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. Epub 2019 Dec 19. IV acyclovir for HSV coverage while awaiting PCR results. 2020 Feb;75:55-62.

Plasma 274

Plasma OR ED Critical Care 274

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 144

Plasma ALS OR EMS 144

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. NEJM 2019 Guest Skeptic: Dr. Ryan Radecki is an Emergency Physician at Kaiser Permanente NW, co-host of the Annals of Emergency Medicine podcast and Journal Club section editor. Date: April 5th, 2019 Reference: Connolly et al.

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130

Core EM

JANUARY 24, 2024

Published 2019 Jun 6. 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. Clin Med (Lond). 2018;18(4):314-319. doi:10.7861/clinmedicine.18-4-314

FFP 130

FFP Frozen Plasma Plasma ALS 130

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

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] McGraw Hill Companies, Inc; 2019. lidocaine) or an ester (e.g.,

E-9-1-1 103

E-9-1-1 Plasma Epinephrine ED 103

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. New York Mcgraw-Hill Education; 2019. Choice of the best equation for plasma osmolality calculation: Comparison of fourteen formulae. Goldfrank’s Toxicologic Emergencies.

Plasma 87

Plasma EMS ED OR 87

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

Core EM

OCTOBER 2, 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 100

Allergic Reaction Plasma ED Epinephrine 100

Don't Forget the Bubbles

AUGUST 2, 2023

Pro-inflammatory states may also play a role, as patients with CRPS have significantly higher levels of plasma cytokines and chemokines. 2019 Dec;35(12):933-940. Several neurological mechanisms for CRPS have been suggested, including central sensitisation, alteration in the central nervous system (CNS), and small fibre changes.

MPD 98

MPD ALS Plasma OR 98

Dr. Smith's ECG Blog

FEBRUARY 18, 2022

In fact, there is laboratory evidence that CO toxicity increases Plateletneutrophil aggregates and plasma myeloperoxidase (MPO) concentration and thus may precipitate ACS (though this is by no means clinically proven). Intravascular Neutrophil Activation Due to Carbon Monoxide Poisoning What do you think of this ECG?

ACS 52

ACS Plasma OR STEMI 52

ALiEM

OCTOBER 4, 2023

Note that succinylcholine is contraindicated as it is metabolized by plasma pseudocholinesterase. 2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463. Epub 2019 Jun 24. Use benzodiazepines such as diazepam or midazolam for seizures. Provide supportive care. The patient will likely require intubation. Romano JA Jr, Newmark J.

Plasma 195

Plasma OR ED 195

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.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

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 75

Plasma ALS OR Emergency Department 75

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. J Trauma Acute Care Surg 2019. PMID: 36942533 Innerhofer P et al. Lancet Haematol 2017. PMID: 28457980 Jehan F et al.

FFP 140

FFP Frozen Plasma ALS Plasma 140

Pediatric EM Morsels

MARCH 17, 2023

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. It’s expensive, so if you’re giving some of a vial, give it all.

Frozen Plasma 130

Frozen Plasma Plasma First Aid ICU 130

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Rates of congenital syphilis are increasing. Can identify T.

E-9-1-1 157

E-9-1-1 Plasma Emergency Department OR 157

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. 2019 Aug;31(4):683-687.

E-9-1-1 140

E-9-1-1 FFP Plasma Emergency Department 140

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. McGraw Hill, 2019. McGraw Hill, 2019. Pharmacokinetics: 2 No minimal toxic dose has been established, however, doses up to 22 mg seem to be safe for adults from the available literature. Schier, Capt.

E-9-1-1 88

E-9-1-1 ALS Plasma Emergency Department 88

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. 2019 Apr;20(4):404]. Published 2019 Nov 27. The osmolarity is also increased in the kidneys, which leads to diuresis. Hence, it’s important to monitor blood pressure to avoid any episodes of hypotension after mannitol.

ALS 73

ALS Emergency Department Plasma OR 73

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.” 2019:94(4):697-703.

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

REBEL EM

NOVEMBER 28, 2022

Xian 2019) 4-Factor Prothrombin Complex Concentrates (4F-PCC), or K-Centra, is a derivative of human plasma and is explicitly used to reverse vitamin K antagonists such as warfarin and non-specifically in the reversal of DOACs. 2019, April 4). Conley, P. Verhamme, P., Schmidt, J., Middeldorp, S., Beyer-Westendorf, J.,

Plasma 52

Plasma ALS OR EMS 52

Pediatric EM Morsels

SEPTEMBER 6, 2024

Epub 2019 Oct 1. Arch Pathol Lab Med 1 November 2018; 142 (11): 1341–1346. doi: [link] Selvanathan SN, Suhumaran S, Sahu VK, Chong CY, Tan NWH, Thoon KC. Kikuchi-Fujimoto disease in children. J Paediatr Child Health. 2020 Mar;56(3):389-393. doi: 10.1111/jpc.14628. PMID: 31576642. Fusconi, M. and Zaccharelli, F.

Plasma 157

Plasma OR EMS 157

Don't Forget the Bubbles

MAY 15, 2023

This response varies between individuals, age groups and developmental stages, so a single plasma concentration cannot be defined. If there is clinical concern for hypoglycaemia, plasma glucose concentration should be measured. Learning point: Take a plasma glucose sample and ask the lab to run it urgently – time is sugar!

ED 102

ED Plasma OR ALS 102

EMDocs

JUNE 3, 2023

Institutional protocols should be utilized, keeping in mind that either whole blood or a 1:1:1 ratio of packed red blood cells, platelets, and fresh frozen plasma are optimal. 2019 Dec;38(6):695-696]. 2010;376(9734):23-32. doi:10.1016/S0140-6736(10)60835-16. Incagnoli P, Puidupin A, Ausset S, et al. Anaesth Crit Care Pain Med.

ED 62

ED Operating Room ALS Frozen Plasma 62

EMDocs

JUNE 14, 2023

Two assays available used to help confirm diagnosis, however, do not guide treatment Low levels of activity are consistent with organophosphate poisoning. These are send-out labs with turn-around times that make them unlikely to affect the ED course. 3 However, may be helpful in diagnosing the chronic toxicity forms. References: Tintinalli, J.

E-9-1-1 93

E-9-1-1 Plasma Emergency Department ED 93

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. Br J Clin Pharmacol.

E-9-1-1 98

E-9-1-1 ICU ED Plasma 98

EMDocs

MARCH 11, 2024

3 Between 1990 and 2019, there were approximately 3 million deaths due to cholera globally, indicating a significant public health issue. Non-O1/non-O139 Vibrio cholerae bacteraemia in mainland China from 2005 to 2019: clinical, epidemiological and genetic characteristics. 2023;10:1155751. doi:10.3389/fmed.2023.1155751 2020;148:e186.

ED 102

ED ALS OR Plasma 102

EMDocs

JULY 19, 2023

However, in extreme cases with highly toxic levels, one could consider plasma exchange if no other suitable alternative exists. 2019 Jan 16;2019:4275918. doi: 10.1155/2019/4275918. Secondary to its high volume of distribution, mercury is not readily dialyzable. Case Rep Crit Care. PMID: 30792928; PMCID: PMC6354150.

ACS 89

ACS Plasma OR ED 89

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. 2019, 3 rd edition. From: [link] Sickle Cell Disease in Childhood: Standards and Recommendations for Clinical Care.

E-9-1-1 125

E-9-1-1 ACS OR ICU 125

EMDocs

FEBRUARY 3, 2025

However, the European Alliance of Associations for Rheumatology(EULAR) and American College of Rheumatology (ACR) created a classification criterion in 2019 with a 96.1% Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27). sensitivity and 93.4% doi:10.1001/jama.2024.2315.

ED 67

ED E-9-1-1 ALS OR 67

EMDocs

JANUARY 22, 2025

Drug Overdose Deaths with Evidence of Counterfeit Pill Use – United States, July 2019-December 2021. Profound increase in epinephrine concentration in plasma and cardiovascular stimulation after mu-opioid receptor blockade in opioid-addicted patients during barbiturate-induced anesthesia for acute detoxification. J Med Toxicol.

Naloxone 94

Naloxone E-9-1-1 Overdose ALS 94

Core EM

JANUARY 16, 2025

BMI is not a great predictor of difficult intubation (Moon 2019), however, more obese patients have shorter times to desaturation (Jense 1991), which can make these cases more challenging. Having a class 3 on the upper lip bite test is a strong predictor of a difficult intubation (Detsky 2019) – likelihood ratio of 14!

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

NOVEMBER 2, 2024

The development of an inflammatory process is largely due to the infiltration of lymphocytes and plasma cells which ultimately result in nerve damage (e.g., 2019 Oct 31;381(18):1789. The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.” In: StatPearls.

EMS 104

EMS E-9-1-1 Plasma ALS 104