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PATCH

The Bottom Line

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

RebelEM

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

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Pre-Hospital Antibiotics in Sepsis?

RebelEM

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. Paper: Varney J et al. Health Sci Rep 2022. to 0.97; p = 0.02

Sepsis 131
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SGEM#462: Spooky Scary Access – IV or IO for OHCA

The Skeptics' Guide to EM

With a survival rate to discharge often below 10% globally, rapid, effective interventions are needed to improve patient outcomes. Multiple studies have demonstrated how the administration of epinephrine can improve short-term outcomes, such as return of spontaneous circulation (ROSC).

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Maintenance of Prehospital Anaesthesia in Trauma Patients: Variability in Practice

St. Emlyn

With insights into drug protocols, administration methods, and governance, the article highlights challenges and opportunities for standardisation in prehospital care. Ideal for clinicians and researchers aiming to optimise anaesthesia practices and enhance patient outcomes in emergency settings.

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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

RebelEM

The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Fibrinogen products may also be needed to stabilize clots and stem bleeding. Paper: Davenport R et al.

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Another Study on Peripheral Vasopressors

RebelEM

Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Paper: Yerke JR et al. CHEST 2024.