EMDocs

MAY 27, 2025

11 Transfuse patients who are anemic or coagulopathic, ideally with fresh whole blood; if this is not available, use packed red blood cells (PRBCs) for anemia, and replete coagulopathy with platelets, fresh frozen plasma (FFP), or cryoprecipitate as indicated. doi:10.1101/cshperspect.a025452 Kwiatkowski D, Hill AV, Sambou I, et al.

ED

EMDocs

FEBRUARY 22, 2025

Although the concentration of chloride in the CSF is slightly higher than in plasma, measuring chloride (B) is not an accurate way to detect the presence of CSF. Callen AL, Timpone VM, Schwertner A, Zander D, Grassia F, Lennarson P, Seinfeld J, Lillehei KO, Birlea M, Thaker AA. Amoozegar F, Guglielmin D, Hu W, Chan D, Becker WJ.

E-9-1-1

Core EM

JANUARY 25, 2024

Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al. Ann Emerg Med.

Frozen Plasma

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. sodium chloride), and balanced crystalloid solutions, meaning those with a chloride composition closer to plasma such as lactated ringer’s or Plasma Lyte 148. Reference: Finfer et al.

ICU

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. Date: June 18th, 2022 Reference: Crombie et al. The paramedic asks you, “we have saline, and we also have red-cells and this fancy new lyophilised plasma. Should we give our shocked patient saline or plasma / red cells en route to the ED?” Reference: Crombie et al.

Plasma

Core EM

JANUARY 24, 2024

2017.09.1085 Gómez-Outes A, Alcubilla P, Calvo-Rojas G, et al. doi:10.1186/s13054-019-2492-8 Baugh CW, Levine M, Cornutt D, et al. 2019.09.001 Gilbert BW, Morton L, Huffman JB, et al. 2019.10.013 Patel IJ, Rahim S, Davidson JC, et al. 2019.04.017 Connolly SJ, Milling TJ Jr, Eikelboom JW, et al. J Am Coll Cardiol.

FFP

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

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. Date: April 5th, 2019 Reference: Connolly et al. 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 ).

Frozen Plasma

Pediatric EM Morsels

JUNE 14, 2024

References Absoud, Michael et al. 2019, doi:10.3390/children6050070 Wolf, Varina L et al. ALWAYS rule out a compressive lesion, this is a medical emergency! REMEMBER, ATM can come with other baggage (i.e. first sign of MS). These patients will require ongoing surveillance and management. Pediatric transverse myelitis.” Neurology vol.

Plasma

EMDocs

AUGUST 31, 2023

Plasma half-life of the F(ab’) 2 antivenom is significantly longer at 5.5 Bush SP, Ruha AM, Seifert SA, et al. link] Kanaan NC, Ray J, Stewart M, et al. F(ab) is smaller, consisting of a single antigen binding site, while F(ab’) 2 consists of two antigen-binding sites linked together by an antibody “hinge” region. 5 Figure 1.

Allergic Reaction

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. Cognitive behavioural therapy (CBT) In a study by Brinkers et al. A small, retrospective review by Brooke et al. More recently, Mesaroli et al. Taylor SS, Noor N, Urits I, et al.

MPD

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] doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al.

E-9-1-1

The Overrun Podcast

NOVEMBER 23, 2020

Dr. Fisher’s Twitter feed: [link] Kotwal, et al. study on the 75th Ranger Regiment: [link] the PAMPER trial on prehospital plasma: [link] Fisher on ketamine: [link] Ketamine and PTSD: [link] Stop the Bleed information: [link] [link] [link] On this episode, Dan gets to sit down virtually with Dr.

Plasma

EMDocs

AUGUST 7, 2023

Acute Aortic Dissection (AAD) A meta-analysis found that plasma D-dimer level <500 ng/mL is useful for identifying patients who are unlikely to have an AAD and do not require further aortic imaging. doi:10.4103/1947-2714.143278 van der Pol LM, Tromeur C, Bistervels IM, et al. x Douma RA, le Gal G, Söhne M, et al.

E-9-1-1

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. doi:10.1186/s13613-018-0402-x McNab S, Duke T, South M, et al. Crit Care Med.

Plasma

ACEP Now

FEBRUARY 6, 2024

2 Parsa, et al. 3 Casavant, et al. 3 Casavant, et al. Parsa, et al. Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Al Aboud DM, Gossman W. Hack’s recommendation for examining urine under ultraviolet (UV) light for suspected ethylene glycol ingestions.

ALS

Dr. Smith's ECG Blog

FEBRUARY 2, 2017

mEq/L, the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Internal potassium balance and the control of the plasma potassium concentration. The estimated deficit associated with a serum decrease from 4.0 mEq/L to 3.0 mEq/L is 100-200 mEq of total body K, and from 3.0 mEq/L to 2.0 Medicine (Baltimore) 1981;60:339-54].

Plasma

Dr. Smith's ECG Blog

JULY 27, 2023

Peak plasma concentration of amphetamines is rapid ( within minutes ) following inhalation or injection. PEARL #3: The pathophysiologic mechanism for producing amphetamine-induced acute MI is unclear ( Bazmi et al — SQUMJ 17(10); e31-37, 2017 — and — Sinha et al — Case Rep Cardiol, 2016 ).

Coronary

ACEP Now

FEBRUARY 11, 2024

One side effect of this medication is that it can reduce the absorption of antiepileptic medications such as valproate, vigabatrin, and lamotrigine and reduce their plasma concentration, thus putting patients taking these medications at higher risk of seizure. Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Bansal AB, Al Khalili Y.

Overdose

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Internal potassium balance and the control of the plasma potassium concentration. The estimated deficit associated with a serum decrease from 4.0 mEq/L is 100-200 mEq of total body K, and from 3.0 Medicine (Baltimore) 1981;60:339-54].

Plasma

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). Yelken B et al. Intravascular Neutrophil Activation Due to Carbon Monoxide Poisoning What do you think of this ECG?

ACS

Core EM

JANUARY 25, 2024

Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. Decreases production of anti-ADAMTS13 antibodies by removing the B cells that mature into autoantibody-secreting plasma cells. Paydary, Koosha, et al.

Plasma

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. 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)? years ( 2 ).

Frozen Plasma

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. 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?

OR

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. 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.

FFP

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

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. References Evans L, Rhodes A, Alhazzani W, et al. Piccioni A, Saviano A, Cicchinelli S, et al. Fleischmann C, Scherag A, Adhikari NK, et al. Rhee C, Dantes R, Epstein L, et al.

E-9-1-1

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

The Skeptics' Guide to EM

SEPTEMBER 24, 2022

Date: September 20th, 2022 Reference: Menon et al. Date: September 20th, 2022 Reference: Menon et al. Tenecteplase (TNK) is a genetically modified variant of alteplase with greater fibrin specificity (15-fold higher) and longer plasma half-life (22 min vs 3.5 Reference: Menon et al.

Plasma

EMDocs

MARCH 4, 2024

1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. doi:10.1016/B978-0-323-48109-0.00036-5 Todd Taylor A, Wheatley M, Chung AS, et al. doi:10.3109/00365529309098282 Newsome PN, Cramb R, Davison SM, et al. 2012.05.002 Gurusamy KS, Giljaca V, Takwoingi Y, et al.

Emergency Department

Pediatric EM Morsels

MARCH 17, 2023

Available from: [link] Correa JA, Fallon SC, Cruz AT, et al. Sarkar S, Sinha R, Chaudhury AR, et al. (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. It’s expensive, so if you’re giving some of a vial, give it all. Snake Toxicity.

Frozen Plasma

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. References Sukumar S, Lämmle B, et al. Kessler CS, Khan BA, et al. Li XM, Mo XY, et al. 2021;46:556-9 Long B, Bridwell RE, et al.

Frozen Plasma

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. Metabolism of DEG adapted from Bessenhofer, et al. References: Abubukar et al. Nelson, et al. Conklin, Laura, et al. Nelson, et al. Schier, Capt. McGraw Hill, 2019. 1, 2010, pp.

E-9-1-1

Don't Forget the Bubbles

AUGUST 12, 2024

Hypertonic saline contains a higher sodium concentration than normal plasma and interstitial fluid. Ben Abdeljelil A, Freire GC, Yanchar N, et al. Doi:10.1056/NEJMc2201761 Kochanek PM, Adelson PD, Rosario BL, et al. 2022.0891 Kochanek PM, Tasker RC, Carney N, et al. 2019.00528 Rauchman SH, Zubair A, Jacob B, et al.

ALS

Dr. Smith's ECG Blog

APRIL 8, 2016

the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Internal potassium balance and the control of the plasma potassium concentration. Plasma potassium ([K] p ) was measured at 15-minute intervals during and after the infusion in 31 patients. The estimated deficit associated with a serum decrease from 4.0

STEMI

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