The American journal of emergency medicine
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We present the case of a patient who presented to the emergency department complaining of diffuse myalgias, severe jaw pain and chills. She met criteria for severe sepsis and received treatment including analgesia, antibiotics, intravenous fluids, and antipyretics. Workup revealed an elevated lactate and leukocytosis however, did not reveal any infectious source. ⋯ The key to the treatment of this patient was steroids, antihistamines, and supportive treatment. Emergency physicians do not often encounter infliximab infusion reactions because they occur so infrequently. Along with more common diagnoses such as sepsis, emergency physicians should include infliximab infusion reactions on the differential diagnosis in patients receiving this medication.
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Temporary transvenous cardiac pacing is a life-saving procedure in an emergency. Transvenous cardiac pacing catheterization guided by intracavitary electrocardiogram (IC-ECG), instead of fluoroscope, is practical. Tips for controlling the orientation of the pacing catheter tip and utilizing IC-ECG to monitor the positions of electrodes make bedside temporary transvenous cardiac pacing catheter placement feasible and 'visible'. The technique discussed here is comparable to the operation under fluoroscopy，but without exposure to X-ray.
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In 2018, the FDA approved andexanet alfa for the reversal of life-threatening hemorrhages in patients anticoagulated with apixaban or rivaroxaban. Yet, cost-effective factor Xa inhibitor reversal remains controversial. The objective of this study was to describe real world utilization of andexanet alfa. ⋯ This is the largest series to date describing real-world utilization of andexanet alfa. Our series showed hemostatic efficacy in 90.9% of patients with ICH, and 100% in patients undergoing surgical procedures. There were no thrombotic complications. Yet, larger and comparative studies are needed to clarify the optimal agent and patient selection for reversal of factor Xa inhibitors.
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This study aimed to evaluate the usefulness of coagulation biomarkers as predictors of the need for massive transfusion (MT) in patients with pelvic fractures. ⋯ The results of the study indicated that Fbg levels on admission can be an independent predictor of MT in patients with pelvic fractures. The optimal cut-off value of Fbg for MT prediction in this study was 193.0 mg/dL.