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Idarucizumab (PRADAXA ®) as a sole reversal agent in an unstable hemorrhagic shock patient on an unknown anticoagulant with elevated protime/international normalized ratio (PT/INR).
We present a case of an 85-year-old female with an unknown medication history, shortness of breath and severe anemia due to an upper gastrointestinal bleed. Laboratory abnormalities were significant for INR 6.43 and serum creatinine 2.21  mg/dL.
Source: The American Journal of Emergency Medicine - February 5, 2021 Category: Emergency Medicine Authors: Sara Kutner, Nicholas Scaturo, Brett Williams Source Type: research

A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study
Conclusion: Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
Source: Shock - January 16, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Flight Medics, Nurses in NM Provide Crucial Rural Lifeline
This article originally appeared on Las Cruces Sun-News: Healers & Builders 2021: Flight medics and nurses provide crucial rural lifeline ___ (c)2020 the Las Cruces Sun-News (Las Cruces, N.M.) Visit the Las Cruces Sun-News (Las Cruces, N.M.) at www.lcsun-news.com Distributed by Tribune Content Agency, LLC. The post Flight Medics, Nurses in NM Provide Crucial Rural Lifeline appeared first on JEMS.
Source: JEMS Patient Care - January 3, 2021 Category: Emergency Medicine Authors: JEMS Staff Tags: Coronavirus News News Feed Flight Medic New Mexico Source Type: news

Short-Term Efficacy and Safety of Different Mechanical Hemodynamic Support Devices for Cardiogenic Shock or High-Risk Pci: a Network Meta-Analysis of Thirty-Seven Trials
Conclusion: Following this analysis, ECMO+IABP might be a more suitable intervention measure in improving short-term mortality for patients with CS and who underwent HS-PCI. However, the result was limited by the lack of sufficient direct comparisons and evidence from randomized controlled trials. Moreover, bleeding and other device-related complications should be considered in clinical applications.
Source: Shock - December 21, 2020 Category: Emergency Medicine Tags: Review Articles Source Type: research

2020 International Consensus on First Aid Science With Treatment Recommendations
This is the summary publication of the International Liaison Committee on Resuscitation ’s 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques f or cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tou...
Source: Resuscitation - October 21, 2020 Category: Emergency Medicine Authors: Eunice M. Singletary, David Zideman, Jason C. Bendall, David Berry, Vere Borra, Jestin N. Carlson, Pascal Cassan, Wei-Tien Chang, Nathan Charlton, Therese Dj ärv, Matthew J. Douma, Jonathan L. Epstein, Natalie A. Hood, David Markenson, Daniel Meyran, Aar Tags: Circulation Source Type: research

Ticagrelor-Aspirin Combo: Fewer Repeat Strokes, but More Bleeds Ticagrelor-Aspirin Combo: Fewer Repeat Strokes, but More Bleeds
The combination of ticagrelor and aspirin prevents secondary stroke and cuts mortality, but it also appears to increase the risk for severe bleeding.Medscape Medical News
Source: Medscape Emergency Medicine Headlines - July 20, 2020 Category: Emergency Medicine Tags: Neurology & Neurosurgery News Source Type: news

Practice Gap in Atrial Fibrillation Oral Anticoagulation Prescribing at Emergency Department Home Discharge
Introduction: Current U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.Methods: This retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart reviewe...
Source: Western Journal of Emergency Medicine - June 29, 2020 Category: Emergency Medicine Source Type: research

Concomitant Aspirin and Anticoagulation Is Associated With Increased Risk for Major Bleeding in Surgical Patients Requiring Postoperative Intensive Care*
Conclusions: Concomitant aspirin and anticoagulation in critically ill surgical patients was associated with an increased rate of major bleeding. Future investigations are warranted to further define optimal management of antiplatelet therapy during anticoagulation in surgical patients.
Source: Critical Care Medicine - June 20, 2020 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Clopidogrel versus ticagrelor in high-bleeding risk patients presenting with acute coronary syndromes: insights from the multicenter START-ANTIPLATELET registry
AbstractOptimal dual antiplatelet therapy (DAPT) strategy in high-bleeding risk (HBR) patients presenting with acute coronary syndrome remains debated. We sought to investigate the use of clopidogrel versus ticagrelor in HBR patients with acute coronary syndrome and their impact on ischemic and bleeding events at 1  year. In the START-ANTIPLATELET registry (NCT02219984), consecutive patients with ≥ 1 HBR criteria were stratified by DAPT type in clopidogrel versus ticagrelor groups. The primary endpoint was net adverse clinical endpoints (NACE), defined as a composite of all-cause death, myocardial infarct ion, stroke,...
Source: Internal and Emergency Medicine - June 14, 2020 Category: Emergency Medicine Source Type: research

Design and rationale of a randomized, placebo-controlled trial on the efficacy and safety of sulodexide for extended treatment in elderly patients after a first venous thromboembolism
AbstractHow to prevent recurrences after a first venous thromboembolic (VTE) event in elderly patients is still an open issue, especially because of the high bleeding risk of anticoagulation in these patients. The placebo-controlled “Jason” study aims at assessing the efficacy and safety for secondary VTE prevention in elderly patients of oral Sulodexide (Vessel®) administration, a mixture of glycosaminoglycans (Alfasigma, Bologna, Italy) which proved effective against recurrences in a general population (SURVET study) without major bleeding (MB) complications. 1450 patients, aged  ≥ 75 years, after at least 3�...
Source: Internal and Emergency Medicine - May 24, 2020 Category: Emergency Medicine Source Type: research

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