recent articles

em@3am

EM@3AM – Disseminated Intravascular Coagulation

A 37-year-old trauma patient, involved in a motor vehicle collision six hours prior to arrival and stabilized at a county hospital, is transferred to your ED. A nurse notes blood oozing from the man's central and peripheral lines. What laboratory studies do you order? If you're in need of a refresher, take a look at this week's review of disseminated intravascular coagulation.

practice updates

The Thromboelastogram (TEG®): A Five-Minute Primer for the Emergency Physician

Thromboelastography is a mechanism of assessing coagulation based upon the viscoelastic properties of whole blood, and when compared to other coagulation assessments, this test allows for an assessment of near real-time, in-vivo clotting capacity. The point-of-care assay, which uses graphic interpretation of thromboelastography (the TEG), offers the opportunity for an expedited assessment of coagulopathies (thrombocytopenia, factor deficiency, heparin effect, hypofibrinogenemia, and hyperfibrinolysis). How can you use this modality in the ED? This post is full of pearls on interpreting TEG.

practice updates

Chronic Liver Disease and Hemostasis

Patients with chronic liver disease typically have elevated INRs and thromocytopenia. Thus, clinicians may believe that blood clots are not possible in this patient group. This is a brief review of hemostasis in liver disease and why blood clots can occur even with low platelet counts and elevated INRs.