All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Health Advocate Case Description A patient is admitted to the internal medicine ward and after 5 days of clinical stability, she develops respiratory failure and is admitted to ICU. After 72 hours of mechanical ventilation her D-Dimer is increasing, and she develops worsening oxygenation. When should one suspect PE in COVID-19, and how to establish …
Blood & Clots Series: What is the role of convalescent plasma for treating COVID-19?
All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar, advocate Case Description A 45-year-old patient is diagnosed with COVID-19 and is receiving supportive care on the inpatient medicine ward. It is early in her clinical course and she continues to require supplemental oxygen via nasal prongs, but remains in stable condition with mild shortness of breath and intermittent fevers. One day while in …
Blood & Clots Series: Subsegmental PE – To Treat or Not To Treat?
All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar Main Messages Improved technology has led to an increase in the detection of subsegmental PE (SSPE) An algorithmic approach can help identify patients who will benefit from anticoagulation: generally those with concomitant DVTs and patients with additional risk factors for progression There is clinical equipoise regarding the decision to anticoagulate in this case, and …
Blood & Clots Series: When is it safe to perform neuraxial procedures in an anticoagulated patient?
All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Collaborator Case Description You are assessing a 55-year-old male patient in the emergency room who is presenting with headache, fever, and neck stiffness. He needs a lumbar puncture to rule out bacterial meningitis. However, he is on apixaban 5 mg twice daily for atrial fibrillation with a CHADS65 score of 1 point for hypertension. His …
Blood & Clots Series: How do I determine if my patient on a DOAC is still at increased risk of bleeding?
CanMEDS Roles addressed: Expert Main Messages At standard doses DOACs are safe and effective for most patients and lab monitoring is not required for routine use. If the time of the last dose is known, an estimate of current anticoagulation effect can be obtained by measuring the number of half-lives that have elapsed in those with normal renal function. If the last ingestion is unknown, an estimate of current anticoagulation effect can be …