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HAEM/ONC

THINNER REVERSAL

Consider charcoal if just taken their meds
PromptNon blanching rash post commencement of LMWH
ResponseHeparin induced thrombocytopaenia syndrome
FBC for platelet levels
Coags
Change to fondaparinux (or reassess need for heparin)
Self-rate:
PromptNOAC reversal (Specific)
ResponseDabigatran
  • Idarucizumab 5g dose
  • Ciraprantag
Rivatoxaban/Apixaban
  • Andexxa (generic = Andexanet Alpha) - 400 mg stat then 480 mg infused over 2h (Pretty new drug. Unlikely tob e on exam)
Self-rate:
PromptWarfarin reversal
ResponseVitamin K 10 mg IV
Prothombinex 50U/kg IV
+/- FFP 2 U (may be part of MTP) (15 mL/kg in kids)
Self-rate:
PromptThrombolysis reversal
(note question was STEMI - so they had antiplatelets and heparin also)
ResponseFibrinolysis reversal
  • FFP 2U Q6H x 24h
  • Cryoprecipitate 10U
  • TXA 1g IV
Antiplatelet reversal
  • Platelets 1U
  • DDAVP (desmopressin) 0.3 mics/kg in 50 mL N/S
Anticoagulant reversal
  • Protamine 1 mg per 1 mg of clexane or per 100 U of heparin
  • LITFL
Self-rate:
PromptSPONTANEOUS BLEEDING
Response
Self-rate:
Prompt
ResponseExtensive left sided abdominal wall haematoma
Arterial blush suggesting active bleeding
Swirl sign - hypodensity suggesting active bleeding (Swirl sign seems to be for intracranial bleeds - the different Abdominal “Swirl sign” is for malrotation + vovulus. Think this is technically wrong)
No haemoperitoneum/pneumoperitoneum

Mgmt:
Analgesia - fentanyl
Specific - IR for embolisation of vessel
Disposition - HDU/ICU for haemodynamic monitoring, transfusion targets etc.
Self-rate:
PromptSICKLE CELL STUFF
ResponseIts important. RNSH trial had Acute chest syndrome. Its in Rosh too. Look it up.
Self-rate:
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