Emergency medicine is one of the most important fields in health care and an essential component of many hospitals. In this fast-moving discipline, emergency physicians provide care to patients in life-threatening situations. In order to treat critically-ill patients, physicians must be prepared for a number of unpredictable situations, and very often, acute major bleeding.
To learn more about the significance of emergency medicine, we sat down with Jim Williams, MS, DO, FACEP, Senior Medical Director, US Field Physician Acute Care Team.
Q: What is emergency medicine? What do emergency physicians do and who do they treat?
A: Emergency care can include anything from a simple suture repair to resuscitation of a dying patient, and emergency physicians care for patients 24 hours a day, seven days a week, 365 days a year. They attend to any patients in need of acute care. Our specialization—which has been around for 55 years—focuses on evaluating, diagnosing, and treating acutely ill patients.
Q: What types of patients do you commonly care for in the emergency room?
A: Some of the most common critically ill patients we care for are trauma patients, stroke patients, those with acute major bleeding, those with sepsis (a life-threatening infection), and heart attack patients. In particular, I’d like to highlight stroke and trauma patients.
Stroke is the fifth leading cause of death in the United States and a major cause of disability.1 It can severely limit a patient's quality of life it is often associated with severe complications. Symptoms include facial drooping, arm weakness, leg weakness, slurred speech, altered mental status, and acute headaches.2 If anyone experiences these symptoms, they should call 911 and go to the emergency department immediately for the best possible treatment and outcome. We often emphasize that time is brain – the more time elapses, the more brain cells die, the worse the disability and possibility of death.3
Trauma can include things like a fall while going to the bathroom or a car accident, both of which can result in acute major bleeds. Traumatic accidents are a particular concern for patients taking direct oral anticoagulants (DOACs), as most of these patients are older and have other medical issues.4
Q: How are stroke and trauma patients treated in the emergency room?
A: For patients experiencing a hemorrhagic stroke, when a weakened vessel ruptures and bleeds into the surrounding brain5, it's essential to control the bleeding and minimize the impact on the brain. After initial evaluation and stabilization, there are two main treatments: blood pressure control and reversal of anticoagulation. It's critical that emergency physicians manage acute major bleeds as soon as possible to reverse the anticoagulation effect and minimize the bleed and expansion of a hematoma, or a collection of blood outside of a blood vessel following an injury.6 This is directly related to a patient's outcome.7 For trauma patients, treatment should be started as soon as possible to minimize complications.8
Q: What are the risks of DOACs that patients need to be aware of?
A: Millions of people worldwide depend on blood thinning medication to prevent harmful blood clots from forming, but these agents also carry a small but significant risk of increasing the likelihood that an acute major bleed could occur.9 One of the most feared complications of anticoagulant use is bleeding in the brain or hemorrhagic stroke.10 The most common complication is bleeding from the gastrointestinal tract or anywhere from the stomach, small intestine, to large intestine. Sometimes this can be mild, but other times it can be as severe as a gunshot wound with a patient experiencing life-threatening bleeding.11
Q: How can patients on DOACs and hospitals be prepared in case of emergency?
A: It's critical that patients be aware of the risks of DOACs and whether their hospital has antidotes for DOACs available in case they are needed. It's also helpful for patients to have a wallet card listing their medications or a list on their refrigerator so paramedics or family can quickly grab this information in the event the patient is unable give it themselves.
Physicians and their hospitals have a responsibility to provide the best possible care to their patients, making informed treatment decisions based on clinical trial data and guideline recommendations. Physicians can advocate for critical treatment to their hospital leadership and Pharmacy & Therapeutics committee to ensure their hospitals have access to life-saving medication on formulary. I recommend increasing awareness and education among prescribers about the risks of DOACs and the antidote that can reverse the effects of DOACs when needed.
Here at AstraZeneca, we are committed to improving patient outcomes, recognizing the importance of emergency medicine, and advancing the science behind reversing uncontrolled bleeds.
References
- American Stroke Association. About Stroke. [Cited 2023 May 26] Available from: URL: https://www.stroke.org/en/about-stroke
- American Stroke Association. Stroke Symptoms. [Cited 2023 May 26] Available from: URL: https://www.stroke.org/en/about-stroke/stroke-symptoms
- Saver, Jeffrey. Time Is Brain – Quantified. Stroke. 2006;37:263–266.
https://doi.org/10.1161/01.STR.0000196957.55928.ab - Torn M, Bollen WLEM, van der Meer FJM, van der Wall EE, Rosendaal FR. Risks of Oral Anticoagulant Therapy With Increasing Age. Arch Intern Med. 2005;165(13):1527–1532. doi:10.1001/archinte.165.13.1527
- American Stroke Association. Hemorrhagic Stroke (Bleeds). [Cited 2023 May 26] Available from: URL: https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds
- American Blood Clot Association. Hematomas. Cited 2023 May 26] Available from: URL: https://bloodclot.org/hematomas/
- American Stroke Association. Why Getting Quick Stroke Treatment Is Important [Cited 2023 May 30] Available from: URL: https://www.stroke.org/en/about-stroke/types-of-stroke/is-getting-quick-stroke-treatment-important
- Medscape. Initial Evaluation of the Trauma Patient. [Cited 2023 May 30] Available from: URL: https://emedicine.medscape.com/article/434707-overview
- National Blood Clot Alliance. Bleeding Risk Survey 2020. [Cited 2023 May 26] Available from: URL: https://www.stoptheclot.org/news/bleeding-risk-survey/
- Robert G. Hart , MD , Bradley S. Boop , MD , and David C. Anderson , MD. Oral Anticoagulants and Intracranial Hemorrhage. Stroke. 1995;26:1471–1477. https://doi.org/10.1161/01.STR.26.8.1471
- Xu Y, Siegal DM. Anticoagulant-associated gastrointestinal bleeding: Framework for decisions about whether, when and how to resume anticoagulants. J Thromb Haemost. 2021;19(10):2383-2393. doi:10.1111/jth.15466