9, 2021

Until the results of lab testing come back and hemorrhage pace is slowed, what ratio of plasma to RBCs should we target? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused? What should be the lab resuscitation targets? How do we mitigate the risk of hypothermia?

Plasma 130

Plasma ED OR FFP 130

Emergency Medicine Ireland

APRIL 16, 2024

This time the tonicity is high from something else such as high glucose or mannitol drawing water from cells into plasma. A normal sane and functioning kidney will try and lose water to conentrate the plasma in order to bring the sodium back up to normal, in other words the kidney should be producing a dilute urine with a low osm.

Critical Care 74

Critical Care Plasma OR ED 74

Medgadget

SEPTEMBER 20, 2023

The researchers used a relatively simple plasma etching technique to create such nanopillars on titanium surfaces, and tested their ability to kill multi-drug resistant Candida cells, a fungal pathogen behind many medical device infections. “As it slowly stretches, the weakest point in the latex will become thinner and eventually tear.

Plasma 90

Plasma OR 90

ALiEM

OCTOBER 20, 2023

Necrobiosis Lipoidica – This patient had a previous skin biopsy with histopathologic changes demonstrating a granulomatous dermatitis involving the dermis and subcutaneous tissues with necrobiosis of collagen and inflammatory infiltrates of lymphocytes and plasma cells consistent with a diagnosis of necrobiosis lipoidica.

Plasma 161

Plasma Coronary Emergency Department OR 161

Dr. Smith's ECG Blog

MAY 22, 2024

Don't forget beta agonists in the treatment of hyperkalemia: Terbutaline and Albuterol for Lowering of Plasma Postassium (includes many abstracts) The below abstracts show that beta 2 adrenergic agonists are effective at treating hyperkalemia. Both together are VERY likely to be due to hyperkalemia. Is This a Simple Right Bundle Branch Block?

Plasma 112

Plasma ICU OR 112

The Overrun Podcast

MARCH 14, 2023

Enrolled 789 patients RePHILL Study Question and Methods: Multicenter RCT out of the UK that investigated prehospital resuscitation using PRBCs and plasma versus normal saline to improve tissue perfusion or mortality in adult trauma patients with hemorrhagic shock.

Plasma 52

Plasma CPR OR 52

EMDocs

JULY 11, 2023

Today on the emDOCs cast, Brit Long, MD ( @long_brit) covers hemophilia, including background, severity, evaluation, and management. Episode 81: Hemophilia What is hemophilia? Bleeding disorder due to a deficiency in one or more of the proteins (factors) involved in the coagulation pathway. Most common site is hemarthrosis (70-80% of cases).

Plasma 62

Plasma ALS OR Emergency Department 62

Chicago EMT Training

AUGUST 6, 2021

Various assistant/tech roles around the hospital/Plasma Donation Centers I personally became an Anesthesia Technician at Northwestern solely off of my experience as a paramedic and have been fortunate to bring on coworkers who were EMT students of ours. It opens many doors in various industries.

EMT 130

EMT EMT Paramedic Ambulance 130

Emergency Medicine Ireland

MARCH 13, 2023

In broad terms we can compare dialysis (the movement of small molecules across a membrane along an osmotic gradient) with ultrafiltration (the squeezing of plasma through a big sieve that retains the big bits of the plasma and lets the other bits leak out). These rejoice in the acronyms CVVH, CVVHD and CVVHDF respectively.

Critical Care 52

Critical Care Plasma ICU OR 52

EMDocs

APRIL 10, 2024

Metabolism of ester anesthetics is by plasma cholinesterase, whereas amides are metabolized by the cytochrome P450 system in the liver. [6] 6] Action of local anesthetics is dependent upon the molecule crossing the plasma membrane in a unionized form. [2] 2] This linking group can be either an amide (e.g., lidocaine) or an ester (e.g.,

E-9-1-1 93

E-9-1-1 Plasma Epinephrine Life Support 93

EMDocs

MAY 23, 2024

3 Measured in analytical testing : Laboratories measure plasma concentration using osmometers which measures values as a function of kilograms of solvent. Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae. Validation of equations used to predict plasma osmolality in a healthy adult cohort.

Plasma 65

Plasma EMS ED OR 65

The Overrun

JUNE 3, 2023

Through the years, we see a change to plasma, then crystalloid, and then 1:1:1 therapy. Once compared, while 1:1:1 therapy or giving PRBCs or plasma alone is better than crystalloid, whole blood is preferable and may have more of a survival benefit for patients. In the First World War, the preferred resuscitation fluid was whole blood.

Plasma 52

Plasma Paramedicine Paramedicine EMS 52

Emergency Medicine Ireland

MARCH 7, 2022

On the other hand, lymphoid cells have a much smaller and narrower family tree differentiating into different types of lymphocytes and plasma cells. This is a cancer of plasma cells which are the grown up and left home versions of B lymphocytes. They are also distinct in histology and outcomes from the solid organ malignancies.

Critical Care 52

Critical Care Plasma ICU OR 52

Emergency Medicine Ireland

APRIL 29, 2024

If it’s rising too quick it’s often because the patient is losing lots of water through the kidneys which concentrates the plasma raising the Na in the blood. But as we all know in critical care we often work with less than ideal information and have to begin treatment while the diagnostic process is ongoing.

Critical Care 75

Critical Care Plasma OR ED 75

Emergency Medicine Ireland

FEBRUARY 11, 2021

Up front there are some problems with the terminology * Plasmapheresis = process of removing plasma from the blood. Welcome back to the tasty morsels of critical care podcast. Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Unlike CRRT we tend to defer to another specialty to do this.

Critical Care 40

Critical Care Plasma ICU OR 40

International Journal of Paramedicine

JANUARY 5, 2024

Results - A higher shock index score after arrival to the emergency department experienced longer hospital, intensive care unit, and mechanical ventilation days, injury severity scores, packed red blood cells, plasma, platelets, and total blood product usage. The shock index was calculated as heart rate/systolic blood pressure.

Emergency Department 52

Emergency Department Plasma OR 52

Medgadget

MAY 11, 2023

Red cells are healthy monocytes, green and yellow are plasma cells. In such cancers, finding the right drug or drug combination for a given patent is critical. The approach involves seeding the cancer cells into 384-well plates, and then placing different drugs or drug combinations into each well.

Plasma 80

Plasma OR 80

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. So as an important starter, the serum level of calcium does not tell us much about overall levels in the body.

Critical Care 52

Critical Care Plasma ICU OR 52

Critical Care Scenarios

OCTOBER 31, 2021

Plasma free hemoglobin levels may be a useful marker that changing your oxygenator could improve gas exchange.* Cannulation can be done by whomever is skilled and trained, such as cardiac surgery, trauma surgery, trained intensivists, etc.* Anticoagulate most patients on VV ECMO with heparin to a PTT of 45-55.

Interfacility Transport 100

Interfacility Transport Plasma ICU EMS 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

Critical Care Scenarios

JANUARY 10, 2021

You may consider remdesevir or convalescent plasma at this point in the science, but don’t expect too much effect.* .* Worsening tachypnea, distress, and ventilatory (not hypoxic) failure are a marker to upgrade care and/or intubate a borderline COVID patient.* Prone early, when the lungs are still recruitable and salvageable. .*

Critical Care 100

Critical Care Plasma ICU OR 100

Emergency Medicine Ireland

MARCH 11, 2021

Plasmapheresis (which involves spinning the blood in a big machine until the plasma separates out, then removing all the plasma and replacing the volume with some 5% albumin and letting the body reproduce all the other plasma components itself) is another treatment supported by a 2012 Cochrane review of randomised trials.

Critical Care 40

Critical Care Plasma ICU OR 40

The Overrun Podcast

NOVEMBER 23, 2020

This is long episode, but there’s a TON of information…everything from tourniquets, pain management, blood vs. crystalloid, “scoop and run”, and much, much more. We also talk about education, and how The Church is looking to educate while still having a laugh or two. Dr. Fisher’s Twitter feed: [link] Kotwal, et al.

EMT 52

EMT EMT Plasma Paramedic 52

The Curious Clinicians

JANUARY 16, 2024

One well-known study bled volunteers to a hemoglobin of 5 g/dL, while keeping them isovolemic with albumin or plasma infusions. There is one value, however, which we not only leave alone until it is well below normal, but only replenish to barely half the normal value: Hemoglobin (Hgb). Let’s focus on that last point.

Plasma 52

Plasma Critical Care ACS OR 52

The Skeptics' Guide to EM

APRIL 6, 2019

In contrast, protamine could be used for heparin and LMWH reversal and vitamin K, fresh frozen plasma and prothrombinase complex concentrate could be used to reverse coumadin ( Hunt and Levi BMJ 2018 ). Level A One of the concerns clinicians had with DOACs was there was no way to reverse these new anti-coagulants when they were introduced.

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130

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). Conditional recommendation, low-quality evidence).

Frozen Plasma 79

Frozen Plasma FFP Plasma OR 79

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

OCTOBER 28, 2020

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. The plasma replacement replaces factors and reduces the bleeding risk (which is already high) but also acts as a source of ADAMSTS13.

Critical Care 40

Critical Care Plasma FFP ICU 40

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication. 1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity?

E-9-1-1 65

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

Emergency Medicine Ireland

DECEMBER 7, 2020

Pregnancy itself with its bump in plasma volume, reduced Hb and increased cardiac output is like one long exercise stress test. Critical illness in pregnancy is remarkably rare given the somewhat bonkers system for reproduction that we seem to have evolved over the past million or years. Improved care of complex.

Critical Care 40

Critical Care CAD Plasma ACS 40

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.” 6 Balloon tamponade (i.e.,

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

ACEP Now

APRIL 2, 2024

Quantification of hypoglycin A and methylenecyclopropylglycine in human plasma by HPLC-MS/MS. THS is generally characterized by the acute onset of profuse vomiting within six to 48 hours of ingestion of the unripe ackee, with subsequent hypoglycemia. 1 In severe cases altered mental status, seizures, coma, or even death have been observed.

Plasma 40

Plasma ALS Emergency Department ED 40

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. Her medical history is significant for hypertension, hyperlipidemia, and hypothyroidism.

Emergency Department 86

Emergency Department E-9-1-1 OR ALS 86

EMDocs

JUNE 14, 2023

He has a glove and stocking pattern of numbness to his extremities. Motor and sensory findings are symmetrical. Patellar reflexes are 1+. He has no saddle anesthesia or back pain and denies any difficulty urinating or issues with defecation. Paraquat Influenza vaccine Methanol Organophosphate Are his symptoms reversible?

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70