lumbar paraspinous hematoma after RFA
50's cardiac history on warfarin.
had two successful mbb, and then lumbar RFA 2 weeks ago.
post procedure meeting - 2 weeks - complained of severe pain in right low back with hip flexion weakness, i got stat MRI
this is what the MRI shows
3cm hematoma in the paraspinous muscles. no impingement in neuroforamen/no hematoma in epidural space. of note, he does have a known 5cm AAA. i think the hematoma is causing the pain - any thoughts? how would you proceed? drain it? leave it...
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Source: Student Doctor Network - August 9, 2022 Category: Universities & Medical Training Authors: TIVAndy Tags: Pain Medicine Source Type: forums
Med Mal: Kidney biopsy -- > Hemorrhagic Shock -- > Pressors -- > 9 fingers amputated
Case here: Hemorrhagic Shock from Biopsy
Lady with antiphospholipid syndrome (also history of PE and DVT) comes to ED with SOB.
No PE/DVT, admitted.
Presumptive diagnosis of lupus nephritis made, biopsy recommended.
Warfarin held, switched to heparin before procedure, then Lovenox afterward (plan to monitor with anti Xa levels).
Anti Xa levels never come back.
Patient develops hemorrhagic shock, started on pressors, fingers ischemic. 9 digits amputated (right thumb lives to fight...
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Source: Student Doctor Network - November 2, 2021 Category: Universities & Medical Training Authors: bbc586 Tags: Internal Medicine and IM Subspecialties Source Type: forums
Can we finally ditch Coumadin?
ACP Journals
Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation
So we can use DOACs now for valvular Afib (See study above), we've been using DOACs for other VTEs, and recently shown to be safe in even cancer-related VTEs. Is there any reason (maybe poor renal function) to continue using warfarin? (Source: Student Doctor Network)
Source: Student Doctor Network - October 23, 2021 Category: Universities & Medical Training Authors: DrMetal Tags: Internal Medicine and IM Subspecialties Source Type: forums
Dangerous QV2 change 2021
Technicians will be bagging prescriptions next year as part of workflow. Not sure if some other companies already practice this policy. While I am aware the risk for errors is low, I think it is a fair concern since I'm guessing liability falls back to the pharmacist.
Thoughts? How do we protect ourselves? This is just an error waiting to happen like bagging Warfarin to the wrong person (Source: Student Doctor Network)
Source: Student Doctor Network - March 5, 2021 Category: Universities & Medical Training Authors: GP7777 Tags: Pharmacy Source Type: forums
Re: Warfarin in patients with mechanical heart valves
(Source: BMJ Comments)
Source: BMJ Comments - October 30, 2020 Category: General Medicine Source Type: forums
Minimum duration 15 mg iso bupiv with epi
Oral board type case: Knee removal of antibiotic spacer, placement of new implant. Obese, COPD/asthma, MH susceptible, on Coumadin (held) INR 1.2.
Prefer to do spinal MAC, AWARE I COULD do CSE but seems like a pain in her and INR 1.2.
So... a big boy dose of iso bupiv 12-15 mg with epi and narcotic should be VERY likely to last 4 hours, yes? (Haven’t used tetracaine in 20 years) (Source: Student Doctor Network)
Source: Student Doctor Network - May 14, 2020 Category: Universities & Medical Training Authors: caligas Tags: Anesthesiology Source Type: forums
Spontaneous retroperitoneal hemorrhage
If patient develops spontaneous retroperitoneal bleed from coumadin ( no injury or fall or anything) assuming Hgb and vitals are stable and remain stable for a few days. Any point in getting a repeat CT to monitor??? (Source: Student Doctor Network)
Source: Student Doctor Network - March 5, 2020 Category: Universities & Medical Training Authors: Cadet133 Tags: Internal Medicine and IM Subspecialties Source Type: forums
New hazardeous drug reqs @walg
Anyone know what happened that we now have 15 page document full of new reqs with multiple pages of new hazardeous drugs? Cant even use drivethru tube for pages and pages of new drugs such as warfarin? My word. Head hurts just thinking about this. (Source: Student Doctor Network)
Source: Student Doctor Network - November 5, 2019 Category: Universities & Medical Training Authors: Charcoales Tags: Pharmacy Source Type: forums
Back to the future? Re: Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting
(Source: BMJ Comments)
Source: BMJ Comments - July 12, 2018 Category: General Medicine Source Type: forums
What is the working life as a speciality trainee? (hours etc)
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What is the working life as a speciality trainee? (hours etc)
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Source: The Student Room - May 9, 2018 Category: Universities & Medical Training Authors: junior.doctor Tags: Medicine Source Type: forums
Bridging
Please settle this debate...
pt was an apixiban prior to admission for Afib.
Pt admitted for chest pain, no planned procedures .
MD wants to switch to Coumadin and patient’s INR =1.1.
Consult was for Afib with goal of 2-3.
No prior stroke/dvt/pe hx.
Do you bridge or not?
Sent from my iPhone using SDN mobile (Source: Student Doctor Network)
Source: Student Doctor Network - May 6, 2018 Category: Universities & Medical Training Authors: Stella14 Source Type: forums
Stopping anticoagulants, a cautionary tale
One of my favorite patients, a 93 y.o. man with a H/O Afib, had his Coumadin stopped for a Mohs procedure. It was D/C until the sutures came out. Well, he had a large stroke and is now wheelchair bound in an assisted living facility. I treat his family members and his daughter bitterly told me the story yesterday.
I will miss seeing Frank but his daughter did tell me that since he is not weight bearing he is not having pain. I never had to stop his anticoagulants for RFA or joint...
Stopping anticoagulants, a cautionary tale (Source: Student Doctor Network)
Source: Student Doctor Network - May 4, 2018 Category: Universities & Medical Training Authors: pastafan Source Type: forums
Physician Assistant is better than Rph
I already posted that a PA makes more money in Southern Cal. But now I am looking at admissions. I looked at the Western University prospective students for both. The results are below. I can see why being a PA is better. Two years school vs 4. Your job is clinical and not pill pushing. PAs and nurses are taking over blood pressure, cholesterol, and diabetes clinics. Coumadin clinics have lost 70 percent of their volume due to direct thrombin inhibitors. Based on the data below, PA...
Physician Assistant is better than Rph (Source: Student Doctor Network)
Source: Student Doctor Network - November 17, 2017 Category: Universities & Medical Training Authors: MrBonita Source Type: forums
Net clinical benefit of dabigatran vs. warfarin: Nothing. Zero.
(Source: BMJ Comments)
Source: BMJ Comments - November 15, 2017 Category: General Medicine Source Type: forums
switching from DOACs to warfarin
Hi, I was wondering when you switch from DOACs (like xarelto,eliquis) to warfarin, why do you have to bridge with LMWH? isn't keeping the patient on both for a few days until warfarin become therapeutic is enough? Or is it too dangerous to be on both, even for a few days? Please help me clarify. Many thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - November 3, 2017 Category: Universities & Medical Training Authors: qtern Source Type: forums
