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ToxCard: Iron

EMDocs

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. Radiology in the management of acute iron poisoning.

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Trauma Resuscitation Updates

RebelEM

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

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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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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

E.g. burns, neurosurgery, interventional radiology. Fluid Resuscitation in Trauma In trauma where the cause of shock is most likely to be haemorrhagic, fluid resuscitation should ideally be with blood products – replacing losses. What are your next priorities, and how do these differ from a non-traumatic cardiac arrest?

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EM@3AM: Retroperitoneal Hematoma

EMDocs

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

EMS 97
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emDOCs Revamp: Esophageal Perforation

EMDocs

2 , 4 , 5 Recommended by the American College of Radiology (ACR) Appropriateness Criteria but otherwise limited for cervical perforations or alternative etiologies of chest pain. PPI administration to decrease gastric acid secretion. 5 Consider antifungal administration. Discuss with GI/surgeons prior to placement.

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Corticosteroids in Severe Community Acquired Pneumonia: Could CAPE COD catalyze a change in critical care management?

RebelEM

Pneumonia diagnosis supported by clinical and radiologic criteria. The treating physicians and research personnel were all unaware of the treatment arm, reducing the potential for bias in treatment administration and outcome assessment. Population Inclusion Criteria: Adult patients (≥18 years old).