The American journal of emergency medicine
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With respect to reversal of life threatening bleeds associated with the use of oral factor Xa inhibitors, current guidelines provide few recommendations for a preferred reversal agent. When the initial reversal agent fails to achieve the desired hemostatic response, there is little to no recommendations for the use of additional reversal agents. ⋯ An 86-year-old female on apixaban (ELIQUIS) for atrial fibrillation, presented from an outside hospital due to a spontaneous intracranial hemorrhage (sICH). Computed tomography (CT) scan revealed multifocal left sided sICH. Due to use of apixaban in the setting to sICH, patient received andexanet alfa (AA) for reversal. Patient was then transferred and upon arrival to receiving emergency department (ED), repeat CT scans showed an expanding sICH, progression of midline shift, and low-molecular weight heparin levels that were ≥ 2 international units (IU) per milliliter (mL), indicating therapeutic apixaban activity. The patient was subsequently given four-factor prothrombin complex concentrate (4F-PCC). WHY AN EMERGENCY MEDICINE PHYSICIAN SHOULD BE AWARE OF THIS INCLUDE THE FOLLOWING KEY POINTS.
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Case Reports
A rare combination of methemoglobinemia and carboxyhemoglobinemia in pesticide poisoning.
Dyshemoglobinemias are disorders in which the haemoglobin is functionally altered and prevented from carrying oxygen. They include carboxyhemoglobin, methemoglobin, and sulfhemoglobin. This increase in abnormal haemoglobin has reduced oxygen binding capacity, which leads to decrease in total oxygen content in the blood causing anaemic-hypoxia. ⋯ The patient's signs and symptoms gradually reduced in a few days and got discharged after 2 weeks without any neurological and cardiorespiratory sequelae. An early suspicion and personalized emergency management was the key to success. As in all fields of Medicine, Emergency Medicine is also witnessing a change towards precision and personalized Medicine practice.