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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, July 9, 2016

Approach to ED Paracentes

Las Vegas EM - 7/7/2016
"There are two reasons to do a paracentesis in the emergency department: a “diagnostic paracentesis” to evaluate the cause of ascites and look for evidence of infection, and a “therapeutic paracentesis” to relieve discomfort and shortness of breath in a patient with large-volume, tense ascites. The first requires only a few milliliters of fluid be removed, but the second involves removing several liters, and may make ED providers nervous about causing dangerous “fluid shifts” and resultant hypotension and electrolyte imbalances. In both cases, abnormal coagulation studies may discourage the ED provider from attempting either procedure at all. The following is what the literature and specialty societies have to say about these issues
  • Do “fluid shifts” really happen after large-volume paracentesis?
  • How many liters can you safely take off at once? 
  • So albumin really matters?
  • PT/aPTT – How high is too high? Platelets – How low is too low?"