The American journal of emergency medicine
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Reversal of oral factor Xa (FXa) inhibitors, such as apixaban, remains a controversial topic. However, the controversy goes beyond what reversal agent to utilize. ⋯ A paucity of literature exists regarding the utilization of low molecular weight heparin (LMWH) anti-Xa assays and thromboelastography for identifying coagulopathies associated with oral FXa inhibitors. We report a case of apixaban induced coagulopathy utilizing thromboelastography and a LMWH anti-Xa assay as a guide for reversal.
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Emergency Department Observation Units (Obs Units) provide a setting and a mechanism for further care of Emergency Department (ED) patients. Our hospital has a protocol-driven, type 1, complex 20 bed Obs Unit with 36 different protocols. We wanted to understand how the different protocols performed and what types of care were provided. ⋯ An Obs Unit can care for a wide variety of patients who require multiple consultations, procedures, and care coordination while maintaining an acceptable length of stay and admission rate.
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Observational Study
Perceived vs. actual distractions in the emergency department.
The emergency department (ED) has been shown to be an interrupt-driven workplace fraught with potential for distractions and interruptions that increase the potential for medical error. Accuracy of provider perception of these distractions and interruptions has yet to be investigated. ⋯ The perceived amount and rate of distractions and interruptions are significantly higher than the actual amount and rate of distractions and interruptions. Attending physicians both perceive and experience more distractions and interruptions. Further work should be done to evaluate the power of provider perception, and the potential contribution of inaccurate perception to medical error and provider burnout.
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Left ventricular non-compaction (LVNC) is a cardiomyopathy with altered ventricular wall anatomy. This condition is characterized by the presence of prominent left ventricular trabeculae, a thin compacted layer, and deep intertrabecular recesses that are continuous with the left ventricular cavity and separated from the epicardial coronary. Left ventricular non-compaction can present with acute heart failure, arrhythmias, or sudden cardiac death. We present a case of a common cardiac arrhythmia in the emergency department with a work up consistent with LVNC being the underlying etiology.