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

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

The EMS Show

NOVEMBER 17, 2023

PACT Trial: [link] Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemmorhagic Shock: [link] Guyette is a Professor of Emergency Medicine, University of Pittsburgh Medical Director - STAT MedEVAC as well as the Principal Investigator for the ongoing PACT Trial.

Medical Transportation 40

Medical Transportation Plasma EMS 40

The EMS Show

NOVEMBER 17, 2023

PACT Trial: [link] Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemmorhagic Shock: [link] Guyette is a Professor of Emergency Medicine, University of Pittsburgh Medical Director - STAT MedEVAC as well as the Principal Investigator for the ongoing PACT Trial.

Medical Transportation 40

Medical Transportation Plasma EMS 40

Pediatric EM Morsels

MARCH 29, 2024

Your genetics and inpatient colleagues will thank you!

ED 244

ED Plasma OR EMS 244

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

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

International Journal of Paramedicine

JANUARY 5, 2024

Results - A higher shock index score after arrival to the emergency department experienced longer hospital, intensive care unit, and mechanical ventilation days, injury severity scores, packed red blood cells, plasma, platelets, and total blood product usage. Mortality was higher in the groups with an SI of ≥ 0.9

Emergency Department 52

Emergency Department Plasma OR 52

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 61

Plasma OR ALS Emergency Department 61

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 92

E-9-1-1 Plasma Epinephrine Life Support 92

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

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

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

EMergucate

JULY 18, 2012

– fasting plasma glucose > 7 mmol/L – symptoms + random plasma … Continue reading → When do you diagnose your patient with diabetes?

Plasma 100

Plasma 100

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

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

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 Ambulance 130

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 80

Plasma OR 80

Emergency Medicine Ireland

MARCH 11, 2021

Plasmapheresis (which involves spinning the blood in a big machine until the plasma separates out, then removing all the plasma and replacing the volume with some 5% albumin and letting the body reproduce all the other plasma components itself) is another treatment supported by a 2012 Cochrane review of randomised trials.

Critical Care 40

Critical Care Plasma ICU OR 40

Medgadget

JULY 19, 2023

Study in journal ACS Nano : STAMP-Based Digital CRISPR-Cas13a for Amplification-Free Quantification of HIV-1 Plasma Viral Loads Via: Penn State By counting the signals, researchers can quantify the viral load in a sample. Credit: Provided by Weihua Guan.

Plasma 57

Plasma ACS 57

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

The Overrun Podcast

NOVEMBER 23, 2020

We also talk about education, and how The Church is looking to educate while still having a laugh or two. Dr. Fisher’s Twitter feed: [link] Kotwal, et al.

EMT 52

EMT EMT Plasma Paramedic 52

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

The Curious Clinicians

JANUARY 16, 2024

One well-known study bled volunteers to a hemoglobin of 5 g/dL, while keeping them isovolemic with albumin or plasma infusions. The subjects’ blood was less viscous than normal, due to the isovolemic replenishment with plasma and albumin, making it flow more easily. A patient with hemorrhagic shock has problems with both.

Plasma 52

Plasma Critical Care ACS OR 52

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

Emergency Medicine Ireland

OCTOBER 28, 2020

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. The plasma replacement replaces factors and reduces the bleeding risk (which is already high) but also acts as a source of ADAMSTS13.

Critical Care 40

Critical Care Plasma FFP ICU 40

K.S. Chew

APRIL 29, 2015

According to the AHA 2005 on CPR & ERC, it says:"Absorption and subsequent achievement of maximum plasma concentration after subcutaneous administration is slower and may be significantly delayed with shock. IM vs SC - which is preferred? Thus, intramuscular (IM) administration is favored."Thus,

Plasma 40

Plasma CPR 40

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?

Plasma 80

Plasma ALS ICU Critical Care 80

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 130

Frozen Plasma First Aid Plasma OR 130

ACEP Now

APRIL 2, 2024

Quantification of hypoglycin A and methylenecyclopropylglycine in human plasma by HPLC-MS/MS. Jamaican vomiting sickness in Toledo, Ohio. Ann Emerg Med. 1994;23(5):1116-8. Sanford AA, Isenberg SL, et al. J Chromatogr B Biomed Appl. 2018;1095:112–118. Hypoglycin A and Ackee Fruit. Food and Drug Administration website. Updated 03/05/2024.

Plasma 40

Plasma ALS Emergency Department ED 40

Emergency Medicine Ireland

DECEMBER 7, 2020

Pregnancy itself with its bump in plasma volume, reduced Hb and increased cardiac output is like one long exercise stress test. Well, most commonly we’re going to see ACS. As the pregnant population continues to age and with RF and smoking and DM still common we can expect to see pregnant woman with CAD.

Critical Care 40

Critical Care CAD Plasma ACS 40

EMDocs

NOVEMBER 20, 2023

For patients on VKAs to prevent stroke in nonvalvular atrial fibrillation who require reversal, 4-factor prothrombin complex concentrate (PCC) is preferred to fresh frozen plasma (FFP) because of the rapidity of INR reduction (Conditional recommendation, very low-quality evidence).

Frozen Plasma 78

Frozen Plasma FFP Plasma OR 78

ACEP Now

FEBRUARY 6, 2024

Artifactual elevation of measured plasma L-lactate concentration in the presence of glycolate. An illustrated case of ethylene glycol, direct and indirect. 2023;43(10):20-21. Morgan, Thomas J. MBBS, FFICANZCA; Clark, Christopher FIBMS, MAIMS; Clague, Alan MBBS, BSc, FRCPA. Critical Care Medicine. 27(10):p 2177-2179, October 1999.

ALS 52

ALS Plasma Critical Care OR 52

EMDocs

SEPTEMBER 7, 2023

DEG is rapidly absorbed when ingested and can reach peak plasma and brain tissue concentrations within four hours of ingestion. 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.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

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

Emergency Medicine Ireland

JUNE 28, 2021

it is most commonly used for measuring heparin activity (which is a post in itself) but if the APTT is raised in in the absence of heparin then it might reflect factor deficiency (eg one of the thrombophilias) where it should correct to normal with a mixing study where normal plasma is added.

Critical Care 40

Critical Care Plasma OR 40