Pharmacological management of cerebral venous sinus thrombosis with full-dose IV heparin infusion and its clinical outcomes.

OBJECTIVE: To report a case of successful use of unfractionated heparin (UFH) infusion to treat cerebral venous sinus thrombosis (CVST). CASE SUMMARY: A 54-year-old female with a history of ovarian cancer addressed through palliative care, presents to the Emergency Department complaining of nausea, vomiting and headache for the last 72h. The patient was on a home regimen of enoxaparin 1.5mg/kg subcutaneously daily for recent pulmonary embolism and deep vein thrombosis that developed while on warfarin therapy previously. CT scan showed superior sagittal sinus thrombosis. UFH infusion was initiated and continued for 48h until the headache dissipated. DISCUSSION: Stable CVST may be treated with UFH infusion; however, there is limited literature that describes UFH dosing for CVST management. CONCLUSIONS: UFH may be considered as one of the pharmacological agents to manage CVST. The dosing for UFH bolus and infusion is similar to treatment dose for pulmonary embolism/deep vein thrombosis management with goal anti-Xa between 0.3 and 0.7units/mL.

Location of airway management in air medical transport.

BACKGROUND: Prehospital providers are constantly challenged with the task of managing airways in unpredictable and often inhospitable environments. Air medical transport (AMT) crews must be prepared to work in restrictive spaces with limited resources while in the aircraft. This study examines flight crew success rate and circumstances surrounding airway management in different locations. METHODS: This was a retrospective analysis of intubations performed by a university-based air medical transport team from January 1, 1995, to May 31, 2007. Patient records and prospectively gathered airway management quality assurance data were reviewed for location of intubation, patient characteristics, and success rates. Success was defined as placing a cuffed tube in the trachea nonsurgically. RESULTS: Nine hundred thirty-eight patients required 939 advanced airway management procedures, and 936 cases had information sufficient for analysis. Six hundred twenty-seven (67%) of these intubations took place on scene, 235 (25.1%) at the referring hospital, 67 en-route (7.2%), and seven (0.7%) at the receiving hospital. The overall intubation success rate was 96% and the highest rate was for hospital intubations (98.8%), followed by scene (94.9%) and en-route (89.6%) airway encounters. Intubation success was more likely in the hospital setting (odds ratio [OR] = 8.7, 95% confidence interval [CI] 2.2-35.0, p = 0.002] and on the scene [OR = 2.3, 95% CI 0.95-5.7, p = 0.065] compared with those en-route. Unanticipated patient deterioration was noted as the most common reason for in-flight airway management. Type of aircraft was not significantly associated with intubation success (p = 0.132). CONCLUSIONS: Airway management was performed with a high success rate in a variety of locations and patient characteristics by our air medical crew. When in the hospital environment, flight crew success rates were comparable to those of other emergency personnel. Caution should be used, however, when considering intubating in-flight because of slightly lower success rates.