Von Willebrand Disease (vWD) bleeding managment

A patient suffered a 3 cm linear scalp laceration during an MVA.  The bleeding is controlled initially with direct pressure but continues to bleed intermittently while you prep to staple it closed.  Even after staples are placed the laceration continue to steadily ooze along the approximated skin.  While you continue to hold pressure over the lac after repair the patient informs you that he has Von Willebrand Disease and always needs medication prior to any of his dental procedures.   You consult your ED pharmacist and hematology and they inform you that the patient should receive 75 IU/kg of Humate-P which is a concentrate of  Von Willebrand factor and factor VIII.… Read more

How to dose sugammadex

One of the newest drugs available to some EM provider is Sugammadex.  Trade name, Bridion, the drug functions as a reversal agent for Rocuronium.  An IV bolus of 16 mg/kg over 10 seconds via a central or peripheral line will reverse a single 1.2 mg/kg dose of rocuronium in approximately 3 minutes.  Although rarely used in the emergent setting, keep the dose in the back of your mind or reference on the WikEM app just incase you need to order it.… Read more