Tranexamic acid (TXA) is a synthetic form of the amino acid lysine that binds to receptors on plasmin and prevents it from breaking down fibrin clots. Numerous studies have investigated its utility in preventing or treating traumatic hemorrhage, and the World Health Organization now includes TXA on its list of Essential Medicines. In addition to trauma, TXA may be effective in other clinical scenarios relevant to Emergency Medicine, including gynecological hemorrhage and epistaxis. ALiEM Cards: TXA, written by Dr. Sam Ashoo, reviews the dosing and potential indications for TXA use in the ED.
Podcast Follow-up: Interview with Dr. Debbie Yi Madhok, Co-Author of “Update on the ED Management of Intracranial Hemorrhage”
Intracranial hemorrhage (ICH) is associated with significant disability and mortality. Although evidence-based guidelines exist, many hospitals have their own institutional practice patterns, which can make it difficult to care for these patients in the ED. Dr. Debbie Yi Madhok, an emergency physician and neurointensivist, sat down with Dr. Derek Monette, the ALiEM Deputy Editor in Chief, to discuss updates in the management of ICH. This interview follows up her original popular 2017 ALiEM post on dilemmas in ICH management, and takes a deeper dive into the nuances of seizure prophylaxis, blood pressure control, and platelet transfusions. We present the podcast and key learning points.
Penetrating fishhook injuries can be a common occurrence during the warm weather months. Initially, it is important to evaluate what type of fishhook was being used. How many and where are the barbs? What shape is it (treble hook, single hook)? The physical examination requires a thorough neurovascular exam and, if penetration depth is difficult to assess, radiographs should be utilized for further evaluation.
What approach do you use to remove these barbed fishhooks?
A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?
Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.
A young man is brought into an emergency department after an electric lawn edger cut through his work boot and into the dorsum of his right foot. He has a clearly contaminated 5 cm x 1 cm laceration on the lateral side, and an underlying tendon is exposed. Sensation is diminished around the wound and he is unable to actively extend his 5th toe past a neutral position. How would you diagnose and repair his extensor tendon injury?
Robust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH). From the Emergency Department perspective, the primary dilemmas involve specific blood pressure goals and whether seizure prophylaxis with phenytoin is necessary. The Brain Trauma Foundation provides an excellent summary of the current guidelines.1