#EMDutch Review – The Halloween Edition

31 Oct


Be advised: This month’s “special” review is written in blood (which was a silly thing to do, it took me ages to clean the keyboard afterwards)

A little known fact about vampires is that longevity means there will come a point when you need dentures. Luckily blood can be thinner than water : 25% of trauma patients suffer from acute coagulopathy of trauma from the moment they enter your ED. This is caused by shock itself (due to activation of anticoagulant and fibrinolytic pathways) and not the classically taught combination of acidosis, hypothermia, dilution and consumption. If you didn’t know this, go listen to: coagulopathy and if you did know, then go listen to it anyway. There even is an European guideline, which you really should go and read.

But how do we know which of our patients suffer from coagulopathy ? It may be present even with an INR of 1.2, so maybe we need another test or maybe you need to listen to this: TEG. Alternatively you could read this: thromboelastogram, you probably should (read it).

Now if you’re one of these thin blooded people then you probably want to know how to protect yourself from edentulous vampires. Should you use garlic or transexamic acid ? The answer can be found here: how CRASH-2 got it wrong. You should listen to it.

Quick, look behind you! Ah no, the evil bloodsucker got you. Now what ? Should you transfuse yourself ? Not according to this: GI bleeds. Guess you should read it. Maybe you should use haemostatic resuscitation ? (hint: listen to it) And is there a real benefit from 1:1 transfusion or is it solely due to survival bias ? Read it. Read it all !!

See you later

Iwan Dierckx

Now I probably should go and see a dentist, I have this painful canine tooth…


4 Responses to “#EMDutch Review – The Halloween Edition”

  1. Michiel November 1, 2013 at 13:00 #

    LOL! EBM on Halloween! The only thing I’m missing evidence of the existing of Zombies and Vampires. But hey, alot of what we do isn’t evidence based.

  2. Derek Sifford (@flightmed1) November 1, 2013 at 15:10 #

    I find it disappointing that you only shared Dr Walsh’s “How CRASH-2 got it wrong” rant and not Scott Weingart’s rebuttal (http://marylandccproject.org/2013/10/04/crash-2-got-right-counterpoint-dr-scott-weingart/) — Maybe consider adding it?

    • Iwan Dierckx November 1, 2013 at 18:09 #

      I’m very sorry. You’re absolutely right and I should have added it. Only I think most of us know and love TXA and CRASH-2. I thought it would be interesting to hear a counterargument for a change.

      Thanks for your comment and link to Scott’s rebuttal.


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