Panic Value: INR

One of my favorite phone calls in the ED is the INR of 4 on an otherwise stable, coumadinized patient. Especially when they are going to be admitted for unrelated reasons. While I certainly understand why the lab calls, my action plan is relatively simple: continue to not give the patient coumadin.

Some background information about me:

• I'm an emergency resident chief at a large university hospital in Manhattan with tight copyright control, a view of central park, and affiliated with large public hospital in Queens
• clinical interests include airway, critical care, and focused ultrasound
• broader interests are healthcare delivery & policy, i.e. the meta-issues of who to practice airway, critical care, and focused ultrasound on
• other relevant overlapping areas of interest include education and pall care
• general philosophy is the intersection of EMCrit & SMART-EM, sprinkled with Emergency Medical Abstracts and obscure movie references
• some specific topics I enjoy include crowding, unhelpful/harmful treatments (e.g. lasix in CHF, BB in MI, and PPIs in GIB) and tests
• incidentally, I edit the Images of the Week at emedcentral

Enjoy-

- nst