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                Skip to content skip to navigation home about journals european critical care & emergency medicine emergency medicine & critical care partners search site search this site: login | register specialties anesthesia and analgesia cardiac emergencies critical care diagnostic testing and imaging emergency department management hemostatic management infection control neurological emergencies psychiatric emergencies respiratory and airway management sepsis trauma wound care treating hemophilia emergencies michael a coyne emergency medicine & critical care , 2005:80-83 download pdf hemophilia is a coagulation disorder caused primarily by a deficiency of one of two circulating plasma proteins – either factor viii or factor ix. Hemophilia caused by factor viii deficiency is ‘classic’ hemophilia or hemophilia a. Hemophilia resulting from a deficiency in factor ix is called hemophilia b, or christmas disease. Patients with hemophilia are unable to produce the specific clotting factor protein critical to the functioning of the intrinsic coagulation cascade. They are otherwise normal. That pathway becomes activated when blood comes into contact with collagen, a substance that is exposed when the inside lining of a blood vessel is damaged. Bleeding in individuals with hemophilia is protracted and may be life- and limb-threatening. Treatment consists of prompt replacement of the missing clotting factor or, for some patients with mild hemophilia a, administration of desmopressin. Challenges for emergency physicians the evaluation of persons who present to the emergency department (ed) with hemophilia requires special knowledge and expertise. A failure to understand the subtle medical complexities of hemophilia not only increases the patient’s risks of bleeding-related morbidity and death, but presents a preventable and unnecessary legal risk to the clinician. Patients may present for treatment of a specific bleeding-related problem or they might have an injury or require a procedure that will result in delayed bleeding complication, which the physician must anticipate and recognize. Understanding the indications for factor replacement therapy makes decision analysis simpler and improves patient outcome. It is important to keep in mind that diagnosis of a specific bleeding episode will typically be founded on patient history. In the early stages of hemorrhage, whether it appears in the joints, soft tissue, or central nervous system, abnormal physical findings will often not be present. If the history of an injury suggests that bleeding may develop, factor replacement should be administered immediately. When in doubt, physicians should admini. online prescriptions for viagra buy viagra canada buy viagra generic viagra prices generic viagra overnighted generic viagra fast shipping viagra without prescription online usa canada viagra no prescription 100 mg generic viagra