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EM@3AM: Aplastic Anemia

A 28-year-old female presents with fatigue, bruising, and vaginal bleeding. She reports a history of heavy menstrual cycles; however, this cycle has been significantly worse. Over the past week, she has experienced dizziness, generalized fatigue, and increased bruising. She felt warm earlier this morning but was not able to take her temperature. She denies any family history of bleeding disorders. Initial vital signs include BP 110/70, HR 120, RR 14, SpO2 100% on RA, and T 100.5F. On exam, she has diffuse petechiae and ecchymoses. Labs reveal hemoglobin 6.5, WBC 1.6, and platelet count of 40. What is the diagnosis?

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    Articles

    • practice updates

    EM Mindset: Steve Carroll – Masters of the Undifferentiated Patient

    • 7 Comments
    Continuing with our EM Mindset series, here is another piece by Dr. Carroll to kick off Monday. We are masters of the undifferentiated patients. Focus on these tips before, during and after your shift. Enjoy!
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    Renal Infarction: Pearls and Pitfalls

    • 2 Comments
    A focused review of the presentation, diagnosis, and management of renal infarction.
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    • FOAMED, happenings, perspectives

    The Patient Experience: Why Is It Important? Why Do We Hate It So Much? What Can We Do To Improve?

    • 5 Comments
    I HAVE BECOME INFATUATED WITH THE PATIENT CARE EXPERIENCE. I believe the term “patient care experience” is a more inclusive term that describes our technical expertise while also including everything else, such as communication, department ambience, throughput, and the behavior of everyone a patient comes into contact with while in
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    • practice updates

    I’ve got a pulse… now what? – Post-Arrest Care in the Acute Setting

    • 2 Comments
    “I’ve got a pulse,” you hear the nurse shout. Finally, a sigh of relief comes over the crowded resuscitation room and you take a moment to reflect on what just happened... but, your work is just now about to truly begin. It is up to you to determine why the
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    Foot Injuries in the Emergency Department

    • 5 Comments
    Everything you ever wanted to know about foot injuries in the emergency department
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    • practice updates

    EM Mindset: Reuben Strayer – 8 Responsibilities of the EM Doc

    • 10 Comments
    Continuing with our EM Mindset series, here is refreshing piece by Dr. Strayer to kick off Monday. Learn the eight discrete responsibilities of the emergency doc. Enjoy!
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    Acute heart failure exacerbation disposition

    Not all patients require admission

     

    Consider patient hemodynamics, respiratory status, ECG, labs (Cr, troponin, sodium/electrolytes), ability to ambulate, follow up

     

    Elevated troponin and serum Cr associated with worse outcomes

     

    Don’t use risk tools alone for DC, but Ottawa Heart Failure Risk Scale may assist in admission (ACEP Level B)

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