Sensible Medicine

SEPTEMBER 20, 2024

Given the fact that there seemed to be both neuropathic pain as well as some mental health symptoms, I thought I had a bright idea. It may not feel as satisfying as diagnosing an upper GI bleed and seeing the patient feel better after a blood transfusion, but it’s just as vital a part of our job.

Blood Transfusions 109

Blood Transfusions Wellness 109

EMDocs

DECEMBER 6, 2024

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.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

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 78

Blood Transfusions Research Outcomes Hospitals 78

PEMBlog

APRIL 24, 2024

Retrospective use has been shown to be valid and reliable in one cross-sectional study ( Beslow 2012 ).This Early consultation with a pediatric hematologist and neurologist is mandatory. References / Key Articles Ichord RN, Bastian R, Abraham L, et al.

Stroke 59

Stroke Pediatrics Blood Transfusions Radiology 59

EMDocs

JUNE 22, 2024

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.

EMS 110

EMS Resuscitation Blood Transfusions Seizures 110

RebelEM

OCTOBER 30, 2023

This would normally make me worry about dilution of results and biasing the results to the null hypothesis, but in the per protocol analysis (170 patients excluded from the full cohort, due to no longer requiring blood transfusion, dying within 90 minutes of arrival or being randomized in error) didn’t seem to affect this result either.

Administration 125

Administration Blood Transfusions Outcomes Hospitals 125

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. The Role of Whole Blood Transfusions in Civilian Trauma: A Review of Literature in Military and Civilian Trauma. NEJM 1994. [2] Cureus 2022.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

JUNE 19, 2023

Demographics were well balanced in the two groups. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Randomization and blinding were appropriately conducted. Lancet 2010; 376(9734): 23-32.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. The amount of blood that comes from the heart with each contraction is the stroke volume (SV).

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. Convalescent plasma, it was concluded, didn’t help patients with severe Covid-19 as a general group. Only it turns out, it did help.

Blood Transfusions 98

Blood Transfusions Operations Infectious Diseases Resuscitation 98

EMDocs

AUGUST 22, 2023

In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause. Other organ system involvement & hypotension/low perfusion affect EtCO 2.

Emergency Department 87

Emergency Department Blood Transfusions Resuscitation Sepsis 87

Intensive Blog

AUGUST 17, 2023

What is an appropriate “trigger threshold” for blood transfusion in ECMO patients? Blood transfusion is common in ECMO patients, as evidenced by almost 90% of all patients receiving at least one packed red blood cell transfusion during VV-ECMO support (Kalbhenn and Zieger, 2022). 2020.08.068.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

Emergency Medicine Journal

MAY 23, 2023

A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data. Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Wellness 40

Dr. Smith's ECG Blog

JULY 3, 2020

She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. 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 Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

Ziqitza HealthCare Ltd

JULY 23, 2023

It provides sufficient oxygen, blood transfusions and other medication that helps the patient to be in a stabilized condition till reaching the hospital. Life-saver – These ventilator ambulances are well equipped with all necessary life-saving equipment such as defibrillators and ventilators. Such services can save lives.

Ambulance Services 52

Ambulance Services Basic Life Support Blood Transfusions Patient Safety 52

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

The Skeptics' Guide to EM

MARCH 10, 2018

She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. TXA has been widely used in elective surgical cases and has shown decreased need for blood transfusion and reduction in mortality. It made sense to look at it for the treatment of epistaxis.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

RebelEM

SEPTEMBER 26, 2022

Randomized study design Blind adjudication of transfusion reaction outcomes Follow-up was complete. Patients from both groups are well balanced regarding results from a wide range of coagulation studies. Significant coagulopathy: INR > 1.8 Investigators performed an Intention-to-treat analysis. Ann Intern Med. Transplant Proc.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. To reverse these effects as well as refractory hypotension, hydrocortisone is the preferred agent due to both its glucocorticoid and mineralocorticoid properties.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

OMI recognition cannot be learned well by reading text, but our best "sentence" or "criteria" for helping learners see posterior OMI is: In the context of acute symptoms suspicious for ACS, ST depression maximal in V1-V4 (without an abnormal QRS cause) is specific for posterior OMI until proven otherwise. The RVH is not new.

EKG/ECG 52

EKG/ECG Blood Transfusions Wellness 52

Taming the SRU

SEPTEMBER 16, 2024

In the era of modern medicine, blood transfusions are commonplace, especially in the emergency department. Transfusion reactions are a spectrum of adverse events that can occur with the transfusion of whole blood or any of its components. One of the major risk factors is receiving a blood transfusion in the past.

Blood Transfusions 90

Blood Transfusions Anaphylaxis Emergency Department Sepsis 90

Downeast Emergency Medicine

APRIL 26, 2021

The primary outcome was 30-day mortality with secondary outcomes of 1-year functional neurological outcome based on GCS as well as hospital length of stay. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomized, placebo-controlled trial.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Mind The Bleep

JULY 23, 2023

Increased risk in growth restricted infants, premature babies, maternal drug abuse, formula fed babies, infants receiving blood transfusions. Diagnostic Findings: High CRP, high white cell count with neutrophilia, hypoglycaemia, thrombocytopaenia, metabolic or mixed acidosis, raised lactate, positive blood culture or CSF culture.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. But don’t be reassured by normal vitals, especially in the young, who may be compensating well despite being quite ill. Nachi: Definitely. Let’s move on to treatment.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

MAY 30, 2023

Methods include hydration, emergency plasmapheresis if indicated, and treatment of the underlying pathology, usually with chemotherapy Severe Iron Deficiency Anemia often related to poor nutrition in the pediatric population complication is high output cardiac failure feared and rare complication of chronic anemia is high output heart failure, the (..)

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

EB Medicine

OCTOBER 1, 2018

Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? If it’s possible to establish an IV and initiate fluids without delaying transport, EMS should do that as well. Meaning, you’ve tried everything else, so you might as well try. Nachi : And of course, oxygen for the hypoxic patients!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

The Trauma Pro

SEPTEMBER 18, 2023

Severe injury and blood transfusion are already known to be associated with a higher likelihood of VTE. The fact that the longer door-to-prophylaxis group had more frequent VTE may very well be due to their higher ISS and greater number of transfusions.

Blood Transfusions 113

Blood Transfusions Resuscitation Hospitals Wellness 113

Don't Forget the Bubbles

JUNE 7, 2023

Take a dietary history , and ask specifically about breast and cow’s milk intake, as well as iron intake. co-trimoxazole, sulphonamides) as well as symptoms of haemolysis (i.e. Blood transfusions should only be considered for patients who are actively bleeding or haemodynamically unstable.

Blood Transfusions 141

Blood Transfusions Wellness 141

RebelEM

FEBRUARY 1, 2024

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 mg/kg followed by 0.81

Stroke 132

Stroke Blood Transfusions Outcomes EMS 132

PulmCCM

JANUARY 8, 2024

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.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

Taming the SRU

OCTOBER 25, 2023

It should be made based on a balance between risk of thromboembolic events vs recurrent bleeding (risk-benefit), as well as cost-benefit. 100U (30-60 min prior), 0.25-0.375/100U

Blood Transfusions 98

Blood Transfusions Hospitals Stroke Anaphylaxis 98

EMDocs

JULY 3, 2023

All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. 27 Prudent transfer of patients to a center with neurosurgical capabilities should be considered in any SAH, though this is not well studied.

Seizures 98

Seizures Stroke Outcomes EMS 98

EMDocs

JUNE 3, 2023

23 Pelvic binding remains a critical resuscitation step well within the purview of the ED physician, and can be reviewed here: [link]. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

Fractures 60

Fractures Resuscitation Operations EMS 60

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. His immunizations are current and has received all pneumococcal vaccinations.

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

RebelEM

FEBRUARY 22, 2024

in liberal) received a blood transfusion (2.3 as well as their primary outcome confidence interval certainly limits the overall confidence in the trial results. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Circulation. 2012;126(16):2020-2035. Type 1: 41.7

Blood Transfusions 58

Blood Transfusions Outcomes Wellness Research 58

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. 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.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

RCEM Learning

NOVEMBER 28, 2022

It is important to closely monitor the patient’s haemodynamic status and repeat the pelvic x-ray post binder removal because a well-applied pelvic binder can mask fracture. See example below of pelvic x-ray with and without binder. 25 Image via Everyday E(B)M Sometimes even the CT will appear normal with the pelvic binder on.

Fractures 40

Fractures Blood Transfusions Sepsis Operations 40