pediatric blood transfusion

So you’re in peds and your patient is anemic. You need to transfuse, but you are confused. How much blood do you give? How fast do you give it? How much: The volume of blood to be transfused may vary depending on the clinical scenario…

Overshot that INR

There have been a few cases of supra-therapeutic INR in the Sinai ED recently, and at the request of one of our superstar interns, below you will find a brief set of recommendations regarding Supratherapeutic INR. The following bolded recom…

Tumor Lysis Syndrome

A young lad with acute lymphocytic leukemia (ALL) shows up to your ED feeling very weak and c/o sever muscle cramps. On further questioning he reveals that he started chemotherapy 3 days ago. Labs show potassium of 6.5 mEq/L, calcium of 6.3…

Six of One, Half Dozen of the Other?

Your patient is a 50 year old male who presents with head trauma.  He takes aspirin daily.  Neuroimaging demonstrates subdural and subarachnoid hemorrhage.  You plan to treat with DDAVP and platelet transfusion.    When ordering the platele…

Pittfalls in Dvt Management

You’re on your last patient of the day, starting to thinking about which type of sushi you’re going to order later, when the ultrasound comes back. Positive study, you were sure of it, after all, the patient had a hx of cancer a…

Ddavp for Hemorrhage in Esrd Patients

CASE: 45F h/o ESRD on dialysis presents ped struck. Pt is obtunded, intubated for airway protection. CT head shows subdural hematoma with midline shift. Neurosurgery is activated. No antiplatelets or anticoagulants. Is this person coagulopa…

Head Injury in Hemophilia

An 8 year old female is brought in by her mother after falling off her scooter one hour ago. She was not wearing a helmet, and hit her head on the ground. Patient and mother deny LOC. On exam, she is well-appearing, playing with her mother…

Heme Questions

Here are some Heme questions for your holiday weekend. Enjoy! 1. A 9-year-old female with mild type I von Willebrand’s disease presents with mild gingival bleeding after her first overly vigorous attempt to use dental floss. She stopp…

Pearl for 12/21

A 25 yo male with no PMH walks into your ED complaining of right neck pain, right shoulder stiffness,  and cough x 1 month, no fevers chills. On exam his vitals are all within normal limits, exam is notable for right sided swelling and asym…

Clinical Pearl

26 M pmh sickle cell disease p/w chest pain, sob, fever, and cough. She is noted to be hypoxic, anemic and has new pulmonary infiltrates on cxr. What diagnosis must be considered?   A: Acute chest syndrome “Acute chest syndrome i…

Daily Em Pearl 4/15/12

A pleasant 64yoM w/NIDDM and afib (on coumadin) p/w an abscess to R-medial thigh. He is afeb but there is some surrounding erythema at the abscess site. You perform a thorough incision and drainage and instruct him to return in 2days for wo…

Daily EM Pearl 4/5

A 60yoM h/o A-Fib on Dabigatran, took his medication this morning and then slipped in the shower 10 mins later, hitting his head with +LOC. He did not want to come to the emergency room at first but approximately 14 hours later, complains o…

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