A 4-year-old vaccinated male is brought to the ED by his parents for 3 days of hematuria and abdominal pain. They present now because he refuses to ambulate. He has a rash on his legs that family attributes to playing outside in the grass. His vital signs include HR 135, RR 20, and temperature of 37.9 C. His abdomen is diffusely tender, and he has red, raised papules on the buttocks and lower legs. What is the diagnosis, and what is the most common gastrointestinal complication?

A 63-year-old male without any past medical history presents to the emergency department with several weeks of headaches, some blurry vision while walking at a quick pace, and shortness of breath. His last checkup with his primary doctor was about 3 years ago and everything was ‘normal’. He takes no medications, has no allergies, and has no previous surgeries. He admits to being a long-term smoker, about a half a pack a day for 20 years. Examination in the ED is normal. Basic lab work is drawn which reveals a hematocrit of 63%, elevated RBC mass, and thrombocytosis to 550K/ml. On further evaluation as an inpatient, it was found the patient had a low erythropoietin level. What is the diagnosis? 

Cerebral venous thrombosis is a tough diagnosis... Why is it missed, and how can we improve diagnosis?

What is the literature behind fixed-dose PCC for reversal of vitamin K antagonist-associated bleeding? Can you use this for your next shift?

This month's Medical Malpractice Insights from Dr. Pilcher brings you a tough case of a fall and undiagnosed hemorrhage in a patient on warfarin.

Fast forward to today and we are finding all kinds of uses for TXA other than trauma including post-partum hemorrhage, epistaxis, hemoptysis, gastrointestinal hemorrhage, and many more.

A 36-year-old male with a history of HIV presents to the ED complaining of dyspnea on exertion and fatigue. He is not compliant with his anti-retroviral medications. His conjunctivae are pale. There is a painful ulcer to the distal aspect of the tongue and scattered petechiae on his legs. Laboratory evaluation reveals WBC 2,000/microL, Hgb 8.5 g/dL, and platelets 90,000/microL. What do the exam and lab findings suggest?

Is whole blood ready for routine use in trauma? What is the evidence behind it? This post evaluates whole blood and provides a glimpse into a currently-used protocol.