This blog post covers identifying the need for MTP, MTP protocol, goals of therapy, evidence behind MTP, adjuncts to MTP, and newer testing for coagulopathy. There is also a review of blood transfusion reactions.
As emergency physicians, we know how to handle bleeding. But what about when the patient is on anticoagulants? Last week our ED pharmacist, Gary Peksa, PharmD, gave us some advice on how to stop the bleeding in a patient on anticoagulants. Here is a brief overview on what he taught us. Let’s start by discussing all the intricacies of the coagulation cascade and how each of the anticoagulants work:
Last week we had the opportunity to learn about posterior circulation ischemic strokes from vascular neurologist, Dr. Osteraas.
Diagnosing posterior circulation ischemic strokes can be challenging in the emergency department, largely because posterior circulation ischemic strokes frequently lack “traditional” stroke signs and symptoms and the symptoms that you do see are often non-specific and can be slow onset. Despite this, it is important to do our best to diagnose these as about 20% of ischemic events involve the posterior circulation and posterior circulation ischemic strokes can lead to some of the most devastating neurologic outcomes, including massive cerebellar infarcts with subsequent herniation and locked in syndrome.
Here’s some how to’s when it comes to burns. First off- do your ABCs. Get your history from the patient, from family, from EMS. You need to figure out the mechanism of this burn. Was this an explosion? You may need to worry about associated injuries. Was this inside? You may need to worry about toxic gases.
Bleeding AV Access
Most often occurs at dialysis center after fistula site is accessed
- Presents as punctate bleed overlying fistula. Can be slow oozing bleed from uremia or high-pressure bleed similar to arterial bleed
- Slow oozing bleed is less common in ED as hemostasis is often achieved at dialysis center
5-Minute Journal Article (PECARN Head CT Rule)
Dr. Brian Yu did a great 5-minute summary on the PECARN head CT Rule that was published in 2009. It’s an ambitious study that involved 25 emergency departments and included 42,412 patients under the age of 18 years who presented with blunt head trauma. It further risk stratified these patients into 2 major cohorts of <2 years of age and 2-18 years of age. It excluded patients with trivial injury, penetrating trauma, neurologic history, and those with prior imaging. The outcomes this study aimed for were clinically important findings including death, need for neurosurgical intervention, intubation >24 hours, and admission >2 nights.
Here’s a summary of the more common forearm fractures and what to do about them.
Dr. Somy Thottathil did an awesome lecture on bioterrorism this past week. And although it is hopefully something we never have to see, as one of the major hospitals designated as a bioterrorism site in Chicago, it is something that we should be prepared to recognize and treat. It’s also good review for all the med school knowledge we haven’t needed (thankfully) for some time now. The main topics we’ll focus on are the Category A agents: Botulism, Plague, Anthrax, Smallpox, and Viral Hemorrhagic Fevers (which includes Ebola, Marburg, Lassa Fever, and Crimean-Congo Hemorrhagic Fever). We are only going to discuss Ebola as current outbreaks are still occurring.
Heres the no frills details behind ITP and TTP. Your board scores can thank me later.