How and When to Work Up Bleeding Disorder in Suspected Abuse
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Not all pediatric bruising needs workup for a bleeding disorder. This report details not only how but when to do it.
Hematology/Oncology
How to Treat Cancer-Associated Hypercalcemia
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Cancer-associated hypercalcemia requires prompt recognition and treatment in the ED, starting with aggressive rehydration +/- loop diuretics as well as coordination of initiation of bone resorption inhibition, which can take up to 48 or longer hours to have a full effect.
Source
Cancer-Associated Hypercalemia. N Engl J Med 2022; 386: 1443-51. DOI 10.1056/NEJMcp2113128.
TBI + DOACs = Delayed Head CT?
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Delayed intracranial hemorrhage for patients on direct oral anticoagulant therapy with minor traumatic brain injury is rare (~1.5%) after a negative initial head CT.
Febrile Neutropenia – Procalcitonin vs MASCC Score
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In patients that develop febrile neutropenia, procalcitonin levels were better at identifying those at a higher risk for 30-day mortality and bacteremia than the commonly used MASCC score.
How to Manage Postpartum Hemorrhage
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Postpartum hemorrhage is defined as ≥1000mL of blood loss irrespective of the delivery route, with associated shock. Remember the four “T’s”: tone (uterine atony), trauma (lacerations, uterine rupture), tissue (retained placenta, clots) and thrombin (coagulopathies). Manage the ABCs (especially two large bore IV’s for massive transfusion) and tailor treatment to the specific cause. Recommendations for balanced transfusion are derived from the trauma literature, but it is important to administer cryoprecipitate earlier to maintain a higher fibrinogen level (at term the normal level is >350mg/dL).
Is Thoracentesis Safe in Coagulopathic Patients?
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There is a very low, perhaps 0% bleeding and mortality risk, in performing thoracentesis or tube thoracostomy on patients taking antiplatelet or anticoagulant agents or those with thrombocytopenia or coagulopathy from a disease process, like cirrhosis.
CT and Cancer Risk
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CT abdomen and pelvis is associated with a higher incidence of hematologic malignancies over a two year span, especially in younger patients.
REALITY RCT – PRBC Transfusion in Acute MI
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A restrictive vs liberal transfusion strategy in patients with acute MI was non-inferior when considering 30-day MACE.
VTE Week | PEPCOV – COVID-19 and PE Risk in Emergency Patients
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For ED patients, the probability of PE was the same in COVID-positive and COVID-negative patients. This does not apply to other hospitalized COVID-19 patient populations.
New Leukemia Presenting as Facial Palsy In Children
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Facial nerve palsy in children may very rarely be caused by leukemia. If starting steroids, consider a CBC first.