Question

A 60-year-old man presents to the ED after accidentally cutting his left index finger with a knife while cutting onions. A 3-cm laceration through the finger pad actively bleeds if pressure is released. There is full range of motion of the DIP, good two point discrimination, and distal capillary refill. He tells you that he takes coumadin $5.0 \mathrm{mg}$ every day since he had a deep venous thrombosis 5 months ago. He has not had his INR checked in 3 months. He denies chest pain, shortness of breath, or new leg swelling. You send a stat PT and INR and have the patient apply pressure while you prepare to anesthetize and clean the laceration. The INR is 6 . Which of the following is the MOST appropriate action? (A) Repair the laceration and instruct the patient to skip the next dose of coumadin. (B) Repair the laceration and instruct the patient to contact his private provider as soon as possible. (C) Repair the laceration and administer oral vitamin K 1-2 mg. (D) Repair the laceration and administer intravenous vitamin K 5-10 mg slowly.

   A 60-year-old man presents to the ED after accidentally cutting his left index finger with a knife while cutting onions. A 3-cm laceration through the finger pad actively bleeds if pressure is released. There is full range of motion of the DIP, good two point discrimination, and distal capillary refill. He tells you that he takes coumadin $5.0 \mathrm{mg}$ every day since he had a deep venous thrombosis 5 months ago. He has not had his INR checked in 3 months. He denies chest pain, shortness of
breath, or new leg swelling. You send a stat PT and INR and have the patient apply pressure while you prepare to anesthetize and clean the laceration. The INR is 6 . Which of the following is the MOST appropriate action?
(A) Repair the laceration and instruct the patient to skip the next dose of coumadin.
(B) Repair the laceration and instruct the patient to contact his private provider as soon as possible.
(C) Repair the laceration and administer oral vitamin K 1-2 mg.
(D) Repair the laceration and administer intravenous vitamin K 5-10 mg slowly.
Show more…
Emergency Medicine Examination & Board Review
Emergency Medicine Examination & Board Review
Susan Promes 3rd Edition
Chapter 11, Problem 22 ↓

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Step 1: Assess the patient's current condition and vital signs to ensure he is stable and not experiencing any signs of bleeding complications such as hypotension or tachycardia.  Show more…

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A 60-year-old man presents to the ED after accidentally cutting his left index finger with a knife while cutting onions. A 3-cm laceration through the finger pad actively bleeds if pressure is released. There is full range of motion of the DIP, good two point discrimination, and distal capillary refill. He tells you that he takes coumadin $5.0 \mathrm{mg}$ every day since he had a deep venous thrombosis 5 months ago. He has not had his INR checked in 3 months. He denies chest pain, shortness of breath, or new leg swelling. You send a stat PT and INR and have the patient apply pressure while you prepare to anesthetize and clean the laceration. The INR is 6 . Which of the following is the MOST appropriate action? (A) Repair the laceration and instruct the patient to skip the next dose of coumadin. (B) Repair the laceration and instruct the patient to contact his private provider as soon as possible. (C) Repair the laceration and administer oral vitamin K 1-2 mg. (D) Repair the laceration and administer intravenous vitamin K 5-10 mg slowly.
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