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The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated p...
Source: Emergency Medicine Journal - January 15, 2014 Category: Emergency Medicine Authors: Alikhan, R., Rayment, R., Keeling, D., Baglin, T., Benson, G., Green, L., Marshall, S., Patel, R., Pavord, S., Rose, P., Tait, C. Tags: Poisoning/Injestion, Open access, Drugs: cardiovascular system, Stroke, Poisoning Review Source Type: research

Fatal dabigatran toxicity secondary to acute renal failure
We describe the case of a 74-year-old man taking dabigatran 150 mg twice daily for atrial fibrillation who presented to the emergency department after 20 mL of hematemesis at home. Laboratory evaluation revealed a partial thromboplastin time of 99 seconds, international normalized ratio of 11.7, and creatine of 3.1 mg/dL (baseline creatine, 0.9 mg/dL). Upper endoscopy revealed diffuse gastritis and bleeding. Despite treatment with packed red blood cells and fresh frozen plasma, the patient's hematemesis persisted resulting in significant aspiration requiring endotracheal intubation. Per poison control center recommendation...
Source: The American Journal of Emergency Medicine - November 19, 2012 Category: Emergency Medicine Authors: Joseph K. Maddry, Mana Kouros Amir, Daniel Sessions, Kennon Heard Tags: Case Reports Source Type: research

Short answer question case series: a dangerous cause of dyspnoea
Case vignette A 52-year-old man with hepatitis C and a remote history of recreational drug abuse presents with several days of shortness of breath, cough and malaise. He was seen at an outside hospital and diagnosed with pneumonia given his cough and shortness of breath. Subsequently, he was seen again and found to have a small abscess of his arm that was drained. On review of systems, he endorses nausea and generalised weakness but denies abdominal pain, chest pain, numbness, fever, headache or dizziness. On physical exam, he is afebrile but tachypnoeic, has decreased breath sounds at the bases, and has an appropriately h...
Source: Emergency Medicine Journal - July 19, 2013 Category: Emergency Medicine Authors: Woodfield, A., Runde, D., Jang, T. Tags: Poisoning/Injestion, Foodborne infections, Hepatitis and other GI infections, Pneumonia (infectious disease), TB and other respiratory infections, Cranial nerves, Headache (including migraine), Pain (neurology), Stroke, Drugs misuse (including addiction), Source Type: research

S100B protein in children with carbon monoxide poisoning
S100B has been shown to increase in patients with cardiac arrest, stroke, subarachnoid hemorrhage, and traumatic and hypoxic brain damage . In contrast to adult studies, we found that serum S100B protein levels did not increase in pediatric patients with carbon monoxide (CO) poisoning . Patients with a positive history of CO exposure and elevated blood carboxyhemoglobin (>10%) levels associated with relevant clinical findings were diagnosed with CO poisoning. The most common complaints were headache (n = 27), dizziness (n = 27), nausea and vomiting (n = 28), syncope (n = 7), and convulsion (n = 2). In addition, we also cla...
Source: The American Journal of Emergency Medicine - August 12, 2013 Category: Emergency Medicine Authors: Ahmet Zulfikar Akelma, Aydin Celik,, Osman Ozdemir, Fatma Kavak Akelma Tags: Correspondence Source Type: research

A Stroke Mimic: A 14-Year-Old Cancer Patient Presenting With Acute Right-Sided Weakness
No abstract available
Source: Pediatric Emergency Care - March 1, 2017 Category: Emergency Medicine Tags: Pick Your Poison Source Type: research

Impact of the COVID-19 pandemic on visits to the hospital emergency service in two hospitals in Spain, from March 14, 2020 to June 21, 2020
This study will describe trends in the use of emergency departments before and after the Spanish State of Alarm, especially in pathologies not directly related to this infection. A cross-sectional study was conducted of all visits to the emergency departments in two third-level hospitals in two Spanish communities during the Spanish State of Alarm, compared with the same period of the previous year. The variables collected included the day of the week, the time of the visit, the duration of the visit, the final destination of the patients (home, admission to a conventional hospitalization ward, admission to the intensive c...
Source: Internal and Emergency Medicine - June 12, 2023 Category: Emergency Medicine Source Type: research