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A Case of Entrapment - Field Amputation

Stuart Swadron, MD, FRCPC and Wally Bugg, MD
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19:33
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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03:34

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EMRAP 2019 04 April Written Summary 439 KB - PDF

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Nicholas L. -

There was discussion on blood products and patient's significant blood loss during the extraction. While carrying blood products would be difficult and obviously have associated obstacles. Has there been any consideration for TXA in your HERT kit?

Castrenze -

When discussing the fluid choice it was stated that lactated ringers was not given due to fear of causing hyperkalemia. Lactated ringers does include 4 mEq/L of potassium. One would think that giving a patient with hyperkalemia additional potassium would worsen the hyperkalemia however this is not correct. Even if the patient has hyperkalemia the concentration of potassium in lactated ringers would be lower than the patient's potassium concentration. Administering lactated ringers to a patient with hyperkalemia will bring the patient's potassium towards 4 mEq/L and decrease the potassium level. Additionally, lactated ringers may be a better choice when compared to normal saline. Normal saline causes a non-anion gap metabolic acidosis which shifts potassium out of cells thereby increasing the potassium level. This effect is not seen with lactated ringers.
Good Pulmcrit article explaining this: https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/

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EM:RAP 2019 April Full episode audio for MD edition 224:11 min - 312 MB - M4AEM:RAP 2019 April Spanish Edition Español 90:50 min - 125 MB - MP3EM:RAP 2019 April German Edition Deutsche 98:37 min - 135 MB - MP3EM:RAP 2019 April Canadian Edition Canadian 28:51 min - 40 MB - MP3EM:RAP 2019 April Aussie Edition Australian 25:30 min - 35 MB - MP3EM:RAP 2019 April Farsi Edition Farsi 98:02 min - 135 MB - MP3EM:RAP 2019 April French Edition Français 20:25 min - 28 MB - MP3EMRAP 2019 04 April Board Review Answers 131 KB - PDFEMRAP 2019 04 April Board Review Questions 590 KB - PDFEMRAP 2019 04 April Individual MP3 Files 262 MB - ZIPEMRAP 2019 04 April Individual Summaries 693 KB - ZIPEMRAP 2019 04 April (SPA Summary) 712 KB - PDFEMRAP 2019 04 April Written Summary 439 KB - PDF

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6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)

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