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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

    Ectopic Pregnancy

    • 2 Comments
    Ectopic pregnancy is a common and potentially fatal emergency in early pregnancy. Its prevalence is about 2% in the general population, but is as high as 16% in women presenting to the emergency department with concerning symptoms. Ectopic pregnancy is a cause of pregnancy-related death and can also lead to
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    TXA Use in Trauma: An Update

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    As Emergency Physicians, we are always looking for ways to improve the care we provide to our patients. Based on clinical data which have come to light over the past several years, tranexamic acid (TXA) displays considerable promise toward reducing mortality in hemorrhagic trauma. It’s widely available, cost-effective, and an
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    • practice updates

    The Evaluation of Occult Subarachnoid Hemorrhage: Why Are We Still Doing LPs? Is CTA A Better Alternative?

    • 4 Comments
    It’s 4pm on a Wednesday. As per usual, the chart rack is full, and you’re trying to stay positive and keep up morale of the entire team. You pick up your next chart, and as you read the chief complaint, your heart sinks into your belly. The complaint is, “severe
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    • practice updates

    EM Mindset: Bob Stuntz – Developing the EM Mindset

    • 2 Comments
    Whether we are working with a medical student, an off-service resident, or even one of our own, most of us involved in the education of emergency medicine have described the mindset of emergency medicine as different from most other specialties. But are we really unique in our approach to patient
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    Transesophageal Echocardiography in Cardiac Arrest

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    What if there was a way to better visualize the heart during cardiac arrest? What if you could see something on the ultrasound screen that triggered a specific, critical, and time-sensitive intervention? According to the 2008 ACEP Ultrasound Guidelines, as well as Matt and Mike from the Ultrasound podcast, that
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    Pediatric Cardiogenic Shock

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    Pediatric cardiogenic shock is an often insidious phenomenon with presentations requiring a broad differential diagnosis. Even after narrowing the diagnosis to cardiogenic shock, the list of possible etiologies is vast and the cause important to determine because the source of the shock will respond differently to different treatments.
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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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