Blood & Clots Series: What are the risks of reversing anticoagulation?

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All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, Communicator Case Description You are working a shift in your local emergency department and an 89-year-old female is brought in with a 2-day history of melena stool.  The patient has a history of atrial fibrillation and uncontrolled hypertension despite being on an ACE-inhibitor. Her initial bloodwork shows a hemoglobin of 102 g/L (no baseline provided), …

Blood & Clots Series: When and how should I reverse anticoagulation with warfarin?

In Blood & Clots, Medical Concepts by Andrew ShihLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description You are in the emergency department seeing an 89-year-old female presenting with five episodes of coffee ground emesis over the last twenty-four hours. She has atrial fibrillation and is on long-term warfarin for stroke prevention. She also has CAD and had two drug eluting stents placed 4 years ago but is no longer …

Blood and Clots Series: What are the complications of transfusion? What symptoms/signs should I worry about?

In Blood & Clots, Medical Concepts by Andrew Shih1 Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Communicator, Leader Case Description You are a resident physician rotating through the ICU. You’ve been taking care of a 32-year-old woman who sustained injuries in a high-speed motor vehicle collision two days ago. She is now stable and extubated in the ICU. Her hemoglobin has been stable in the 80s since arriving in the ICU …

Blood and Clots Series: Massive transfusion protocol: what is it, why does it exist, and when should I call one?

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All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description  A 32-year old woman presents to the ED following a motor vehicle collision with lateral impact (T-bone collision) and is brought into the trauma bay. Significant bleeding was reported on scene and the patient arrives looking diaphoretic, pale, and unwell. Vitals in the trauma bay are BP 104/64 mmHg, HR 128, RR 22 …

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Blood and Clots Series: Does my complex patient have DIC?

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All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert Case Description You are seeing a 56M in your critical care suite who has just arrived as a transfer from a peripheral hospital.  The patient has had a recent diagnosis of acute leukemia and was given chemotherapy and a recent stem cell transplant 20 days ago at this hospital.  When he started getting sicker, they requested …

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Blood and Clots Series: What are the risks of reversing DOAC-associated intracranial bleeding?

In Blood & Clots, Medical Concepts by Andrew Shih1 Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description You are seeing a 54F in the emergency department after she sustained a mechanical fall. She struck her head on the pavement and is now confused. Her comorbidities include: hypertension, diabetes mellitus, and atrial fibrillation.  She has been taking rivaroxaban 20 mg daily for three years without incident. Her complete blood count (CBC) …