For years we’ve been transfusing red cells in the ED to patients who don’t actually need them. A study looking at trends in transfusion practice in the ED found that about 1/3 of transfusions given were deemed totally inappropriate. As we explained in previous EM Cases episodes, there have been a whole slew of articles in the literature over the years that have shown that morbidity and mortality outcomes with lower hemoglobin thresholds, like 70g/L for transfusing ICU patients (TRICC trial), patients in septic shock (TRISS trial), and patients with GI bleeds are similar to outcomes with traditional higher hemoglobin thresholds of 90 or 100g/L. We’re simply transfusing blood way too much! The American Association of Blood Banks in conjunction with the American Board of Internal Medicine’s Choosing Wisely campaign, as one of its 5 statements on overuse of procedures, stated, “don’t transfuse iron deficiency without hemodynamic instability”.
So, in this episode with the help of Transfusion specialist, researcher and co-author of the American Association of Blood Banks transfusion guidelines Dr. Jeannie Callum, Transfusion specialist and researcher Dr. Yulia Lin, and ‘the walking encyclopedia of EM’ Dr. Walter Himmel, we give you an understanding of why it’s important to avoid red cell transfusions in certain situations, why IV iron is sometimes a better option in a significant subset of anemic patients in the ED, and the practicalities of exactly how to administer IV iron.
Best Case Ever 35: Taking Action in Emergency Medicine
Best Case Ever 34: Inferior MI Presenting with Abdominal Pain
Best Case Ever 33: Over-correction of Hyponatremia
Rapid over-correction of Hyponatremia can have devastating consequences: for one, osmotic demyelination syndrome (ODS) can result in destruction of the pons and a locked-in state. We don't see ODS very much as it's onset is delayed and usually sets in after the patient is admitted to hospital (or worse, sent home). Nonetheless, we need to know how to manage Hyponatremia in the ED so that we prevent ODS from ever happening. In this Best Case Ever, Dr. Melanie Baimel describes the case of a young woman who came in to the ED after drinking alcohol and taking Ecstasy, wanted to leave AMA after her Hyponatremia had inadvertently been corrected too rapidly, and the conundrum that ensued.
In the upcoming episode, Dr. Baimel and the first ever Internal Medicine specialist on EM Cases, Dr. Ed Etchells, discuss a rational step-wise approach to managing Hyponatremia, tailored for the EM practitioner; when you might consider giving DDAVP in the ED, the best way to correct Hyponatremia, how to manage the patient who's Hyponatremia has been corrected too quickly, and an easy approach to the differential diagnosis. Get a sneak peak at the algorithm that will be explain and review in the upcoming episode......
Best Case Ever 32 Carr’s Cases – Endocarditis and Blood Culture Interpretation
David Carr discusses his top 10 pearls on endocarditis and blood culture interpretation in this Carr's Cases Best Case Ever on EM Cases.
Best Case Ever 31: Emergency Pericardiocentesis
Quick Links to Recent Emergency Medicine Cases Episodes
The entire Emergency Medicine Cases Library is Free Open Access
Episode 63 Pediatric DKA with Sarah Reid & Sarah Curtis
Episode 62 Diagnostic Decision Making Part 1 with Walter Himmel, David Dushenski & Chris Hicks
Episode 61 Whistler’s Update in EM 2015 Highlights with Joel Yaphe, Paul Hannam & Anil Chopra
Episode 60 Emergency Management of Hyponatremia with Melanie Baimel & Ed Etchells
Episode 59 Bronchiolitis with Sanjay Mehta & Dennis Scolnik
Episode 58 Tendons & Ligaments – Commonly Missed Uncommon Injuries P2 with Ivy Cheng & Hussein Mehdian
Episode 57 The Steill Sessions 2: Update in Atrial Fibrillation with Ian Stiell
Episode 56 The Stiell Sessions 1: CDRs & Risk Scales with Ian Stiell & Hans Rosenberg
Episode 55 Weingart-Himmel Sessions 2 – Fluids in Sepsis & Post Intubation Sedation with Walter Himmel & Scott Weingart
Episode 54 Weingart-Himmel Sessions 1 – Preoxygenation & Delayed Sequence Intubation with Walter Himmel & Scott Weingart
Episode 53 Pediatric Point of Care Ultrasound with Jason Fischer, Alyssa Abo, Alex Arroyo & Adam Sivitz
Episode 52 Commonly Missed Uncommon Orthopedic Injuries P1 with Ivy Cheng & Hossein Mehdian
Episode 51 Managing Difficult Patients with Walter Himmel, Jean Pierre Champagne & Ann Shook
Episode 50 Recognition & Management of Pediatric Sepsis and Septic Shock with Sarah Reid & Gina Neto
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