Thursday

#EMConf: Massive Hemoptysis

48M arrives in the passenger seat of wifes car coughing up a large amount of blood. He is very pale appearing, his pulse becomes thready and the patient starts to become unresponsive. Wife tells you he has a history of AML and is being treated with Amphotericin B for an Aspergilloma. The patient arrives to the resuscitation room in cardiac arrest. 

Category (Day): 

#EMConf: Reversal of Lovenox

Recommend against reversal of LMWH in patients receiving prophylactic dosing of LMWH. 

Low quality of evidence for the use of FFP or PCC to reverse LMWH. 

Protamine:

  • Dosed within 8 hours - 1 mg IV per 1 mg Lovenox (up to 50 mg in a single dose).
  • Dosed within 8-12 hours - 0.5 mg IV per 1 mg Lovenox (up to 50 mg in a single dose). 
  • Minimal utility in reversal of >12h from dosing. 

rFVIIa: 90 ug/kg iV if Protamine is contraindicated. 

Category (Day): 

#EMConf: Management of Tick Borne Illnesses

Consider tick borne illness when:

  • Influenza-like illness presentations, especially during the summer months. 
  • Fever of unknown origin
  • When viral meningitis is on your differential diagnosis. 

Babesiosis:

  • PO: Atovaquone + Azithromycin
  • IV: Clindamycin + Quinine
  • Exchange transfusion indications (would need Hematology/Oncology consult): 1. Asplenia       2. Parasite Load > 10%

Lyme's Disease:

Category (Day): 

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