Emergency Medicine Cases
EM Quick Hits 54 Button Battery Ingestion, C. difficile, ECG in Tox, Bed Bugs, Fibrinogen in Trauma, Cold Air for Croup
Jan 23, 2024
Dr. Olivia Austro discusses the danger of button battery ingestion in children. The podcast also covers C. difficile infection, ECG interpretation in toxicology, treatment for bed bug bites, fibrinogen replacement in trauma patients, and the use of cold air for croup.
57:52
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Quick takeaways
- Early and empirical high-dose cryoprecipitate does not improve mortality in trauma patients, emphasizing the need to wait for fibrinogen levels before administering fibrinogen concentrate.
- Button battery ingestion requires immediate medical attention and close monitoring for delayed complications, with interventions like honey or celecoxib potentially providing benefits within 12 hours.
Deep dives
Fibrinogen Replacement in Trauma Patients: Lessons from the Cryostat-2 Trial
The Cryostat-2 trial studied the administration of cryoprecipitate for trauma patients and found that early and empirical high-dose cryoprecipitate did not improve all-cause 28-day mortality. The trial emphasizes the importance of waiting for fibrinogen levels before administering fibrinogen concentrate, and it reinforces the practice of not giving fibrinogen concentrate empirically. Clinicians should also be aware of the limitations of surrogate outcomes and the potential for unblinded trials to introduce bias in their interpretation of trial results.
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