WMJ : official publication of the State Medical Society of Wisconsin
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Little data describes the role of child abuse pediatricians in consultation for physical abuse patients the pediatric emergency department. ⋯ Child abuse consultation in the pediatric emergency department improves compliance with clinical guidelines and decreases the likelihood that patients will need to return for further testing.
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Dabigatran is a direct thrombin inhibitor that reduces the risk of systemic embolism in patients with nonvalvular atrial fibrillation. We report a case of an elderly man who developed unexplained rapid decline in renal function 6 weeks after starting dabigatran. A renal biopsy was planned to find out the etiology of acute renal failure, but the patient has significantly prolonged coagulation parameters despite holding medication for 5 days per manufacturer's recommendation. ⋯ Renal biopsy showed renal atheroembolic disease, which was possibly induced by dabigatran. Although renal atheroembolic disease is a known rare complication following treatment with warfarin, heparin, and thrombolytic agents, this is the first reported case of renal atheroembolic disease potentially caused by dabigatran. This case also highlights the extended duration of prolonged coagulation parameters after holding dabigatran and its implication for timing of nonemergent invasive procedures.
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Pedestrian-vehicle crashes are a significant problem in public health. Understanding contributing factors within a specific community helps recognize and target key intervention points. ⋯ Elderly patients struck by a motor vehicle have a mortality rate twice that of the nonelderly and a higher rate of discharge to a skilled nursing facility, despite having a similar injury severity score on admission. This highlights the need for aggressive prevention efforts targeted at the elderly population.