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Performing non-neuraxial bedside procedures on patients taking anticoagulants

In Blood & Clots, Medical Concepts by Calvin YehLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addresse: Medical expert Case Description You are assessing a patient in the emergency room who is presenting with a unilateral large pleural effusion that is causing hypoxia and shortness of breath. She needs a thoracentesis but her INR is 3.0 due to the Warfarin she takes for atrial fibrillation. How can this procedure be performed safely? What about …

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Anticoagulation for patients with moderate to severe renal dysfunction

In Blood & Clots, Medical Concepts by Menaka PaiLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, Manager Case Description You are called to assess an active and energetic 79 year old man who has come to the ER complaining of palpitations for three months. You do an EKG which shows atrial fibrillation. The patient has a history of gout, hemorrhoids, hypertension, and diabetes. His only medications are a thiazide diuretic and …

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Blood & Clots Series: How do you choose an anticoagulant for stroke prevention in atrial fibrillation?

In Blood & Clots, Medical Concepts by Kerstin de WitLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, health advocate, communicator Case Description A 52 year old lady attends the emergency department with a several week history of palpitations. She is found to have atrial fibrillation. You have started a beta blocker and she is in a stable condition for discharge. You evaluate the need for stroke prevention and discuss the options with her. …

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Blood & Clots Series: How do I manage acute VTE in pregnancy?

In Blood & Clots, Medical Concepts by Eric Tseng1 Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Collaborator Case Description You’re an EM resident seconded off-service on your internal medicine rotation,  and it’s your night on call. The emergency physician asks you to see a pregnant patient with acute pulmonary embolism. Your patient is a 32 year old G3P2 female at 33 weeks gestational age. Her previous pregnancies were uneventful spontaneous vaginal …

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Blood & Clots Series: ThromboPhonia E01, Mechanical Valves and Intracranial Hemorrhage

In Blood & Clots, Medical Concepts by Sameer SharifLeave a Comment

Blood & Clots Podcast, Thrombophonia: Episode 1 A 65-year-old man presents to the Emergency Department after suffering from an intracerebral hemorrhage (ICH). He has a past medical history of hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. How should this patient be managed? What should be done with his anticoagulation? Listen to the podcast below and read the blog post below! Objectives …

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Blood and Clots Series: Diagnosing pulmonary embolism in pregnancy

In Blood & Clots, Medical Concepts by Eric Tseng3 Comments

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description  A pregnant 32 year old female presents to the ER with chest pain. She is 33 weeks gestational age, and this is her third pregnancy (two prior uneventful deliveries). Her pain started 3 hours ago while she was watching television. It is sharp, worse with inspiration, and located along the right costal margin. …