Third Case August 11, 2013: Subsequent Patient Management

Click this link to download the case file from box.net:https://app.box.com/s/1rb9se1qh5htb7cznxcv

If you do not download the file after opening the link in box.net, then you will not be able to easily see all of the information in the file. This discussion follows the initial patient presentation posted August 11, 2013 and gives members a chance to compare how they feel the patient should be managed with how the patient was actually managed. A commentary on the patient case management will be posted later in the week.

The patient is a 56 year-old male patient with acute GI bleed and chronic anticoagulation for PE. If information is not listed in the patient case sheet, then assume that it is not recorded in the chart or is not significant. The hemoglobin is 11.6 gm/dL and the INR is 7.1, 1 hour and 42 minutes prior to admission. The hemoglobin is 9.8 gm/dL 6 hours and 08 minutes post-admission.

****ER Physician documents: Not actively bleeding/hemodynamically stable so FFP held at this time, will continue to monitor, type & screen sent, vitamin K 5 mg IV.

What key comments can be made about clinical blood management in this case?