ICD question/Case tomorrow
Have a 73 y/o lady who’s coming tomorrow for completely elective ORIF hip. She is 95kg, a fib, EF<20% on echo 2 years ago, no significant structural disease besides severely reduced LVEF and a well functioning MVR. Last cath 2 years ago showed 60% left circ disease. She has a BIV ICD and is pacemaker depedent (100% paced). Cleared by cards (of course).
Anterior replacement, supine. Appears to be on lovenox bridge per chart.
You guys getting a rep to come and disable the device? I’m not...
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Source: Student Doctor Network - March 28, 2022 Category: Universities & Medical Training Authors: DrOwnage Tags: Anesthesiology 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
OB case
Saw this last week, curious how y'all would have approached.
26F h/o meth and etoh abuse showed up to maternity clinic at 36w pregnant with dyspnea no prenatal care prior. Had TTE done in clinic showing EF 30% and was instructed to admit for further workup but declined. A week later showed up by EMS with hemoptysis, given therapeutic lovenox in ER (no idea why), CTA showed pulmonary edema, admitted to ICU for SROM and active labor 4cm dilated station 0, contractions every 3-4 minutes...
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Source: Student Doctor Network - April 25, 2021 Category: Universities & Medical Training Authors: chessknt Tags: Anesthesiology Source Type: forums
Subq heparin or lovenox before induction of GA
Often times subcutaneous injections are performed by the preop RN before the patient goes to the OR. That seems to make more sense to me, thry can time it to sign out before we roll back.
In some cases, in the OR we do the preinduction checklist and sign in and are asked by surgeon to give subcutaneous injection. We typically give it preinduction as the thought it VTE is most likely to happen with induction of GA (edit: not the most likely to cause VTE, but may create conditions that allow...
Subq heparin or lovenox before induction of GA (Source: Student Doctor Network)
Source: Student Doctor Network - November 1, 2020 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
DVT R-O at night
Do you guys have 24h availability? If so, what is the annual volume of your ED?
Is anyone actually in an environment where they are forced to administer lovenox to elderly patients who are high fall risk with scheduled morning DVT studies?
We're having to re-visit this battle with our vascular surgery department who is trying to cut out US services for DVTs at night, in a 60K ED no less. (Source: Student Doctor Network)
Source: Student Doctor Network - October 8, 2019 Category: Universities & Medical Training Authors: Groove Tags: Emergency Medicine Source Type: forums
neonate and infant dillutions
What are the best resources for learning how to calculate insulin and enoxaparin dilutions for this population? We get some pretty wacky orders. Are there any calculators for double checking calculaitons? Thank you and I look forward to your responses. (Source: Student Doctor Network)
Source: Student Doctor Network - May 20, 2019 Category: Universities & Medical Training Authors: nampa Tags: Pharmacy Source Type: forums
epidural catheter removal and platelets.
I know...we have had this discussion before.
Anyway.
Clinical scenario -
Patient with history x 2 of DVT (I think one was also a PE) and on Coumadin....bridged to lovenox for Knee replacement.
Epidural placed with platelets 102.
Day one - platelets, 64 at 4am. Surgeons are anxious to start Lovenox - therapeutic dosing. Recheck of platelets at noon - 70.
Decision time. I'm sure there are lots of different ways to do this - but here where the options I thought I should decide on....
epidural catheter removal and platelets. (Source: Student Doctor Network)
Source: Student Doctor Network - December 16, 2016 Category: Universities & Medical Training Authors: epidural man Source Type: forums
Factor V Leiden and Regional Anesthesia in Pregnancy
What are your guys thoughts?
Last week I had a 22yo VERY NON-COMPLIANT patient with history of FVL present in labor. Patient was "seen" by MFM and heme-onc, sporadically. Her history of FVL included MULTIPLE blood clots including thrombotic events even during periods of compliance with anticoagulation. Per her notes in between clotting episodes she had been put on numerous meds including Lovenox and Xarelto. Back in 2015 she had in intracardiac thrombus which hwas usrgically removed...
Factor V Leiden and Regional Anesthesia in Pregnancy (Source: Student Doctor Network)
Source: Student Doctor Network - November 11, 2016 Category: Universities & Medical Training Authors: sigrhoillusion Source Type: forums
