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

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

REBEL EM

SEPTEMBER 13, 2023

Bradykinin Mediated Plasma globulins called kininogens release bradykinin and cause vascular permeability. Image: ( Morgan 2010 ) Features Absence of urticaria and pruritus Insidious onset (24-36 hours) ACE Inhibitors Inhibition of ACE hinders the degradation of bradykinin and can lead to idiosyncratic angioedema.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

Medgadget

OCTOBER 20, 2022

This involves using a plasma ray that glows a pleasing pink color and methane gas as a carbon source. The plasma causes the methane to dissociate into reactive species and then the carbon can be deposited onto the surface of the electrical components. See a video about the technique below. Via: CalTech.

Plasma 92

Plasma ACS 92

Core EM

JULY 23, 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

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

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

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

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

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

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

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

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

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

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

Don't Forget the Bubbles

NOVEMBER 29, 2024

The osmolar gap measures the difference between the measured plasma osmolality and the calculated plasma osmolality , providing an estimate of unmeasured solutes in the blood. How to Calculate the Osmolar Gap The formula for calculated plasma osmolality is: [Na⁺] is the plasma sodium concentration (mEq/L or mmol/L).

Plasma 64

Plasma E-9-1-1 OR ALS 64

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

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

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 117

Plasma ICU OR 117

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

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

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

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

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

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.* Very prolonged courses on non-invasive positive pressure ventilation (CPAP/BiPAP) may be more acceptable here than in other diseases; although not very appealing it may be preferable to intubation.

Critical Care 100

Critical Care Plasma ICU OR 100

Critical Care Scenarios

OCTOBER 31, 2021

Plasma free hemoglobin levels may be a useful marker that changing your oxygenator could improve gas exchange.* .* Hypoxemia can occur in VV ECMO patients due to too much flow through the native circulation and shunted lungs. In such cases, beta blockade may actually improve systemic oxygenation.*

Interfacility Transport 100

Interfacility Transport Plasma ICU EMS 100

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

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

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

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

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

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

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

REBEL EM

JUNE 26, 2023

Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial. PMID: 36942533 Innerhofer P et al. Lancet Haematol 2017. PMID: 28457980 Jehan F et al.

FFP 145

FFP Frozen Plasma ALS Plasma 145

The Overrun Podcast

MAY 23, 2019

Mark Merlin on Twitter at : @ccareanywhere The NJ EMS and Disaster Medicine Fellowship can be found at: www.emsfellowship.com The MD1 physician response program: www.md1program.org Dr. Qasim is on Twitter at: @emeddoc Dr. Callelo: @DrDianeC, @njpoisoncenter, also at @ToxAndHound The COMBAT trial for prehospital plasma: [link] The PAMPHER trial: [link] (..)

EMS 52

EMS Plasma Epinephrine CPR 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. 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