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Are we on the right TRACT? 

Don't Forget the Bubbles

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.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Blood transfusion Reduces the overall proportion of HbS. Issues with pulse oximetry Pulse oximetry frequently underestimates the alveolar hypoxia that results in sickling and pulmonary infarction and overestimates the arterial blood oxygen saturation. Improves oxygen carrying capacity. Reduces progression to severe disease.

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Rethinking the Role of TXA: Are We Asking Too Much?

RebelEM

Our bodies have a finely tuned system that allows blood to flow freely and not clot too easily while also allowing the body to form clots when needed. This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. Lancet 2010; 376(9734): 23-32.

Outcomes 104
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emDOCs Revamp – Acute Chest Syndrome

EMDocs

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 C or 100.4 mg/kg, max 0.4

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emDOCs Podcast – Episode 102: Hypocalcemia in Trauma and the Diamond of Death

EMDocs

Previous triad of death = hypothermia, acidosis, and coagulopathy. Whole blood does contain less citrate. Liver dysfunction, secondary cirrhosis, critical illness, trauma, and hypothermia reduce citrate metabolism. Hypothermia also leads to hypoCa. Transfusion-Related Hypocalcemia After Trauma. 2011;39(1):46-54.

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Vasopressor Nonresponse

Northwestern EM Blog

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.

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Grand Rounds Recap 5.3.23

Taming the SRU

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