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A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain.
All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups.
TTP is a lovely ICU diagnosis. TTP is a lovely ICU diagnosis. Not so much for the patient but it’s one of those ones that is niche enough to not have been picked up via the usual filters of ED, medical team to the ward. Welcome back to the tasty morsels of critical care podcast.
On arrival to the ED the patient’s initial vital signs are temperature 38.5C, BP 102/48, HR 106, RR 20. Coagulopathy: Parenteral vitamin K and/or fresh frozen plasma (FFP) as clinically indicated. She was initiated on deferoxamine and admitted to the ICU. 10 Maximum daily dose of 6-8g total of defuroxamine. Tenenbein M.
ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.
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