Cardiology

Ductal Dependent Lesions

• Present 1^st week to 1^st month
• Normal duct seals by 3 weeks
• If dependent on shunt for pulmonary flow  cyanosis
• If dependent on shunt for systemic flow cold shock (may be worse w/ fluids)
• Prostaglandin E₁
  • 1 mg/kg/min
  • Side effects include apnea, bradycardia, hypotension, seizure
    • Consider intubating prior to administration
  • IVF, cover for sepsis

Congestive Heart Failure

• Present 2^nd to 6^th month
• Presents with respiratory symptoms (wheezing, retractions, tachypnea)
• Difficulty with feeding (the infant stress test)
• Treatment: Supportive

 Tetrology of Fallot

1. Calm the child, knee to chest
2. O₂ = reduction in PVR
3. Analgesia: morphine 0.1mg/kg, fentanyl 1.5 mcg/kg, ketamine 0.25 mg/kg
4. Establish Access: 10-20cc/kg bolus
5. Phenylephrine 0.2 mg/kg IV (to increase SVR)
6. +/- HCO₃ 1mmol/kg (if acidosis)
7. +/- beta blocker (with cardiology consultation)
8. PGE₁ 0.05mcg/kg/min titrating to 0.1mcg/kg/min

Dermatology

Slapped Cheek/5^th Disease

• Parvo B19
• Slapped cheeks, lacy reticular pattern of rash on body
• Complications:
  • Pregnancy hydrops
  • Sickle Cell Disease  aplastic crisis

Measles

• Koplik spots, conjunctivitis, fever
• Can cause blindness

VZV

• Different stages of development
• Treat with acyclovir if > 12 years old
• Give VZIG in neonates and immunocompromised

Scarlet Fever

• Erythematous rash, palatal petechiae, pastia’s lines
• Strawberry tongue
• Trunk to periphery
• Treat with Pen VK: 50mg/kg BID x10d or Amox 20mg/kg BID x10d
• Pen allergic: Azithro 10mg/kg day 1 then 5mg/kg 2-5

Staphylococcal Scalded Skin Syndrome

• Toxin mediated, negative Nikolsky, good prognosis
• Treatment: Anti-staphylococcal antibiotics
  • Nafcillin 25mg/kg/d IV
  • Augmentin 45mg/kg/d PO in 2 divdied doses 7-10d
  • Keflex 10mg/kg/d QID x7-10d

Henoch-Schonlein Purpura

• Palpable purpura in dependent areas
• Arthralgia/Arthritis (50-84%)
• Abdominal pain (50%): vascular lesions in bowel, may be intussusception lead point
• Renal Disease (20-50%) may develop within 2 months
• Treatment: Supportive, NSAIDs

Kawasaki Disease

• 5 days of fever + 4/5 of criteria
  • Diffuse polymorphous diffuse rash
  • Conjunctivitis
  • Mucous membrane change (strawberry tongue)
  • Cervical LAD (usually unilateral)
  • Extremity changes
• Incomplete and atypical forms more common in infants
• Treatment (drop complications from 25% to 4-5%)
  • Aspirin 20mg/kg/dose Q6H
  • IVIG 2gm/kg over 12H

Gastroenterology

Bilious Vomiting

• Bilious vomiting malrotation with volvulus until proven otherwise  surgical emergency
• 1^st month of life “pre-verbal child’s disease”
• Dx: Upper GI Series (10-15%) false positive rate

Necrotizing Enterocolitis

• 10% of cases full term
• XR w/ pneumatosis intestinalis

Hirschsprung’s

• No meconium, slightly distended abdomen
• Less severe  later presentation, p/w constipation

Pyloric Stenosis

• Presents around 6 wks: vomiting but very hungry
• Diagnosis
  • US pylorus > 4mm thick, >15mm long
  • NGT aspiration 5cc is abnormal
• Treatment
  • Resuscitate
  • Correct metabolic abnormalities
  • Consult surgery

Intussusception

• Most common infant emergency
  • 3 months – 2 years
• Abdominal pain, currant jelly, palpable mass (30% only)
• Typical presentation
  • Lethargy (may be only sign)
  • Vomiting
  • Paroxysms of pain
  • SBO
  • PO intolerance
• Diagnosis: US
• Treatment: Enema (80-95% successful), 10% recurrence

Meckel’s Diverticulum

• Around 2 years of age, boys > girls
• Obstruction, intussusception
• Diagnose with technetium scan

Appendicitis

• 1/3^rd with vomiting and diarrhea (AGE-type syndrome)

Hemolytic Uremic Syndrome

• Watery/bloody diarrhea
• Three components
  • Acute renal failure
  • Thrombocytopenia
  • Microangiopathic hemolytic anemia (MAHA)
• Signs
  • Pallor
  • Abdominal Pain
  • Decreased urine output
  • Low energy/AMS
  • Hypertension
  • Edema
  • Petechiae
  • Icterus
• Treatment: Supportive vs. Dialysis (50%)

GI Bleed by Age

Congenital Disorders

Congenital Adrenal Hyperplasia

• Presents in first two weeks of life
• Chief complaint may be vomiting
• Lyte: HyperK, HypoNa, Hypoglycemia  dysrhythmias, seizures
• Treatment
  • IVF (usual dose)
  • Glucose (usual dose)
  • Hydrocortisone: 25mg (neonate/infant), 50mg child, adolescent/adult 100mg

Inborn Errors of Metabolism

• Possible CC: Vomiting, Lethargy, Seizures, Hepatomegaly, Metab Acidosis, Odor
• May have normal labs and imaging
• Life-threatening: Metabolic acidosis, Hypoglycemia, Hyperammonemia, Sepsis
• Labs
  • VBG (acidosis),
  • CMP (liver, kidney, anion gap)
  • Ammonia, lactate, urine (ketones, reducing substance)
  • Bunch of extra tubes for labs later
• Treatment
  • NPO
  • IVF bolus
  • D10 at 1.5x maintenance
  • Treat Sepsis
  • Control seizures PRN, correct hyperammonemia/acid/lyte (may need dialysis)

Pulmonary

Croup

• Toddlers (6-24 months), 5% of all children, boys > girls
  • PIV #1
  • Rhinovirus, Metapneumovirus, PIV II-IV, RSV, Flu A/B
  • Frequent co-infections with one or more viruses

• Sx: 1-3 days of URI Sx  Abrupt cough/stridor worse for one day, then better
• Signs: Nontoxic, if wheezing likely RSV
• Studies: XR to r/o FB (steeple sign if positive)
• Treatment: Racemic Epi: 0.25-0.75 cc in 3 cc Q 20 minutes, lasts < 2 hours
• Disposition: If stridor at rest then treat if no improvement, then admit

Bronchiolitis

• Children < 2 years old, November through April (peak Jan/Feb)
  • Apnea in neonates and ex-premies < 2 months
  • Bacterial superinfection is very rare
• Presentation: Desat, tachypnea, nasal flaring, intercostal retractions, secretions
• Exam: Fine rales, diffuse/fine wheezing
• Treatment: Suction, O2 (if < 90%), NPPV
• Maybe albuterol, but no steroids/epi/abx

Epiglottitis

• Bimodal (2-6, 20-40y), < 1% URI with stridor, boys = girls, al year
  • Non-typable H.flu, staph/strep, Moraxella
  • Candida, HSV, VZV, crack cocaine
• Symptoms: Muffled voice, drooling rapid progression in hours
• Signs: No pharyngeal findings with severely tender anterior neck
• Studies: XR w/ thumb sign
• Treatment: Laryngoscopy, airway management

Bacterial Tracheitis

• Preschool (1-10y), boys = girls, Downs
• Symptoms: Several days’ URI  toxic in hours, rapid progression
• Signs: Subglottic diffuse inflammation, edema with exudates and pseudomembranes
• Studies: CXR demonstrates narrow trachea
• Treatment: Emergent intubation, 3^rd generation cephalosporin

The post Pediatric Emergencies appeared first on Differential Diagnosis of.

• Risk factors: altitude, rapidity of ascent, sleeping altitude
• Pathophysiology
  • Hypobaric hypoxia
    • Pulmonary: vasoconstriction  pulmonary hypertension capillary leak
    • Cerebral: vasodilation edema
  • Acclimatization
    • Hyperventilation primary respiratory alkalosis compensatory metabolic acidosis
    • Acetazolamide promotes renal bicarbonate excretion and accelerates acclimatization
• Management: oxygen and descent

Acute mountain sickness (2000m)

• Mild cerebral edema
• Symptoms: headache, nausea/vomiting, fatigue (hangover)
• Management: acetazolamide 250mg PO BID, dexamethasone 4mg q6h

High-altitude pulmonary edema (HAPE, 3000m)

• Non-cardiogenic pulmonary edema
• Symptoms: dyspnea at rest, cough, fever
• Signs: hypoxia, crackles
• CXR: patchy infiltrates
• Management: nifedipine, PDEi (sildenafil), HBO

High-altitude cerebral edema (HACE, 4500m)

• Cerebral edema
• Symptoms: ataxia, altered mental status
• Management: acetazolamide 250mg PO BID, dexamethasone 10mg then 4mg q6h, HBO
• Gamow bag: portable HBO

Dysbarism (diving pathology)

• Principles
  • Boyle’s Law: volume = 1/pressure
    • Volume changes greatest near surface
  • Henry’s Law: increased pressure increases proportion of dissolved gas

Barotrauma

• Localized (descent)
  • Barotitis media
    • Mechanism: unequal pressure between external and middle ear.
    • Symptoms: pain, vertigo if ruptured
  • Barotitis externa
    • EAC edema/hemorrhage
  • Barotitis interna
    • Bleeding/rupture of round window
    • Symptoms: vertigo, tinnitus, hearing loss
    • Management: ENT referral
  • Sinus squeeze: pain and epistaxis
  • Mask squeeze: periorbital petechiae
• Localized (ascent)
  • Barodontalgia
    • Air trapped in filling
    • Symptoms: pain, fracture
  • Alternobaric vertigo: Unequal ear pressure causing vertigo
  • GI barotrauma: belching, flatulence
• Pulmonary overpressurization (ascent)
  • Mechanism: rapid ascent without exhalation, focal alveolar rupture leading to pneumomediastinum, rarely pneumothorax
  • CXR: continuous diaphragm sign
  • Symptoms: dysphonia, neck fullness, chest pain
  • Management: supportive
• Air gas embolism (ascent)
  • Mechanism: similar to POP, air enters pulmonary venous circulation
  • Symptoms: MI, arrest, stroke, seizure within 10 minutes
  • Management: IVF, oxygen, HBO

Dissolved Gas Problems

• Nitrogen narcosis
  • At >100ft, nitrogen enters nervous system and acts similarly to general anesthetic
  • Symptoms: similar to alcohol intoxication, complications arise from poor judgement
  • Management: ascent
• Oxygen toxicity
  • Setting: industrial dives, deep
  • Symptoms: seizure, nausea, muscle twitching
• Decompression sickness
  • Mechanism: nitrogen gas dissolves poorly in solution, with ascent forms bubbles, occurs 1-2 hours after ascent
  • Types
    • Musculoskeletal, integumentary (“bends”)
      • Symptoms: arthralgia, cutis marmorata
    • Neurological
      • Lower spinal cord (thoracic/lumbar/sacral)
        • Symptoms: paraplegia, paresthesia, bladder dysfunction
      • Cerebellum (“staggers”)
        • Symptoms: ataxia
      • Pulmonary (“chokes”)
        • Symptoms: similar to pulmonary embolus
      • Management: IVF, oxygen, HBO

The post Altitude and Dysbarism appeared first on Differential Diagnosis of.

• Human: Eikenella corrodens
• Dog/Cat: Pasteurella multocida

Athropod

• Hymenoptra (bee, wasp, hornet, ant)
  • Venom: histamine reaction, anaphylaxis
  • Symptoms
    • Local: pain, swelling, pruritus
    • Toxic (<48h): multiple bits, N/V, syncope, HA
    • Anaphylaxis: minutes
    • Delayed (10-14d): serum sickness, fever, arthralgia, malaise
  • Management
    • Remove stinger
    • Wash, ice, anti-histamine, analgesia

• Brown recluse (violin pattern)
  • Location: Midwest, wood pile
  • Symptoms: initially painless, cytotoxic venom may cause necrosis
  • Management: supportive, Tdap, delayed debridement if necrotic
• Black widow (red hourglass)
  • Venom: neurotoxic, ACh, NE
  • Symptoms: painful, erythema, muscle contractions (“acute abdomen”), localized diaphoresis from ACh release
  • Management: analgesia, benzodiazepines, antivenom for refractory pain (may cause anaphylaxis)

Snake

• Crotalid (rattlesnake, copperhead, cottonmouth, collectively “pit vipers”)
  • Venom: cytotoxic, hemorrhagic
  • Symptoms: erythema/edema (ecchymoisis/bullae), nausea/vomiting, metallic taste
  • Labs: DIC
  • Management
    • Immobilization (no tourniquet)
    • Local wound care, Tdap
    • CBC, INR, fibrinogen (q2h)
    • Antivenom (Crofab 4-6 vials): given until symptoms or laboratory abnormalities arrest
    • Compartment syndrome: avoid surgery
• Elapidae (coral snake, “red on yellow”)
  • Venom: neurotoxic, delayed 10-12h
  • Symptoms: no significant local reaction, bulbar palsies, respiratory depression
  • Management: no antivenom, supportive care, intubation

Cnidaria (jellyfish)

• Symptoms: local pain, erythema, pruritus
• Management: 5% acetic acid, alcohol, remove stinger
  • Antivenom for box jellyfish

Stingray

• Symptoms: local pain, edema
• Management: Local wound care, Tdap, hot water immersion, antibiotics for Vibrio (cephalexin with doxycycline)

Vibrio vulnificus

• Symptoms: necrotizing fasciitis, in cirrhotic primary septicemia after ingesting shellfish

The post Bites appeared first on Differential Diagnosis of.

Physics

• High-voltage defined as >1,000V
• Voltage related to injuries current via resistance (V=IR)
• AC is 3x more lethal than DC
  • Fluctuation at 60Hz causes tetany, maintained grasp on source

Effects

• Dysrhythmia
  • DC: asystole
  • AC: ventricular fibrillation
  • Delayed dysrhythmia uncommon
• Burn
• Tissue ischemia: vascular spasm or thrombosis
• CNS: AMS, seizure, ICH, neuropathy
• MSK: posterior shoulder dislocation

Management

• Asymptomatic: None
• Mild (i.e. small burn): ECG, UA (rhabdo)
• High voltage: Labs, CT, admit for observation
• Pediatrics: oral commissure burn, discharge with plastic surgery follow-up if no LOC, normal ECG, tolerating PO. Risk of delayed labial artery bleeding.

Complications

• Keraunoparalysis: current travels up and down lower extremities causing transient paresthesia and paralysis.
• Trauma: TM rupture, other mechanical injuries

The post Electrical Injuries appeared first on Differential Diagnosis of.

•  Spectrum
  • Cramps
  • Syncope
  • Exhaustion
  • Stroke
• Physiology of cooling
  • Radiation: body warmer than environment, heat radiates away
  • Evaporation: environment warmer than body, sweat promotes heat exchange, affected by ambient humidity

Heat cramps

• Mechanism: fluid/electrolyte depletion resulting in muscle cramps
• Management: IVF, electrolyte repletion, cooling

Heat syncope

• Mechanism: vasodilation resulting in hypotension
• Management: IVF, cooling, rule out alternative etiologies

Heat exhaustion

• Mechanism: similar to heat cramps
• Symptoms: influenza-like, headache, fatigue, dizziness, nausea, normal mental status distinguishes from heat stroke
• Findings: temperature <40°C
• Management: IVF, cooling

Heat stroke

• Mechanism: similar to heat cramps
• Symptoms: prodrome of heat exhaustion
• Signs: AMS, ataxia, seizure
• Findings: temperature >40°C
• Mortality: 30-80%
• Labs: AST/ALT, coagulopathy, DIC, rhabdomyolysis, ATN/AKI
• CXR: pulmonary edema
• Types
  • Classical: elderly, dry skin, mild dehydration, increased mortality
  • Exertional: young athlete, diaphoretic, increased morbidity (organ failure)
• Management
  • Evaporative cooling
  • Ice packs to large vessels
  • GI lavage
  • Liberal intubation
  • Benzodiazepines or thorazine for inappropriate thermogenesis (shivering)
  • Halt cooling at 40°C

The post Heat Emergencies appeared first on Differential Diagnosis of.

• Risk factors
  • Extremes of age
  • Behavioral: psychosis, intoxication
• Types
  • Chillblains
  • Immersion foot
  • Frostnip
  • Frostbite
  • Generalized

Chilblains

• Findings: red/white plaques on extremities
• Symptoms: pruritus, pain
• Management: supportive (gentle warming), topical corticosteroids, consider nifedipine

Immersion foot (trench)

• Mechanism: prolonged immersion in non-freezing water, vasoconstriction leads to ischemia/necrosis
• Findings: pale, mottled skin, paresthesia
• Management: supportive, drying and rewarming
• Complications: gangrene

Frostnip

• Retrospective distinction from frostbite after rewarming if no tissue loss

Frostbite

• Mechanism: extracellular then intracellular crystal formation (mechanistically similar to crush injury)
• Reperfusion: cellular injury triggers cytokine release upon reperfusion, results in microvascular thrombosis and tissue ischemia/necrosis
• Classification: grades I-II superficial to dermis, grades III-IV involve subcutaneous tissue to bone
• Management
  • Rapid rewarming (immersion in warm water at 41°C)
  • Tdap
  • Debridement of clear blisters

Generalized

• Causes
  • Exposure
  • Metabolic (adrenal, thyroid, hypoglycemia)
  • Sepsis
• Grading
  • Mild (32.2-35°C)
    • Findings: excitation, tachycardia, hypertension, shivering thermogenesis
  • Moderate (30-32.2°C)
    • Findings: ataxia, AMS, bradycardia, hypotension, bradypnea
    • ECG:  Osborn wave
  • Severe (<30°C)
    • Complications
      • Increased risk of arrhythmia (bradycardia, slow atrial fibrillation, ventricular fibrillation, asystole)
      • Irritable myocardium
      • Decreased enzymatic activity
        • Renal: cold diuresis
        • Heme: coagulopathy (hidden on labs as blood rewarmed prior to testing)
        • Metabolic: hyperglycemia as insulin ineffective
    • Management
      • Ventricular fibrillation: attempt one shock, then focus on rewarming if ineffective
      • Goal >30°C

The post Hypothermia appeared first on Differential Diagnosis of.

• Units
  • Gray (amount of radiation absorbed by body)
  • Sievert (toxicity associated with radiation exposure)
• Types
  • Alpha: 0.1mm penetration, injury through ingestion
  • Beta: 1cm penetration, injury through skin or ingestion
  • Gamma: deep penetration
• Factors
  • Time and distance (1/d²)
  • Shielding
  • Radiosensitive cells (rapidly dividing such as hematopoetic, GI)

Injury

• Localized: epilation or burns, delayed by days
• Internal (inhaled, ingestion)
  • Radioactive iodine: high dose results in thyroid ablation, low dose increases risk of thyroid malignancy
• External: managed by removing clothing, soap/water shower
• Whole body (gamma)

Key clinical features

• Multiple affected individuals with nausea/vomiting suggests radiation exposure
• Rapidity of onset of symptoms suggests increased dose/exposure
• LD₅₀5G
• Prognosis by lymphocyte count
  • ALC >1000 at 48h suggests good prognosis
  • ALC <300 at 48h suggests poor prognosis

The post Radiation Exposure appeared first on Differential Diagnosis of.

• Breath-holding until eventual involuntary gasp which triggers reflexive laryngospasm. Resultant loss of consciousness may cause laryngeal relaxation and aspiration.
• Fluid aspiration results in decreased surfactant activity and atelectasis. This is complicated by V/Q mismatch and atelectrauma which can lead to ARDS.

Symptoms

• Progressive respiratory distress
• AMS: due to cerebral hypoxia
• Shock: uncommon, consider trauma

Management

• Albuterol
• BiPAP
• Endotracheal intubation
• ECMO

Disposition

• Asymptomatic or minor event: observe 2-3 hours
• Mildly symptomatic: observe 4-6 hours
• Hypoxia: admit
• PPV: ICU

The post Submersion Injury appeared first on Differential Diagnosis of.

• Triggers: infection, acidosis, dehydration, cold-exposure, hypoxia, pregnancy
• Presentation: exclude alternative more serious pathology prior to ascribing pain to vaso-occlusive crisis

Effects by Organ System

Evaluation

• CBC with reticulocyte count
  •  Hemoglobin: suggests sequestration or hemolytic crisis
  • Reticulocyte index: suggests aplastic or megaloblastic crisis
• LDH/haptoglobin: evaluate for hemolysis
• UA: evaluate for infection/infarction
• CXR: evaluate for acute chest syndrome

Management

• Rehydration (hypotonic fluids)
• Analgesia
• Supplemental oxygen if hypoxic
• Exchange transfusion for priapism, neurologic symptoms, aplastic/sequestration/hemolytic crises

Transfusion Reactions

• Epidemiology: overall 0.25%, 0.09% severe
• Management: stop transfusion

Management by Presumed Etiology

The post Hematologic Emergencies appeared first on Differential Diagnosis of.

• Disorders of primary hemostasis
  • General: present with mucocutaneous, post-operative bleeding
  • vWD
  • Platelet disorders
    • Medication-induced: NSAID, valproate, B-lactam, SSRI
    • Systemic disease: hepatic, renal failure
  • ITP: antibody-mediated platelet destruction
• Disorders of secondary hemostasis
  • General: present with bleeding into soft-tissue, joints
  • Hemophilia A (VIII)
  • Hemophilia B (IX)
• Disorders of both primary and secondary hemostasis
  • DIC
  • Liver disease
  • Severe vWD
• Evaluation
  • PT: VII, vitamin K
  • PTT: VIII, IX, XI, XIII, vWD, heparin
  • Increased PT/PTT: XI, V, vitamin K, heparin, DIC
  • CBC: degree of anemia, platelet count, differential (hematopoetic disorders)
• Management
  • Thrombocytopenia
    • Prophylactic transfusion for avoidance of spontaneous hemorrhage for platelet count <10,000
    • Transfusion for active bleeding at platelet count <50,000
    • Dosing
      • Adults: one RDP increases platelet count by 7-10,000
      • Pediatrics: 5-10ml/kg
    • ITP
      • Transfuse platelets for active bleeding
      • High-dose steroids (prednisone 1mg/kg)
      • IVIG (1g/kg/d)
    • Uremia
      • Hemodialysis
      • DDAVP (0.3ug/kg IV)
    • vWD
      • DDAVP (0.3ug/kg IV)
      • Severe: VWF (Humate-P) 40-80IU/kg
      • Tranexamic acid
    • Hemophilia A
      • Minor: 20IU/kg
      • Major: 50IU/kg
    • Hemophilia B
      • Minor: 40IU/kg
      • Major: 100IU/kg

DIC/TTP/HUS

• Disseminated Intravascular Coagulation
  • Etiology: severe systemic illness/injury
    • Trauma, burn, crush
    • Sepsis
    • Malignancy
    • Obstetric complication: abruption, amniotic fluid embolism
    • Hemolytic anemia
  • Exam: petechiae/purpura, hemorrhage (puncture site, GI, GU, pulmonary)
  • Labs:
    • PT/PTT
    • Fibrinogen
    • CBC: schistocytes, thrombocytopenia
    • FDP/D-Dimer
  • Management
    • Treat underlying illness
    • Transfuse (PRBC, FFP for INR > 2, cryoprecipitate for fibrinogen < 100)
    • Heparin if apparent embolic events
    • Consult hematology
• TTP/HUS
  • Presentation
    • Thrombocytopenia
    • Altered mental status
    • Renal dysfunction
    • Fever
    • MAHA
  • TTP: more commonly associated with altered mental status
    • Etiology: drugs, pregnancy, infection (HIV)
    • Mechanism: ULvWF uncleaved by dysfunctional ADAMTS-13
  • HUS: more commonly associated with renal dysfunction
    • Mechanism: toxin from E. coli, Shigella
    • Timing: 1-2wks after diarrheal illness
  • Evaluation
    • CBC: anemia, schistocytes, thrombocytopenia
    • PT/PTT (normal)
    • BUN/Creatinine
    • LDH
  • Management
    • Platelets contraindicated except as stopgap measure in ICH (can worsen process)
    • Plasma exchange with FFP (replaces functional ADAMTS-13)
    • Steroids (prednisone 1mg/kg daily)
    • Hematology consultation

Complications of anti-thrombotic therapy

• Agents
  • Anti-platelet
    • TXA: Aspirin
    • ADP: clopidogrel, ticagrelor, prasugrel
    • GPIIb/IIIa: abciximab, eptifibatide, tirofiban
  • Anti-coagulants
    • Anti-thrombin: heparin, LMWH (enoxaparin, dalteparin)
    • Vitamin K antagonist: warfarn (anti-II, VII, IX, X)
    • Direct thrombin inhibitor: bivalirudin, argatroban, dabigatran
    • Xa inhibitor: rivaroxaban, apixaban
  • Fibrinolytics
    • Alteplase, tenectaplase
• Complications
  • HIT: platelet count decrease >50% at 5 days

Summary of Management

The post Bleeding Disorders appeared first on Differential Diagnosis of.