The Trauma Pro

SEPTEMBER 20, 2023

Until the last few years, massive transfusion in trauma consisted of component therapy, an admixture of packed red cells, plasma, and platelets. Whole blood transfusion is making inroads again, but it is used in a minority of centers.

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Blood Transfusions Military Outcomes Administration 113

ALiEM

NOVEMBER 3, 2023

Highlighted Quality Posts: Trauma Site Article Author Date Label Rebel EM Trauma Resuscitation Update Salim Rezaie, MD May 25, 2023 AIR EM Docs Unstable Pelvic Trauma Patient Luke Wohlford, MD June 3, 2023 AIR EM Docs Maxillofacial Trauma Forrest Turner, MD October 17, 2022 AIR Rebel EM PATCH trauma trial Anand Swaminathan, MD June 19, 2023 HM Don’t (..)

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Blood Transfusions EMS Resuscitation Emergency Department 84

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.

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Blood Transfusions Operations Wellness 52

ALiEM

MAY 29, 2023

Because he presumably had uremia-induced thrombasthenia (weak platelets), he received blood transfusions and IV TXA. We thus removed the anterior packing and instead inserted a Foley catheter into the posterior nasal space and inflated the balloon. Unfortunately, the bleeding still continued.

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Blood Transfusions Emergency Department Shock Hospitals 98

Don't Forget the Bubbles

MAY 8, 2023

Most require no regular treatment, but some may require either occasional or regular blood transfusions. Regular transfusions may ease symptoms but carry the risk of iron overload, resulting in a need for chelation therapy and ongoing monitoring with serum ferritin and Ferriscan imaging.

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Blood Transfusions 52

ACEP Now

MAY 3, 2023

Management requires hospitalization for hydration, oxygenation, intravenous antibiotics, pain control, and blood transfusions and, in some cases, exchange transfusion. See the original question here.) Member Benefit: All ACEP members receive a 20 percent discount on VisualDX. Reference Winter MW, Ingerowski E, Prasad P.

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Blood Transfusions Hospitals 52

Emergency Medicine Journal

MAY 23, 2023

Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days. Methods A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Outcomes 40

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.

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Blood Transfusions Hospitals Outcomes Administration 120

Pediatric EM Morsels

NOVEMBER 3, 2023

It is characterized by a variety of symptoms from mild ataxia or tremor alone to severe encephalopathy accompanied with fever, seizures, aphasia, and sometimes psychiatric symptoms (Yadava 2019) Treatment with artesunate can lead to Post-Artesunate Delayed Hemolysis (PADH) (Forgie 2022) Typically seen 7-21 days after treatment 15% of those treated (..)

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Pediatrics Seizures Infectious Diseases CDC 284

American Medical Compliance

SEPTEMBER 10, 2023

” What you will learn: Definition of informed consent Issues of concern related to informed consent Informed consent and blood transfusions Informed consent in healthcare When informed consent is necessary How to obtain informed consent Details Course length: 30 minutes; CEU: 0.5

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Blood Transfusions Documentation/Coding Operations 52

EMergucate

MAY 17, 2016

Anaemia Anticoagulants Bleeding Disorders Blood Transfusion Reactions Blood Transfusions DIC Haemoglobinopathies Haemostasis & Coagulation Methaemoglobinaemia Neutropaenia Platelet Disorders Thrombophilia

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Blood Transfusions EMS 40

PulmCCM

NOVEMBER 6, 2023

Uncertainty has persisted about the ideal blood transfusion strategy to resuscitate and support trauma victims as they are prepared to undergo surgical and other mechanical interventions to achieve hemostasis.

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Resuscitation Blood Transfusions Infectious Diseases Emergency Department 98

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. This gives the appearance of causation, but it is an association. Again, to simplify this thought experiment, we assume that P pc , R vr and R cardiac are constant [Figure 1B].

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Ultrasounds Resuscitation Blood Transfusions Operations 132

Emergency Medicine Cases

JUNE 27, 2017

Dr. Lloyd reviews how to avoid needless blood transfusions, the indications for IV iron and how to actually administer IV iron, while Dr. Clarridge reviews a novel approach, causes, complications and management of hyponatremia in the ED.

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Blood Transfusions EMS 52

EMergucate

AUGUST 23, 2017

An 80 year old women with severe anaemia secondary to GI bleed Severe anaemia requiring urgent blood transfusion, correction of … Continue reading →

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Blood Transfusions Resuscitation EMS 40

RebelEM

MAY 25, 2023

The Role of Whole Blood Transfusions in Civilian Trauma: A Review of Literature in Military and Civilian Trauma. 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. Cureus 2022.

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

JUNE 19, 2023

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. Read More Core EM: CRASH-2: Tranexamic Acid in Major Trauma References: CRASH-2 Trial Collaborators. Lancet 2010; 376(9734): 23-32.

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Blood Transfusions Resuscitation Outcomes Hyperthermia / Hypothermia 104

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. Basic life support The BLS ambulances of Ambulance on Call are designed in such a way that it provides enhanced medical assistance to their clients during transportation.

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Ambulance Services Blood Transfusions Patient Safety EMS 52

EMDocs

AUGUST 22, 2023

Trauma Associated with severity of injury and need for blood transfusion ↓ EtCO 2 = ↑ likelihood of needing OR EtCO 2 < 25 mm Hg =↓ cardiac output, ↓ BP & ↑ mortality Fluid responsiveness 2 mmHg ↑ EtCO 2 with straight leg raise = patient will be fluid responsive DKA ↓ EtCO 2 levels = ↑likelihood of diagnosis.

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Resuscitation Blood Transfusions Sepsis Emergency Department 75

RebelEM

OCTOBER 19, 2022

Hayes 2013 ) Disposition: Admission to monitored setting if ongoing intravenous repletion (bradycardia and hypertension may occur) Consider giving prophylactic calcium supplementation in patients receiving massive transfusions. mg/dL or an ionized calcium level < 2.0 mEq/L Background Exists in two states Free ionized form (approx.

EKG/ECG 52

EKG/ECG Blood Transfusions EMS Burns 52

PulmCCM

MAY 8, 2023

Among 324 patients with trauma and life-threatening bleeding at 12 French hospitals who were randomized to receive 1ml/kg PCC or placebo, there was no reduction observed in 24-hour blood transfusion needs in the PCC group. PCC was associated with a significantly higher risk for thromboembolic complications (35% vs 24%).

Blood Transfusions 52

Blood Transfusions Stroke Anaphylaxis Hospitals 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

The citrate in blood products can also bind to calcium and cause a drop in calcium levels, so do anticipate this for any children requiring blood transfusion. Shock and sepsis itself can cause low calcium levels due to intracellular shifts and lactate-binding calcium.

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Shock Sepsis Fluid Resuscitation Resuscitation 124

Emergency Medicine Ireland

OCTOBER 17, 2022

An intensive care unit admission is bad for cancer as there is a sort of immunosupression that comes about with being critically ill, leading to depletion in things like natural killer cells who were rightfully killing off cancer cells till the pneumonia, steroids and blood transfusions came along.

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Blood Transfusions Sepsis 40

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.

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Resuscitation Blood Transfusions Hospitals Outcomes 52

Mind The Bleep

MAY 16, 2023

However, it can also transmit by vertical transmission in utero and by blood transfusion. Lacy-like/ reticulate rash. It is caused by human Parvovirus B19. It spreads mostly via respiratory secretions. The incubation period is around 14-21 days. A child usually presents with fever, malaise and myalgia.

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Blood Transfusions Sepsis 52

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?

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Blood Transfusions Stroke Sepsis Dehydration 112

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9%

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Resuscitation Fluid Resuscitation Blood Transfusions Stroke 40

PHEM Cast

FEBRUARY 23, 2017

.: Prehospital transfusion of plasma and red blood cells in trauma patients. Weaver AE, Eshelby S, Norton J, Lockey DJ: The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service. Prehosp Emerg Care 19(1):1–9, 2015. Scand J Trauma Resusc Emerg Med 21(Suppl1):S27, 2013.

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Blood Transfusions Resuscitation Head Injuries Radiology 52

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. TXA is a synthetic derivative of lysine that inhibits fibrinolysis and thus stabilizing clots that are formed. It made sense to look at it for the treatment of epistaxis.

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Blood Transfusions Emergency Department Hospitals Shock 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. And the authors remind us that this study shows association, not causation.

Blood Transfusions 147

Blood Transfusions Resuscitation Hospitals Wellness 147

RCEM Learning

NOVEMBER 28, 2022

If bleeding is suspected, give IV tranexemic acid 1g bolus followed by infusion if within 3 hours of injury and activate your local Major Haemorrhage Protocol for an unstable patient requiring blood transfusion Analgesia: IV morphine first line/ IN diamorphine or ketamine (4) Cross match blood along with organising other laboratory blood tests (VBG, (..)

Fractures 52

Fractures Sepsis Resuscitation Blood Transfusions 52

EMDocs

JULY 3, 2023

Blood Transfus. Curr Neurol Neurosci Reports. 2018;18(10):71.  2018;18(10):71. Zanon E, Pasca S. Intracranial haemorrhage in children and adults with haemophilia A and B: a literature review of the last 20 years. 2019 Sep;17(5):378-384. Dubosh NM, Bellolio MF, Rabinstein AA, et al.

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Seizures Stroke EMS Blood Transfusions 93

Dr. Smith's ECG Blog

AUGUST 14, 2023

At this point — I got to see a prior ECG on this patient ( = ECG #2 in Figure-1 ) — and learned about the patient's History ( ie, Sickle Cell Disease with frequent emergency visits for blood transfusions, heart failure, renal insufficiency and pulmonary hypertension from restrictive lung disease with chronic hypoxemic respiratory failure and a history (..)

EKG/ECG 52

EKG/ECG Blood Transfusions Wellness 52

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 (..)

Ultrasounds 52

Ultrasounds Resuscitation Pediatrics OB/GYN 52

Northwestern EM Blog

JANUARY 24, 2022

Those at higher risk of hypocalcemia (vitamin D deficiency, ESRD, hyperparathyroidism, burns, multiple blood transfusions, etc.) Hypocalcemia can be hinted at through history or by hints such as a prolonged QTc on an ECG. may have greater severity of shock with increased mortality.

Anaphylaxis 52

Anaphylaxis Sepsis Resuscitation Shock 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. Age at Onset: Typically presents around 2-3 weeks old but can present earlier or later than this.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

Sensible Medicine

NOVEMBER 18, 2023

Do I have to request my blood transfusion be screened for HIV? First, let’s assume the authors are correct: If health care providers wear surgical masks, that protects immunocompromised and disabled patients. If this is true, then why should patients have to request it? Do I have to request a surgeon use sterile instruments?

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Blood Transfusions Hospitals Wellness 133