Best Case Ever 51 – Anticoagulants and GI Bleed with Walter Himmel

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 8 November 2016

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

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Summary

In anticipation of Episode 88 and 89: DOACs Use, Misuse and Reversal with the president of Thrombosis Canada and world renowned thrombosis researcher Dr. Jim Douketis, internist and thrombosis expert Dr. Benjamin Bell and 'The Walking Encyclopedia of EM' Dr. Walter Himmel, we have Dr. Himmel telling us the story of his Best Case Ever on anticoagulants and GI bleed. He discusses the most important contraindication to DOACs, the importance of not only attempting to reverse the effects of anticoagulants in a bleeding patient but managing the bleed itself as well as more great pearls. In the upcoming episodes we'll run through 6 cases and cover the clinical use of DOACs, how they work, safety, indications, contraindications, management of minor, moderate and severe bleeding, the new DOAC reversal agents, management of DVT with DOAC anticoagulants, stroke prevention in atrial fibrillation with DOACs and much more...

Transcript

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0:00.0	Best case ever.
0:01.8	Best case ever.
0:09.8	Yes, this is EMK's Best Case Ever, Dr. Walter Himmel, Dr. Benjamin Bell, and Dr. Jim DeCatis. We have my good friend,
0:42.2	colleague, mentor, the walking encyclopedia of emergency medicine, known very well to all the
0:47.7	EM cases listeners, Dr. Walter Himmel, who's going to be doing, I think this is his second best
0:52.8	case ever. The first one,
0:54.3	one of my favorites, was on his own personal experience with Caudo Aquinas Syndrome, which was just
0:59.4	an amazing case. Dr. Himmel, let it rip. Let's hear your best case ever when it comes to anticoagulants.
1:06.5	This is only the best case ever because it's the best educational case ever, not the best
1:11.9	outcome ever. So I walked into a shift one day to find out that there was a person with a GI
1:18.4	bleed who'd been there for quite a while. And I realized quickly enough I actually knew this person.
1:24.0	I'd been in practice until the year 2000, about 16 years ago, and I had a patient who had
1:28.4	some kidney problems and blood pressure problems. And my goodness, now the patient was in the emergency
1:33.0	apartment. And here's the story. Unknown to me, that person had had a kidney transplant.
1:40.0	And they were doing fine. And what happened was next. They developed atrial fibrillation, and the person was put on the bigotran at that time.
1:47.5	So I walked into the apartment, and there's a person with a GI bleed who was bleeding and bleeding and
1:54.1	here's what happened.
1:55.9	The person vomited up blood at home that came to the hospital.
1:59.1	They were on the bigotran.
2:00.5	Initial blood work
2:01.2	showed their cratling was about 170 or so. So question number one, they came to mind is,
2:07.5	hmm, that's the right dose to be out when you're in renalia failure? And nonetheless, they began to
	...

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