Blood Transfusions and Shock - Emergency Care Today

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

NOVEMBER 27, 2023

What is Shock? Shock is defined as a type of circulatory failure where lack of oxygen leads to dysfunction of vital organs. There are many types of shock which may affect children, and management is specific to the type of shock. The overall goal in managing any cause of shock is to restore oxygen delivery to the organs.

Shock

Shock Sepsis Fluid Resuscitation Resuscitation

MTP Activation Criteria For Pediatric Patients

The Trauma Pro

JUNE 18, 2024

All of the trauma professionals are busy with the patient and are rudely surprised when they ask for the first unit of blood. The ABC score and the shock index are two of the more common methods. A score greater than or equal to one predicts at least a 2x higher need for blood. But what about children?

Pediatrics

Pediatrics Blood Transfusions Resuscitation Shock

Trick of Trade: Dual Foley catheter to control massive epistaxis

ALiEM

MAY 29, 2023

If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. Because he presumably had uremia-induced thrombasthenia (weak platelets), he received blood transfusions and IV TXA. Unfortunately, the bleeding still continued. And still — he continued bleeding heavily.

Blood Transfusions

Blood Transfusions Emergency Department Shock Hospitals

Chan – Shock DC5 Lecture Series

University of Maryland CC Project

SEPTEMBER 9, 2021

Chee Chan, a Pulmonary Critical Care physician and Medical Director of the Medical Intermediate Care Unit at MedStar Washington presents an interactive discussion on shock as part of the DC5 lecture series.

Shock

Shock Blood Transfusions Sepsis

Trauma Resuscitation Updates

RebelEM

MAY 25, 2023

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%

Resuscitation

Resuscitation Fluid Resuscitation Head Injuries Shock

Are we on the right TRACT?

Don't Forget the Bubbles

JANUARY 10, 2024

Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. However, there is a huge variation in transfusion practice globally.

Blood Transfusions

Blood Transfusions Outcomes Research Hospitals

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

Be careful if the patient has received a recent blood transfusion since it may be misinterpreted as sickle cell trait instead of sickle cell disease. In these cases, repeat the Hb electrophoresis three months after the last blood transfusion. Would you consider this patient for blood transfusion?

Blood Transfusions

Blood Transfusions Stroke Dehydration Sepsis

Neonatal Hypotension

Don't Forget the Bubbles

NOVEMBER 18, 2024

Perinatal Blood Loss: Significant blood loss during delivery, whether due to placental abruption, vasa previa, or traumatic delivery, can result in anaemia and subsequent hypotension. If anaemia is confirmed, a blood transfusion may be necessary to restore adequate circulatory volume and improve oxygen-carrying capacity.

Sepsis

Sepsis Shock Hyperthermia / Hypothermia Administration

Imported Malaria

Pediatric EM Morsels

NOVEMBER 3, 2023

This is otherwise known as Blackwater fever (Forgie 2022) Severe Malaria laboratory findings include acute kidney injury , hyperbilirubinemia , hemoglobinuria , severe anemia, hypoglycemia, lactic acidosis , and hyperparasitemia (Forgie 2022) Severe Malaria is almost entirely attributed to infection with P.

Seizures

Seizures Pediatrics CDC Infectious Diseases

Vasopressor Nonresponse

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis

Anaphylaxis Shock Sepsis Resuscitation

Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated.

Dr. Smith's ECG Blog

JULY 3, 2020

The patient was in shock on arrival in the ED — and multiple blood transfusions were needed. ANSWERS regarding ECG #1: Severe trauma requiring blood transfusions is a common emergency presentation. Blood and fluid volume was rapidly restored, and acidosis was probably quickly corrected.

Blood Transfusions

Blood Transfusions EKG/ECG Shock Fractures

Episode 21- Updates and Controversies in the Early Management of Sepsis and Septic Shock

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis

Sepsis Shock Fluid Resuscitation Hospitals

ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 2

PulmCCM

NOVEMBER 17, 2023

In the second thought experiment, let us consider a patient with significant blood volume loss that is replenished with a series of blood transfusions. Shippy CR, Appel PL, Shoemaker WC: Reliability of clinical monitoring to assess blood volume in critically ill patients. Am J Cardiol 1990, 66(4):493-496.

Operations

Operations Ultrasounds Resuscitation Blood Transfusions

Episode 16: “Blood”

PHEM Cast

FEBRUARY 23, 2017

Prehospital Blood Product Resuscitation for Trauma. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. Prehospital transfusion of plasma and red blood cells in trauma patients. Lots to think about! 2016 Jul;46(1):3–16.

Blood Transfusions

Blood Transfusions Head Injuries Resuscitation Radiology

TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

RebelEM

SEPTEMBER 26, 2022

Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: a randomized clinical trial. Significant coagulopathy: INR > 1.8 CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152(11):726-732.

Resuscitation

Resuscitation Blood Transfusions Outcomes Hospitals

SGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs

The Skeptics' Guide to EM

MARCH 10, 2018

TXA has been widely used in elective surgical cases and has shown decreased need for blood transfusion and reduction in mortality. shock, a bleeding visible vessel, renal disease, or lack of consent. TXA is a synthetic derivative of lysine that inhibits fibrinolysis and thus stabilizing clots that are formed.

Blood Transfusions

Blood Transfusions Emergency Department Shock Hospitals

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Triage vital signs include BP 127/81, HR 119, T 102.9

Pediatrics

Pediatrics Dehydration EMS Hospitals

A guide to major haemorrhage management in paediatrics

Don't Forget the Bubbles

OCTOBER 28, 2024

These definitions include blood loss of 40 mL/kg over 24 hours, transfusion of ≥50% of total blood volume in 3 hours, transfusion of 100% of total blood volume in 24 hours, and bleeding with clinical signs of hypovolaemic shock that is unlikely to be controlled. What is the ‘diamond of death’?

Blood Transfusions

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics

Journal Club - Tranexamic Acid in Trauma

Downeast Emergency Medicine

APRIL 26, 2021

When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. MI or stroke). DOES TXA IMPROVE OUTCOMES IN PATIENTS WITH TBI? Arch Surg 2012; 147:113-119.[

Head Injuries

Head Injuries Administration Outcomes Seizures

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 2021;52(10):2697-2701. doi:10.1016/j.injury.2020.01.042 2020.01.042 CRASH-2 trial collaborators, Shakur H, Roberts I, et al.

Fractures

Fractures Resuscitation Operations EMS

Episode 26 – Blunt Cardiac Injury: Emergency Department Diagnosis and Management (Trauma CME)

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. The latter also recommend ED thoracotomy in those with refractory shock.

Emergency Department

Emergency Department EKG/ECG Operations Fractures

Diagnostics: GI Bleeding

Taming the SRU

OCTOBER 25, 2023

Oakland Score Designed to be evaluated in the ED for patients presenting with LGIB to determine if outpatient management is feasible Factors included for assessment: Age, sex, previous LGIB admission, DRE findings, HR, SBP, Hb Score of 8 or less → 95% probability of safe discharge Safe discharge = absence of rebleeding, blood transfusion, therapeutic (..)

Blood Transfusions

Blood Transfusions Hospitals Stroke Anaphylaxis

emDOCs Podcast – Episode 96: Lower GI Bleeding

EMDocs

MARCH 6, 2024

shock index > 1, evidence of poor systemic perfusion). Red Blood Cell Transfusion: 2023 AABB International Guidelines. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: A systematic review and meta-analysis of randomised controlled trials. 2023 Nov 21;330(19):1892-1902.

Blood Transfusions

Blood Transfusions Outcomes Resuscitation Radiology

Grand Rounds Recap 5.3.23

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding

Documentation/Coding Seizures Psychiatric Wellness

Emergency Care Today

A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

MTP Activation Criteria For Pediatric Patients

Trending Sources

Trick of Trade: Dual Foley catheter to control massive epistaxis

Chan – Shock DC5 Lecture Series

Trauma Resuscitation Updates

Are we on the right TRACT?

Sickle Cell Disease Module

Neonatal Hypotension

Imported Malaria

Vasopressor Nonresponse

Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated.

Episode 21- Updates and Controversies in the Early Management of Sepsis and Septic Shock

ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 2

Episode 16: “Blood”

TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

SGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs

emDOCs Revamp – Acute Chest Syndrome

A guide to major haemorrhage management in paediatrics

Journal Club - Tranexamic Acid in Trauma

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

Episode 26 – Blunt Cardiac Injury: Emergency Department Diagnosis and Management (Trauma CME)

Diagnostics: GI Bleeding

emDOCs Podcast – Episode 96: Lower GI Bleeding

Grand Rounds Recap 5.3.23

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