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Imported Malaria

Pediatric EM Morsels

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2019; 17: 98. 2019; 47(2): 183–193. Third times the charm! Pediatr Clin N Am 69 (2022) 47–64. 8 Dec 2022.

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MTP Activation Criteria For Pediatric Patients

The Trauma Pro

All of the trauma professionals are busy with the patient and are rudely surprised when they ask for the first unit of blood. Objective MTP activation criteria have been developed and are well-supported by the literature. Epub 2019 Nov 1. The ABC score and the shock index are two of the more common methods. J Pediatr Surg.

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ToxCard: Iron

EMDocs

5 Severe metabolic acidosis persists Multi-system organ failure The endpoints of deferoxamine are less well defined but it can be weaned off as the patient is clinically improving, the anion gap resolves, and down-trending serum iron concentration. Blood transfusion for clinically significant blood loss. Tenenbein M.

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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

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Trauma Resuscitation Updates

RebelEM

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Severe Traumatic Brain Injury and Controlled Hemorrhage in Rats: Quest for the Optimal Mean Arterial Blood Pressure After Whole Fresh Donor Blood Resuscitation.

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The Latest in Critical Care, 1/8/23 (Issue #24)

PulmCCM

million gallons) of blood are wasted in this fashion, every year—enough to fill about 700 railroad tanker cars with blood, or about four times the total amount of blood transfused annually. Smaller-volume blood collection tubes are widely available at equivalent cost and are compatible with standard blood analyzers.

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EM@3AM: Amniotic Fluid Embolism

EMDocs

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1, RR 28, SpO2 89% on 6L NC.

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