EM:RAP Emergency Medicine: Reviews and Perspectives

Do you have social workers in the ED arrange with pt's inurance company/pharmacy to make sure they can get the LMW heparin (isn't it still very expensive)? What do you do for the uninsured? Do you have the ER nurses do the injection teaching?

Hi Scott-
For insured patients, we write a script for a five day supply. For an uninsured patient who cannot afford the drug, we have our social workers arrange for the hospital to fill the prescription before the patient leaves.
As far as instruction, there is a video that explains the process and then the nurses make sure that the patient or family member can administer the drug. So instruction comes from two different sources-video tutorial and nurse education.

Thanks Rob. BTW...enjoy your segments hope you meet some great docs in Colorado to continue the series.

Could you please give me a time frame for DVT treatment duration according to the most common underlying conditions , and the veins which are involved , Thx

I'm interested to hear if anybody else is using Rivaroxaban instead of Warfarin for treatment of DVT. I've started having the discussion and offering it to patients that I'm going to send home with DVT, and I'm finding that even with the increased cost, patients are overwhelmingly choosing Rivaroxaban. I'm guessing it's because they don't like the idea of all the drug monitoring that has to go into Warfarin use, and the number of drug interactions.
Does anybody else think the idea of not using these drugs because they aren't "reversible" is silly? Warfarin doesn't really "reverse" with vitamin K for up to 24 hours, and even with FFP you don't ever get complete reversal. LMWH isn't reversed that well with protamine, but nobody hesitates to use it. We've been using drugs that can't be completely reversed immediately for years without complaint . . . and yet some of the docs I work with are using this argument for why we shouldn't use them. There's some new data coming out that says PCC works to reverse Rivaroxaban, but I haven't had the chance to really look at it yet. Share your thoughts? Thank you!

Do NOT engage Dr. Deloughery in any competition involving Broca's center.

You will get lapped.