EM Hema 5: Pearls Flashcards
most common sites of internal bleeding
intracranial?
when circulating levels decrease to below 10,000 to 20,000/mm3, the risk of spontaneous bleeding becomes concerning, particularly for intracranial hemorrhage (1469)
remarks on treatment of VTE
LMW heparin for at least 6 months is recommended in the treatment of VTE in patients with active cancer
Dalteparin
100 IU/kg SC every 12 h or
200 IU/kg SC every day
Enoxaparin
1 mg/kg SC every 12 h, or
1.5 mg/kg SC every day
treatment of elevated INR and presence of life-threatening or serious bleeding
high-risk bleeding:
-75 years of age
-concurrent antiplatelet drug use
-polypharmacy
-liver or renal disease
-alcoholism
-recent surgery or trauma
administer Vitamin K1 5-10 mg SIVP
For INR >6, give 4-factor PCC 50 units/kg (max 5000 units)
for INR 4-6, give 4-factor PCC 35 units/kg (max 3500 units)
for INR <4, 25 units/kg (max 2500 units)
alternatively, may use 3-factor PCC 50 units/kg IV, FFP 10-15mL/kg IV infusion, or rFVIIa 80 mcg/kg SIVP
additional doses of PCC, FFP, or rFVIIa may be required depending on degree of coagulopathy
define massive transfusion
- replacement of 1 blood volume (approx 10 units prbc within a 24-hour period)
- replacement of 50% of blood volume within 3 hours
- ongoing transfusion during a period of rapi bleeding, such a >150 mL/min
Treatment of malignant hypercalcemia
PNSS IV infusion + zolendronate
+ furosemide if with concurrent heart failure or kidney insufficiency
remarks on pRBC transfusion in children
In children, 10-15mL/kg of PRBC will raise the hematocrit by 6-9% and the hemoglobin levels by approximately 2-3 g/dL (20-30g/L)
most common hereditary hemolytic anemia among people of northern European descent
Hereditary sphrocytosis
-most commonly due to mutations in genes for spectrin and ankyrin
-not pliable enough to pass through the spleen
remarks on reticulocytes
as a result of tissue hypoxia or blood loss, reticulocytes appear in the blood within 3-7 days
