Panscan After Out of Hospital Cardiac Arrest

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Panscans, or a combination of head to pelvis CT scans, have been used in patients following significant trauma. Recent attention has shifted to the utility of routine CT scans following cardiac arrest. This is based on (1) identification of potential causes of cardiac arrest (2) identification of complications of resuscitation. In this episode, we cover an article by Branch et al in Academic Emergency Medicine.

Vaccine-Induced Thrombotic Thrombocytopenia

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In this episode, we discuss thrombotic thrombocytopenia associated with the viral vector COVID-19 vaccines (VITT: Vaccine-Induced Thrombotic Thrombocytopenia) – a very very rare, but real entity. Information is still emerging so numbers will likely change in the coming days. For more on cerebral vein thrombosis in general, check out this podcast.

Greinacher et al NEJM 2021
Schultz et al. NEJM 2021
ACIP Presentation by Jannsen 4/14/21, Muir et al NEJM 2021

International Society of Thrombosis and Hemostasis Statement

United Kingdom Guidance On Thrombosis Following Vaccinations

Cerebral Vein Thrombosis

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If you’re looking for vaccine-induced thrombotic thrombocytopenia (CVT/CVST with thrombocytopenia following AstraZeneca or J&J COVID-19 vaccine), check out this podcast.

Multicenter Cohort Study: Ferro JM et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004 Mar;35(3):664-70. Epub 2004 Feb 19. PMID: 14976332.

Utility of D-dimer:

  1. Dentali F et al. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost. 2012 Apr;10(4):582-9.PMID: 22257124.
  2. Meng R et al. Evaluation of plasma D-dimer plus fibrinogen in predicting acute CVST. Int J Stroke. 2014 Feb;9(2):166-73. Epub 2013 Mar 19. PMID: 23506130

Tranexamic acid in epistaxis

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In this episode we cover the literature on tranexamic acid (TXA) in epistaxis, including a new trial in Annals of Emergency Medicine by Reuben et al, the NoPac trial.

Other references include:

  1. Tibbelin et al. Effect of local tranexamic acid gel in the treatment of epistaxis. ORL J Otorhinolaryngol Relat Spec. 1995 Jul-Aug;57(4):207-9. PMID: 7478455.
  2. Zahed et al.A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043. Epub 2013 Jul 30. PMID: 23911102.
  3. Atabaki et al. A Comparative Study on the Effect of Topical Phenylephrine with Topical Tranexamic Acid in Management of Epistaxis. Nurs Midwifery J. 2017; 15 (7) :488-496
  4. Zahed R, et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Acad Emerg Med. 2018 Mar;25(3):261-266. doi: 10.1111/acem.13345. Epub 2017 Dec 9. PMID: 29125679.
  5. Akkan S et al. Evaluating Effectiveness of Nasal Compression With Tranexamic Acid Compared With Simple Nasal Compression and Merocel Packing: A Randomized Controlled Trial. Ann Emerg Med. 2019 Jul;74(1):72-78. doi: 10.1016/j.annemergmed.2019.03.030. Epub 2019 May 9. PMID: 31080025.
  6. Amini et al. Topical Tranexamic Acid versus Phenylephrine-lidocaine for the Treatment of Anterior Epistaxis in Patients Taking Aspirin or Clopidogrel; a Randomized Clinical Trial. Arch Acad Emerg Med. 2020 Nov 19;9(1):e6. PMID: 33313573; PMCID: PMC7720853.
  7. Whitworth et al. Comparative Effectiveness of Topically Administered Tranexamic Acid Versus Topical Oxymetazoline Spray for Achieving Hemostasis in Epistaxis. J Emerg Med. 2020 Feb;58(2):211-216.