J Emerg Med
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Ruptures of the extensor mechanism of the knee are rare, when compared with other knee injuries, and are frequently misdiagnosed. The outcome after surgical repair may be compromised if surgery is delayed. A case of quadriceps tendon rupture that was misdiagnosed for 2 months and a review of the literature are presented. Including extensor mechanism disruption in the differential diagnosis, and careful attention to key physical findings in the examination of all acutely injured knees, will ensure that this important injury is not overlooked.
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Over-anticoagulation from warfarin is a common occurrence, and these patients are often referred to the Emergency Department for further treatment. Unfortunately, there is little guidance in the Emergency Medicine literature for the management of such patients. ⋯ This case report describes a patient who was treated with intravenous vitamin K within the scope of these guidelines at a very low dose (1 mg) and had a fatal anaphylactic reaction. This article will further discuss this patient, the 1998 ACCP guidelines, and the data supporting the alternative of subcutaneously administered vitamin K for patients with over-anticoagulation with no active bleeding.