ACEP Now

FEBRUARY 6, 2024

If uncertainty remains while awaiting definitive testing, a POC lactate is a better clue. Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. Several case reports (including one with no urine fluorescence) found apparent lactate concentrations exceeding 15 mmol/L (often exceeding 30 mmol/L.)

ALS 52

ALS Plasma Critical Care OR 52

Emergency Medicine Ireland

OCTOBER 17, 2022

As mentioned in prior posts it’s fairly definitive at this stage that therapeutcially cooling the injured brain to sub normal temps does not improve outcomes but it would still seem prudent to take the TBI with a temp of 39 down to a more normal range. Osmolality is another manipulable physiological variable we can tinker with.

Critical Care 40

Critical Care ICU Plasma OR 40

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

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. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control.

E-9-1-1 139

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

EMDocs

MARCH 4, 2024

5 Identification of obstructive physiology in the emergency department (ED) and referral for definitive management can spare patients from these damaging downstream consequences. 1 GGT is an enzyme located on the plasma membrane of hepatocytes that is involved in the regeneration of glutathione. How does cholestasis present?

Emergency Department 105

Emergency Department E-9-1-1 ALS OR 105

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

FOAMfrat

AUGUST 15, 2024

I love this definition because it is simple and to the point: bleeding post birth accompanied by shock. Moreover, LTOWB also allows us to administer platelets and plasma, in addition to red cells, to promote clotting and homeostasis. Oxygen Remember our definition of shock? Definitely not. I can totally picture this!

Plasma 69

Plasma Ambulance ALS Emergency Department 69

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

Don't Forget the Bubbles

OCTOBER 28, 2024

Surprisingly, there are different definitions of paediatric major haemorrhage, with no single agreed-upon definition. Many of these definitions are not useful in acutely bleeding children as they require measuring the amount of blood that was lost or transfused over prolonged periods. What is major haemorrhage?

Frozen Plasma 70

Frozen Plasma FFP Plasma ALS 70

Don't Forget the Bubbles

MAY 15, 2023

Although hypoglycaemia is one of the most common paediatric emergencies, consensus on a definition and investigations have not been reached. Even the definition of hypoglycaemia itself is a contentious subject. If there is clinical concern for hypoglycaemia, plasma glucose concentration should be measured.

ED 102

ED Plasma OR ALS 102

EMDocs

JUNE 3, 2023

Figure 1: The Young-Burgess classification of pelvic ring fractures (source: [link] 3 It is paramount to differentiate the definitions of “hemodynamically unstable” and “mechanically unstable” pelvic fractures. For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link].

ED 62

ED Operating Room ALS Frozen Plasma 62

FOAMfrat

SEPTEMBER 19, 2024

is positive thanks to the widespread availability of antivenom, relatively short transport times to definitive care, and the U.S.'s Along with inducing coagulopathy, venom toxins may contribute to local and/or systemic hemorrhage and plasma extravasation by means of basement membrane degradation within the vasculature.

Emergency Department 95

Emergency Department Epinephrine OR Plasma 95

EMDocs

FEBRUARY 3, 2025

While acute cutaneous lupus lesions are highly characteristic of SLE, subacute and chronic skin changes may occasionally develop in individuals without a definitive SLE diagnosis (1,5). Treatment requiresaggressive anticoagulation, glucocorticoids, plasma exchange, and intravenous immunoglobulin (IVIG)(27).

ED 68

ED E-9-1-1 ALS OR 68

EMDocs

MAY 17, 2025

General principles in the approach to massive hemorrhage Definition of Massive Hemorrhage: Definitions of major hemorrhage include: Loss of more than one circulating blood volume within 24h, loss of 50% of total blood volume in <3h, or bleeding in excess of 150mL/min.

E-9-1-1 95

E-9-1-1 EMS FFP Frozen Plasma 95

FOAMfrat

NOVEMBER 25, 2024

Resuscitating patients with low titer O whole blood or with component therapy in a ratio of 1:1:1, with packed red blood cells, platelets, and plasma, is impactful as it will help promote the restoration of circulation and add platelets and hemoglobin to the depleted store.

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105

Core EM

JANUARY 16, 2025

For an unstable patient in the ED, you will definitely not be able to do this entire evaluation, but any part will be helpful – even if its just having them range their neck and thrust their jaw while getting pre-oxygenated, or looking in the mouth to make sure the jaw isnt wired shut! Figure 7: (modified from Tanoubi 2009).

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

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. Haemoglobin electrophoresis: To reach a definitive diagnosis, Hb electrophoresis is used. Other associated signs can be anaemia and high reticulocyte count.

E-9-1-1 125

E-9-1-1 ACS OR ICU 125

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., The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis.” Symptoms: Personality change (i.e., doi:10.1097/OLQ.0b013e31824b1cde

EMS 113

EMS E-9-1-1 Plasma ALS 113

EMDocs

JANUARY 6, 2025

Cholera Case Definitions and Diagnosis.; GI symptoms, right upper quadrant abdominal pain, jaundice. ^ = AMB, a region of sub-Saharan Africa consisting of > 20 countries which have an unusually high incidence of bacterial meningitis and frequency of outbreaks; nearly half of global bacterial meningitis cases occur in the AMB.

ED 74

ED E-9-1-1 ALS Emergency Department 74