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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

    Roc Rocks and Sux Sucks! Why Rocuronium is the Agent of Choice for RSI

    • 15 Comments
    I recently had the pleasure of engaging in a point-counterpoint discussion on the optimal agent for Rapid Sequence Intubation with Billy Mallon at Essentials of Emergency Medicine 2014. I took the pro-rocuronium side. For decades, succinylcholine (suxamethonium) was the paralytic agent of choice (and the only available option) for RSI.
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    Endocarditis – A Complicated Case

    • 2 Comments
    A particularly complicated case and tricky diagnosis, along with the need-to-know information for all emergency physicians
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    • practice updates

    Power Review: Transplant Patient Management

    • No Comments
    The transplant patient is always sicker than they appear. It is important to be aggressive in these patients since they are severely immunocompromised which not only puts them at greater risk of infection but also blunts their normal signs to infection. Always contact the transplant team to help with management
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    To the HEART of the matter

    • 2 Comments
    The HEART score is an invaluable adjunct to emergency physicians when deciding which chest pain patients are appropriate for early discharge.
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    • practice updates

    What’s New: A Review of the Sepsis Literature

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    There have been a number of new publications reviewing our approach to managing sepsis. Both the ProCESS Trial and ARISE trial published in 2014 editions of the New England Journal question whether invasive procedures and rigid protocols are required to have positive patient outcomes. Other studies included in this power
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    • practice updates

    Ask Me Anything With Mike Stone, MD (@bedsidesono)

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    Update: This AMA will be happening Friday, December 12th from Noon-1:30pm EST.

    We're very pleased to announce that our next     Ask Me Anything will be with Mike Stone, MD, RDMS. Dr. Stone is the Division Chief of Emergency Ultrasound and the Emergency Ultrasound Fellowship Director at Brigham and
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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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