Stop the bleeding!

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:

coagulation cascade.png

Bleeding AV Access

Bleeding AV Access

Background

  • 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

Oncologic Emergencies

Okay, so cancer is a broad, difficult topic that I will never be able to cover in one blog post. But we just had a very informative lecture by our very own, behind enemy lines, EM/IM master: the He-Gore. So I’ll touch on a few of the possible cancer related emergencies that he helpfully walked us through.