Heme Onc Part 2- Hematology Emergencies

This is part 2 of the Heme Onc Emergencies series.  This episode will talk about common hematology emergencies that we see in the ED.  Sickle cell disease will be its own episode but this episode will talk about the approach to anemia in the ED, as well as the approach to hemophilias, ITP and TTP.  While you will see lots of anemic patients in the ED, the other diseases are rare but we have to be on the look out for them and know what to do.

Heme Onc Part 2- Hematology Emergencies

Heme Onc Part 2 Show Notes (Word Format)

Heme Onc Part 2 Show Notes (PDF)

Check out the EM Basic page on EB Medicine for free access for residents and discounts for attendings.  The September issue of Pediatric EM Practice discusses Hemophilia and von Willebrand disease in kids.

Factor Replacement Formula

Factor 8- (Target factor activity level – Baseline factor activity level) / (2 x pt weight in kilograms)

Factor 9- (Target factor activity level – Baseline factor activity level) / (pt weight in kilograms)

Heme Onc Part 1- Oncology Emergencies

This is the first of a two part series on Heme-Onc Emergencies.  In this episode, we’ll discuss oncology emergencies to include neutropenic fever, tumor lysis syndrome, malignant spinal cord compression and malignant pericardial effusion.  Neutropenic fever is a common chief complaint for patients on chemotherapy so we have to be especially good at this chief complaint.

Heme Onc Part 1- Oncology Emergencies

Heme Onc Part 1 Show Notes (Word Format)

Heme Onc Part 1 Show Notes (PDF)

 

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Update (10/10/2015)- Someone brought to my attention that some sources have different definitions for neutropenia.  Here’s what I found:

Rosen’s/Tintinalli’s- ANC <1000, Severe neutropenia ANC <500

Uptodate: ANC <1,500, Severe Neutropenia ANC <500

IDSA: Neutropenia starts at ANC <500, “Profound” neutropenia ANC <100

Bottom line: Any ANC in the neighborhood of 1,000 to 1,500 is concerning and needs consultation and follow-up with the patient’s oncologist.  Also remember that an ANC that is expected to drop below <500 in the next 1-2 days is also concerning (remember that the WBC nadir is usually 5-10 days after last chemo dose).

Also- I forgot to add in the ANC calculation that bands are added to neutrophils (sometimes called “Segs” on a CBC with differential).  I fixed it in the show notes.

Here’s the formula:

Absolute Neutrophil Count= (percentage of neutrophils + percentage of bands) x Total WBCs

Example: WBC 1,000, Segs 70%, Bands 5%- (0.7 +0.05) x 1,000 = (0.75) x 1,000 = ANC 750

Measles

Today’s episode is another installment of the EM Basic Project.  Dr. Sheyna Gifford and Dr. Chrisanna Mink will talk about measles.  This is a disease that we thought we had stamped out long ago with vaccination but the rise of the anti-vaccine movement has caused several small outbreaks so we need to be ready and on the lookout.  They will discuss how to recgonize measles, how to order the right testing and treatment, how to properly disposition these patients and the importance of getting your public health colleagues involved.

Measles with Drs. Sheyna Gifford and Chrisanna Mink

 

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Aortic Dissection

Today marks the 4th anniversary of the EM Basic podcast.  To celebrate this occasion, we are going to do a screencast on aortic dissection.  This is a very challenging disease to diagnose because patients have lots of different presentations that can make it difficult to diagnose.  We’ll talk about the common presentations of dissection, the not-so-common presentations, how to order the right imaging, how to treat these patients in the ED, and how to get them to the right level of care.

Aortic Dissection Screencast

Aortic Dissection Screencast Audio File

Aortic Dissection Show Notes (Word Format)

Aortic Dissection Show Notes (PDF)

IRAD study link (Free full text)

IRAD study PDF (Free full text)

Check out our bandwidth sponsor EB Medicine.  Residents can get free access to all of their resources and attending can get a discount on some of their great products at the EB Medicine EM Basic page.  They just released the EB Medicine app that allows access to their entire collection without on your mobile device without WiFi.

Non-Pregnant Vaginal Bleeding

Today’s episode of EM Basic will review vaginal bleeding in patients who are not pregnant.  This is a much different workup from pregnant patients with vaginal bleeding so we have to know how to effectively manage this chief complaint.

This episode was written and recorded by Dr. Adaira Landry, an EM senior resident at NYU/Bellevue and Joe Kennedy, a 4th year medical student at Mayo Medical School who matched into EM just after this episode was recorded.  They’ll review what vital signs to look out for, the important parts of this history and physical, what labs and imaging to order (if any), and the proper disposition of patients with this chief complaint.

Non-pregnant Vaginal Bleeding Podcast

Non-pregnant Vaginal Bleeding Show Notes (Word Format)

Non-pregnant Vaginal Bleeding Show Notes (PDF)

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