Initial Hematology Work Up for Cytopenias
emDOCs » Hematology
by Rachel Bridwell
3M ago
Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA); Alec Pawlukiewicz, MD (EM Attending Physician; Killeen, TX) // Reviewed by: Brit Long, MD (EM Attending Physician, San Antonio, TX) Even prior to COVID-19’s strain on emergency departments (ED), boarding has been a longstanding issue. Especially for clinicians working in EDs with limited resources and consultants, the ED workup may not provide comprehensive care, and thoughtful evaluation can improve inpatient care and aid consultants during moving forward.   Case A 76-year-old male presents with a history of known prostat ..read more
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Utility of D-dimer Testing in Special Populations
emDOCs » Hematology
by Lauren Willoughby
8M ago
Authors: Lauren Willoughby, MD (Education Fellow, University of Wisconsin); Benjamin H. Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain. Her past medical history is notable for hypertension and hyperlipidemia. The chest pain started suddenly today while at rest, is located on the right side, and radiates to her back. She denies other sympt ..read more
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EmDOCs Podcast – Episode 81: Hemophilia
emDOCs » Hematology
by Brit Long
9M ago
Today on the emDOCs cast, Brit Long, MD (@long_brit) covers hemophilia, including background, severity, evaluation, and management. Episode 81: Hemophilia   What is hemophilia?  Bleeding disorder due to a deficiency in one or more of the proteins (factors) involved in the coagulation pathway. Interruption of the coagulation cascade → ↓ fibrin clot formation → Several types: Hemophilia A – deficiency in factor VIII, 80-85% of cases Hemophilia B – deficiency in factor IX Hemophilia C – deficiency in factor XI Females can be affected. Classically thought of as x-linked and only ..read more
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EM@3AM: Acute Hemolytic Anemia
emDOCs » Hematology
by Agnieszka Radziszewska
1y ago
Author: Agnieszka Radziszewska, MD (Advocate Christ Medical Center, EM Resident Physician); Thaer Ahmad, MD (Advocate Christ Medical Center, EM Attending Physician) // Reviewed by: Sophia Görgens, MD (EM Resident Physician, Zucker – Northwell NS/LIJ, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. We’ll keep it short, while you keep that EM brain sharp. A 3-year-old male with G6 ..read more
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EmDOCs Podcast – Episode 37: Cerebral Venous Thrombosis
emDOCs » Hematology
by Brit Long
2y ago
Today on the emDOCs cast with Brit Long, MD (@long_brit), we cover cerebral venous thrombosis. Cerebral Venous Thrombosis Introduction: CVT is an uncommon neurologic emergency that can lead to stroke, seizures, and death. CVT is defined by thrombosis of the intracranial veins and dural sinuses and has an estimated annual incidence of 0.3-1.5 cases/100,000 person-years, accounting for up to 1% of all strokes worldwide. This incidence approaches that of meningitis. Delays in diagnosis are associated with worse morbidity. Pathophysiology: An obstruction within the dural venous system leads to inc ..read more
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EM@3AM: Purpura
emDOCs » Hematology
by Katherine M. Buckley
3y ago
Author: Katherine M. Buckley, MD (EM Resident Physician, UT Southwestern, Dallas, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. We’ll keep it short, while you keep that EM brain sharp. A 4-year-old vaccinated male is brought to the ED by his parents for 3 days of hematuria and abdominal pain. They present now because he refuses to ambulate. He has a rash on his legs that family attributes to playing outside in the grass. His vital ..read more
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EM@3AM: Polycythemia
emDOCs » Hematology
by Brian Sumner
3y ago
Authors: Brian Sumner, MD (@briansumner93, EM Resident, Mount Sinai Morningside/West) and Elizabeth Brem, MD (@DrLizBrem, Attending Hematology and Oncology Physician, UC Irvine) // Reviewed by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics. We’ll keep it short, while you keep that EM brain sharp. A 63-year-old male without any past medical history presents to the emergency department with several weeks of headaches, some blurry vision while walking at ..read more
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Cerebral venous thrombosis: why we miss it and how we can improve
emDOCs » Hematology
by Tony Spadaro
3y ago
Authors: Tony Spadaro, MD, MPH (EM Resident Physician at the Hospital of the University of Pennsylvania) and Kevin R. Scott, MD, MSEd (EM Attending Physician at the Hospital of the University of Pennsylvania) // Reviewed by: Marina Boushra, MD; Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case 1 A 37-year-old female presents with unilateral right-sided headache, nausea, and vomiting that developed gradually over the past week. She complains of associated photophobia and has had no improvement with over-the-counter medications. She denies any prior history of migraines. Her vital si ..read more
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Fixed-Dose PCC Dosing for Vitamin K Antagonist-Associated Hemorrhage: Is it Safe and Effective?
emDOCs » Hematology
by Kayvan Moussavi
4y ago
Authors: Kayvan Moussavi, PharmD, BCCCP (Assistant Professor, Marshall B. Ketchum University College of Pharmacy) and Nhu Quyen Dau, PharmD, BCCP (Assistant Professor, Marshall B. Ketchum University College of Pharmacy) // Reviewed by: Skyler Lentz, MD (@skylerlentz); Alex Koyfman, MD (@EMHighAK); and Brit Long, MD (@long_brit) Case A 77-year-old, 83 kg male presents to your ED for altered mental status and stroke-like symptoms.  GCS is 14, O2 saturation 99%, BP 170/90 mmHg, HR 65.  POC glucose is 120 mg/dL.  Other labs are drawn but results are pending.  After a brief exam ..read more
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Medical Malpractice Insights: Undiagnosed Hemorrhage while on Warfarin
emDOCs » Hematology
by Chuck Pilcher
4y ago
Here’s another case from Medical Malpractice Insights – Learning from Lawsuits, a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Chuck Pilcher, MD, FACEP Editor, Med Mal Insights Undiagnosed Hemorrhage while on Warfarin Patients on warfarin at risk for bleeding deserve an INR Facts: A 75-year-old female is admitted to the hospital from the ED with a DVT and presumed pulmonary embolus. She is trea ..read more
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