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Paper Chase 3: Fixed Dose PCC for Emergent Warfarin Reversal

Sanjay Arora, MD and Mike Menchine, MD
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06:55
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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Kathy Garvin, RN, and Lisa Chavez, RN
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01:40

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EM:RAP 2015 November Summary 665 KB - PDF

Sometimes it can take a long time for an INR to result in a critical patient with life threatening bleeding. Since prothrombin complex concentrate is dosed according to INR, this can lead to a delay in reversal. This retrospective study found that using a fixed dose (1500 units) of PCC for all comers was safe and effective in INR reversal. Clinical outcomes were not assessed.

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daniel h. -

I guess POC testing for INR makes the waiting time a moot point?

Sean G., M.D. -

Sanjay Mike and Mel....I thought an earlier EMRAP showed that the research so far has pretty much clearly shown four factor PCC to have no clinical benefit over FFP, just a lab benefit...ie no serious bleeding events were better treated by the expensive drug then the FFP, although the INR's reversed more rapidly. I don't think a patient really cares much for the "cool factor" that their INR reversed to nl quickly. So why are we assuming we should be using this stuff? Seems like at this point in time there is no evidence to justify the increased expense..
Mel I can not tell you how much better this emrap was now that you have joined the nurses commentary section....My drive to work is like relaxing in a soothing spa at a 5 star resort, or getting a Hot Stone massage..... Your Aussie accent and jocularity is like comfort food for the ER doc....I can almost smell my mother's fresh baked chocolate chip cookies, or the smell of her steaming pumpkin pie topped with whip cream at Thanksgiving......Remember Mel....You ARE Emrap...and for many of us, it just aint the same without you.

p.s. sorry about taking those photos of you over the wall of your palatial mansion as you attempted to escape the paparazzi for a brief moment....your security fellows made their stance quite clear, and thankfully the man with the latex glove was surprisingly gentle....wont happen again.

Sean G., M.D. -

Im joking around a bit of course but I would like a serious answer from the boys on why we are using this stuff based on the research pointing towards there being no clinical benefit. If we are it seems we are ignoring evidence based Medicine....and if we are going to do that....why are we doing research?

Gary M., Jr -

My understanding is: no thaw time, no risk of infection, less volume.

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Codes and Cath Labs Full episode audio for MD edition 231:38 min - 323 MB - M4AEM:RAP 2015 November Aussie Edition Australian 26:35 min - 36 MB - MP3EM:RAP 2015 November Canadian Edition Canadian 16:25 min - 23 MB - MP3EM:RAP 2015 Español Noviembre 2015 Español 72:56 min - 38 MB - MP3EM:RAP 2015 Novembre Résumé en Francais Français 53:50 min - 32 MB - MP3EM:RAP 2015 Español Noviembre 2015 1 MB - PDFEM:RAP 2015 November Board Review Answers 263 KB - PDFEM:RAP 2015 November Board Review Questions 232 KB - PDFEM:RAP 2015 November MP3 279 MB - ZIPEM:RAP 2015 November Summary 665 KB - PDF

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