Case 4 (August 18, 2013): Case Management Commentary Objective Data

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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 case management commentary follows the initial patient presentation posted August 18th and includes commentary about blood management in this patient. If you encounter a problem with the box download, notify me at djadwin@columbia-analytics.com. This material is Copyright 2013 by Columbia Healthcare Analytics, Inc. and may not be used for other purpose without permission.

Objective Data

Row 18: Initial Hemoglobin 10.1 gm/dL, MCV 92 and INR 5.7, 5 hours 30 minutes after ER triage.

Row 25, 26: Vitamin K 10 mg SQ is ordered but recorded as administered IM.

Row 12, 30: Home medications listed as “warfarin”, but no dose or indication of last dose.

Row 37, 48, 59, 65: Four units plasma administered 3:45, 4:40, 5:25, and 5:50 hours post-admission.

Row 73: Hemoglobin 8.9 gm/dL and INR 2.3, 7:13 hours post-admission.

Row 75: Hemoglobin 9.1 gm/dL, 9:42 hours post-admission.

Row 76: Trans-esophageal echocardiogram initiated 9:49 hours post-admission, with large circumferential pericardial effusion with pre-tamponade physiology.

Row 77: INR 2.2, 7:13 hours and 11:22 hours post-admission.

Row 79: Patient consent for transfusion obtained 13:45 hours post-admission, 10 hours post first plasma transfusion.

Row 82, 92: Two units plasma administered 14:00 and 15:10 hours post-admission.

Row 95: Ultrasound-guided pericardiocentesis initiated 15:34 hours post-admission.

Row 103, 108: Two units plasma administered 16:54 and 17:08 hours post-admission.

Row 117: Hemoglobin 8.8 gm/dL and INR 1.8, 18:07 hours post-admission.

Row 120: Ultrasound-guided pericardiocentesis (3 hours 17 minutes) concluded, 18:51 hours post-admission.

Row 121: Pericardiocentesis 18:52 hours post-admission.

Row 123: Hemoglobin 8.3 gm/dL, 20:16 hours post-admission.

Row 132: Hemoglobin 7.3 gm/dL and INR 1.8, 30:56 hours post-admission.

Row 136, 146: Two units PRBC administered 32:37 and 38:00 hours post-admission.

Row 152: Hemoglobin 9.3 gm/dL, 41:00 hours post-admission.

Row 159: Hemoglobin 8.5 gm/dL and INR 1.7, 55:26 hours post-admission.

Row 162: Hemoglobin 9.2 gm/dL, 60:16 hours post-admission.

Row 167, 177: Two units PRBC administered, 18:55 and 22:50 hours post-admission.

Row 187: Hemoglobin 11.4 gm/dL and INR 1.4, 79:34 hours post-admission

Row 189: Discharged; 3.6 day hospital length of stay.