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