Critical Care Scenarios

OCTOBER 31, 2021

Plasma free hemoglobin levels may be a useful marker that changing your oxygenator could improve gas exchange.* Decannulate at the bedside when ready, watch them for 24 hours, then boot them out of the ICU; they’re ready.* In such cases, beta blockade may actually improve systemic oxygenation.*

Interfacility Transport

Emergency Medicine Ireland

MARCH 7, 2022

However in ICM there is a need to have a broad understanding of what some of the haematological acronyms might mean given that a fair number of these patients end up in the ICU. Most of this post will be navigating the basics of the diseases rather than super specific ICU management. Sepsis is probably number 1 on the list.

Critical Care

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

Emergency Medicine Ireland

MARCH 13, 2023

Today we’re covering the ambitious topic of CRRT in the ICU. 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

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. Now let’s turn to hypercalcaemia, a fairly common diagnostic issue in the ICU.

Critical Care

Emergency Medicine Ireland

FEBRUARY 11, 2021

Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Plasmapheresis (or PLEX) is one of the machines we tend not to have responsibility for in the ICU. Up front there are some problems with the terminology * Plasmapheresis = process of removing plasma from the blood.

Critical Care

Emergency Medicine Ireland

MARCH 11, 2021

GBS management can be nicely split into disease specific management and ICU supportive care. GBS management can be nicely split into disease specific management and ICU supportive care. In terms of specific treatment this is. Read More » Welcome back to the tasty morsels of critical care podcast. Hence the multiple sessions.

Critical Care

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

Emergency Medicine Ireland

OCTOBER 28, 2020

TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. Treatment consists of: * PLEX – actual proper PLEX with plasma replacement as opposed to just washing out all the good stuff and giving albumin as replacement. Welcome back to the tasty morsels of critical care podcast.

Critical Care

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. What loss mechanisms do we need to consider? Intensive Care Med. 2018;44(4):409-417.

Plasma

Emergency Medicine Ireland

OCTOBER 17, 2022

We talk a lot about cerebral protective measures in the ICU and hopefully this will give you a little of the basic physiological background. The brain apparently receives 15% of the cardiac output, though I imagine by the end of a typical ICU on call shift, that proportion will have dropped quite significantly.

Critical Care

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

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. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 PMID: 36942533 Innerhofer P et al. Lancet Haematol 2017.

FFP

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. in 1:1:2 group; difference, −5.4% [95% CI, −10.4% to −0.5%]; P  = 0.03.).

E-9-1-1

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. Disposition The SSC guidelines suggest that patients with septic shock or critical illness be moved to the intensive care unit (ICU) within six hours of presentation to the ED. 2020;157(2):286-292.

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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. It’s expensive, so if you’re giving some of a vial, give it all.

Frozen Plasma

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? vs. 78.1%, p=0.006).

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Dr. Smith's ECG Blog

APRIL 6, 2018

Terbutaline and Albuterol for Lowering of Plasma Postassium Initial labs returned and confirmed critical hyperkalemia and new renal failure. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. We should also have given 0.25mg intramuscular terbutaline, but we did not.

Defibrillator

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.

E-9-1-1

Emergency Medicine Ireland

MARCH 4, 2021

GBS is a clinically important diagnosis for both the emergency department and the ICU. GBS is a clinically important diagnosis for both the emergency department and the ICU. In the ICU the diagnosis is usually fairly easy as they come with a label of possible GBS in the referral. Its rareish but common enough that you.

Critical Care

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. They should be admitted to hospital in case of clinical deterioration to receive ICU treatment. This treatment is usually done in the ICU setting.

E-9-1-1

EMDocs

JANUARY 14, 2025

Episode 112: Guillain-Barr Syndrome Part 2 ED treatment: IVIG and plasma exchange are the main treatment modalities. Anyone with progressive symptoms or more findings on exam than paresthesias alone should be admitted to the hospital, likely to an ICU setting, due to the risk of decompensation.

Plasma

Don't Forget the Bubbles

MARCH 24, 2025

Later phase : As plasma levels fall, vasoconstriction decreases. Dexmedetomidine is currently licensed only for adult sedation in an ICU setting, but guidelines exist to support its off-licence use in paediatric intensive care (PICU). Dexmed then reduces sympathetic outflow, which can lead to hypotension. Eur J Pediatr.

E-9-1-1

Core EM

JANUARY 16, 2025

This graph shows the gaseous equivalent volume of oxygen stored in the lungs, bound to hemoglobin, and dissolved in the plasma for people breathing room air (far left) vs the same people pre-oxygenated by breathing 100% O2 (far right), and then after they have desatted to 90% while apneic (center). Figure 7: (modified from Tanoubi 2009).

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