Core EM

JANUARY 24, 2024

Hyperkalemia Cardiac conduction partially depends on a gradient of lower extracellular (plasma) potassium levels and higher intracellular potassium levels. The patient was admitted to the medical intensive care unit and emergent underwent dialysis. His EKG on discharge is shown below.

Plasma 130

Plasma Emergency Department Overdose OR 130

Core EM

JANUARY 24, 2024

Background Around 6 million people in the U.S. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.

FFP 130

FFP Frozen Plasma Plasma ALS 130

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.

Plasma 89

Plasma OR 89

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? If someone is on anti-platelets or anticoagulants what is the best strategy to ensure the docs in the ED know what to give and how much? What's better, 1:1:1 or 2:1:1? Should we ever consider using Recombinant Factor 7a?

Plasma 130

Plasma ED OR FFP 130

ESO

MARCH 15, 2024

They received fewer PRBCs, fresh frozen plasma (FFP), and platelets across their LOS, while total units and volumes were similar. Balance resuscitation strategy, often in a 1:1:1 ratio of PRBCs with fresh frozen plasma and platelets.

Frozen Plasma 111

Frozen Plasma Plasma FFP OR 111

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

Pediatric EM Morsels

JULY 26, 2024

First line therapies for anti-NMBDA receptor encephalitis consists of… High dose steroids , IVIG, and PLEX – Therapeutic plasma exchange Only 50% of patient’s respond, and will require second line therapies such as Rituximab. IV acyclovir for HSV coverage while awaiting PCR results.

Plasma 269

Plasma OR ED Critical Care 269

The EMS Show

NOVEMBER 17, 2023

PACT Trial: [link] Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemmorhagic Shock: [link] Guyette is a Professor of Emergency Medicine, University of Pittsburgh Medical Director - STAT MedEVAC as well as the Principal Investigator for the ongoing PACT Trial.

Medical Transportation 40

Medical Transportation Plasma EMS 40

The EMS Show

NOVEMBER 17, 2023

PACT Trial: [link] Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemmorhagic Shock: [link] Guyette is a Professor of Emergency Medicine, University of Pittsburgh Medical Director - STAT MedEVAC as well as the Principal Investigator for the ongoing PACT Trial.

Medical Transportation 40

Medical Transportation Plasma EMS 40

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).

Critical Care 52

Critical Care Plasma ICU OR 52

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

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. to 1.2%).

Plasma 161

Plasma Coronary Emergency Department OR 161

Pediatric EM Morsels

MARCH 29, 2024

Your genetics and inpatient colleagues will thank you!

ED 294

ED Plasma OR EMS 294

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

Pediatric EM Morsels

JUNE 14, 2024

Diagnostic Criterion for ATM (Tavasoli 2018, Wang 2019) Bilateral sensory, motor, and autonomic dysfunction localized to one OR more spinal segment No evidence of compressive cord lesion Enhancing lesion on MRI Pleocytosis or elevated immunoglobulin type G (IgG) index Transverse myelitis consortium working group can be applied to children May (..)

Plasma 141

Plasma ALS OR EMS 141

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Even with rapid treatment, the mortality rate is high.

Plasma 195

Plasma OR ED 195

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

Pediatric EM Morsels

JANUARY 19, 2024

Confirm a positive result with either a Fluorescent treponemal antibody absorption ( FTA-ABS) and/or micro hemagglutination test for antibodies to T.Pallidum ( MHA-TP ).

Plasma 269

Plasma OR EMS ED 269

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. Is This a Simple Right Bundle Branch Block? They do so by "shifting" K into the cells. --0.5

Plasma 112

Plasma ICU OR 112

EMDocs

JULY 11, 2023

The patient’s plasma is mixed with normal pooled plasma (NPP) which adds sufficient clotting factors to overcome the deficiency. If an inhibitor is present, it will inhibit the clotting factors in patient plasma and the NPP, and the clotting time remains prolonged. Each unit of FVIII/kg raises the plasma FVIII level by 2%.

Plasma 62

Plasma ALS OR Emergency Department 62

REBEL EM

MAY 25, 2023

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al. Ann Emerg Med.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Pediatric EM Morsels

AUGUST 9, 2024

Can identify T. pallidum before antibodies against it can be detected. > 4 weeks of age : Aqueous crystalline penicillin G 50,000 Units/kg IV every 6 hours Treat for 10-14 days.

E-9-1-1 152

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

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. Finally on the list of common haematological malignancies is multiple myeloma.

Critical Care 52

Critical Care Plasma ICU OR 52

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. Mortality was higher in the groups with an SI of ≥ 0.9

Emergency Department 52

Emergency Department Plasma OR 52

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

EMergucate

JULY 18, 2012

– fasting plasma glucose > 7 mmol/L – symptoms + random plasma … Continue reading → When do you diagnose your patient with diabetes?

Plasma 100

Plasma 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. 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

Emergency Medicine Ireland

FEBRUARY 11, 2021

Up front there are some problems with the terminology * Plasmapheresis = process of removing plasma from the blood.

Critical Care 40

Critical Care Plasma ICU OR 40

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.

EMT 130

EMT EMT Paramedic Plasma 130

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

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? Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 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. Therapeutical plasma exchange for thrombotic thrombocytopenic purpura in the emergency department: A single center experience. 1 Dr. J Clin Med.

Frozen Plasma 40

Frozen Plasma Plasma Emergency Department FFP 40

Don't Forget the Bubbles

JUNE 30, 2023

This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. to −0.5%]; P  = 0.03.).

E-9-1-1 139

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

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

Medgadget

MAY 11, 2023

Red cells are healthy monocytes, green and yellow are plasma cells. Study in Nature Cancer : Ex vivo drug response heterogeneity reveals personalized therapeutic strategies for patients with multiple myeloma Image credit: Bone-​marrow cells of a multiple myeloma patient. Image: Berend Snijder Lab / ETH Zurich) Via: ETH Zurich

Plasma 79

Plasma OR 79

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. 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.

Critical Care 75

Critical Care Plasma OR ED 75

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? 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52