The American journal of emergency medicine
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Case Reports
Case report: Topical use of tranexamic acid for the management of post-procedural rectal bleeding.
Tranexamic acid (TXA) is increasingly used in the Emergency Department (ED). While the intravenous form has been extensively studied and used, it's utility in a topical formulation is not as widespread. ⋯ We present a case of a 61 year old male with post-procedural rectal bleeding, responsive to topical application of tranexamic acid. This case report demonstrates another novel application of TXA in emergency care.
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Comparative Study
Comparison of bedside screening methods for frailty assessment in older adult trauma patients in the emergency department.
Frailty is linked to poor outcomes in older patients. We prospectively compared the utility of the picture-based Clinical Frailty Scale (CFS9), clinical assessments, and ultrasound muscle measurements against the reference FRAIL scale in older adult trauma patients in the emergency department (ED). ⋯ The ED needs rapid, validated tools to screen for frailty. The CFS9 has excellent negative predictive value in ruling out frailty. Ultrasound of combined biceps and quadriceps has modest concordance as an alternative in trauma patients who cannot provide a history.
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Review Case Reports
Hepatopulmonary syndrome-attributed extreme hypoxemia and polycythemia revealing liver cirrhosis - A case report.
We report an unusual case of severe hepatopulmonary syndrome with previously unrecognized cirrhosis, presenting with acute on chronic dyspnoea, extreme hypoxemia, secondary polycythemia as well as direct identification of arteriovenous communications on computed tomography angiography. Hepatopulmonary syndrome, defined as the combination of hepatopathy, arterial deoxygenation and pulmonary vascular dilatation, is increasingly recognized as a life-threatening complication in advanced liver disease and transplant candidacy. ⋯ Diagnosis relies on the indirect evidence of pulmonary arteriovenous communications suggested by echocardiography with a bubble study. Clinicians need to be aware of this rare but potential acute presentation at the emergency room.
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Letter Multicenter Study
Epidemiology of and risk factors for iliopsoas abscess in a large community-based study.
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Clinical practice guidelines recommend protamine sulfate for reversal of enoxaparin associated bleeds dependent on the time from last administration and dose of enoxaparin. We present a case of a hemodynamically unstable patient with an enoxaparin induced abdominal wall hematoma/hemorrhage and the previous enoxaparin administration 21.5 h prior to presentation with a therapeutic anti-Xa assay (0.8 IU/mL) upon assessment in the emergency department. ⋯ Our case demonstrates the importance of monitoring renal function and the potential for accumulation of enoxaparin in patients with renal dysfunction leading to prolonged therapeutic anti-Xa assays. With the availability of anti-Xa assays, future reversal recommendations of enoxaparin associated bleeds using protamine sulfate should include the initial anti-Xa assay as a guide for the dosing regimen.