Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Anticoagulation reversal agents
Class Summary
Patients on warfarin can have their anticoagulation reversed with phytonadione.
Phytonadione (Mephyton, Konakion, AquaMEPHYTON)
Vitamin K is a necessary cofactor for gamma carboxylation in the synthesis of factors II, VII, IX, and X in the liver. Used therapeutically in RSH to treat warfarin-induced hypoprothrombinemia.
Protamine
Protamine forms a complex with heparin to create a nonreactive salt. Heparin is neutralized within 5 min of protamine administration. The duration of effect is 2 h. The half-life of protamine is less than heparin; therefore, multiple dosing may be required. LMWHs can be partially reversed with protamine.
The half-life of heparin is 60 min. Therefore, enough protamine should be administered to reverse all of the heparin administered in the last 30 min, one half of the heparin administered the previous hour, and one fourth of the heparin administered the hour before that, assuming no recent bolus.
Analgesia
Class Summary
RSHs are very painful conditions that often mimic or present as an acute abdomen. The clinician should have a low threshold for narcotic analgesia. The clinician should also recognize the theoretic complication of platelet inhibition with nonsteroidal anti-inflammatory analgesics.
Hydrocodone and acetaminophen (Lorcet-HD, Vicodin, Lortab)
Drug combination indicated for moderate to severe pain.
Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)
Drug combination indicated for the relief of moderate to severe pain.
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Rectus Sheath Hematoma. Anatomy of the rectus sheath.
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Rectus Sheath Hematoma. The Cullen sign, periumbilical ecchymosis, in a patient with a rectus sheath hematoma.
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Rectus Sheath Hematoma. Rectus sheath hematoma of the right rectus muscle. Image courtesy of Dr David Gordon.
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Rectus Sheath Hematoma. Note how the rectus sheath hematoma becomes bilobar as it dissects inferiorly (same patient as in the previous image). Image courtesy of Dr David Gordon.
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Rectus Sheath Hematoma. Ultrasound image of a rectus sheath hematoma presenting as a tender, unilateral abdominal mass. Source: Maharaj D, Ramdass M, Teelucksingh S, Perry A, Naraynsingh V. Rectus sheath haematoma: a new set of diagnostic features. Postgraduate Medical Journal. 2002;78:755-6. Reproduced with permission from the BMJ Publishing Group.
