Case 4 (August 18, 2013): Subsequent Patient Management

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Case 4 is an 84 year-old male on Coumadin who presents with a large pericardial effusion and 5.7 INR measured 4.5 hours prior to admission, who received vitamin k 10 mg IM 10 minutes prior to admission. The patient subsequently received 3 units plasma 3:45, 5:25 and 5:50 hours post admission, prior to TEE. The TEE was performed 9:49 hours post-admission, after which 2 additional units plasma were administered prior to ultrasound-guided pericardiocentesis15:34 hours post-admission. He received two additional units plasma post-pericardiocentesis 16:54 and 17:08 hours post admission (total of 7 units of plasma) and subsequently received 4 units PRBC prior to discharge. The discharge hemoglobin was 11.4 gm/dL. The hospital length of stay was 3.6 days.

Any comments about this patient’s case management?

You must download the file after opening the link in box.net, or you will not be able to easily see all of the information in the file. This discussion follows the initial patient presentation posted August 18th and gives members a chance to compare how they felt the patient should be managed with how the patient was actually managed. A commentary on the patient case management will be posted August 20th. This material is Copyright 2013 by Columbia Healthcare Analytics, Inc. and may not be used for other purpose without written permission.