Clinicians might be surprised to learn that after central nervous system injury, hemorrhage/hemorrhagic shock is the second most common injury complex resulting in death for pediatric trauma patients. A thorough understanding of subtle presentations and management is essential to improve the outcome for these children.
In this multicenter study across 12 centers in the United States, a vacuum-induced intrauterine device successfully treated 94% of participants who experienced a postpartum hemorrhage with a median time of three minutes to control of bleeding.
In this prospective, cohort, pharmacokinetic-pharmacodynamic (PKPD) dose-finding study by Ahmadzia and colleagues, 30 pregnant women (10 women in each study arm) received 5 mg/kg, 10 mg/kg, or 15 mg/kg doses of tranexamic acid for the prevention of postpartum hemorrhage. Advanced PKPD modeling demonstrated that 600 mg of tranexamic acid was the optimal dose to use in the prevention of postpartum hemorrhage.
Primary intracerebral hemorrhage is a major cause of severe neurological disability and carries a high rate of death. Tranexamic acid was tested in a study of 2,325 patients with intracerebral hemorrhage within eight hours of symptom onset, but did not significantly improve neurological outcome.
Teen pregnancies are at high risk of obstetrical complications with an increased rate of adverse maternal and fetal outcomes. Acute care clinicians should be familiar with, and adept at, caring for the common or emergent obstetrical complications that may occur in a pregnant teenager.
Falls in patients older than 65 years of age are an increasingly common presentation in U.S. emergency departments, and intricate knowledge and confidence in the evaluation and management of these patients is vital.
Using the Delphi method of arriving at a consensus among clinicians concerning for which patients with atrial fibrillation should oral anticoagulants be recommended, the risk of stroke, the risk of hemorrhage, and patient-specific factors emerged. Many of these factors are not included in the guidelines and should be studied further.
The POINT trial showed a 25% reduction in the composite outcome of ischemic stroke, myocardial infarction, or ischemic vascular death in patients treated with clopidogrel plus aspirin for 90 days, immediately following a transient ischemic attack (TIA) or minor acute ischemic stroke. The investigators performed a secondary analysis and found the risk of major hemorrhages was low in both groups, although treatment with clopidogrel and aspirin together increased the risk of major hemorrhages over aspirin alone. Caution should be taken and very close observation of patients maintained when treating with dual antiplatelet therapies.