Bleeding is the most feared complication of anticoagulants. Rivaroxaban is a newer oral anticoagulant with a favorable regimen due to lack of frequent blood monitoring and fewer drug interactions. We report a case of spontaneous pericardial hemorrhage associated with rivaroxaban. Within 10 days of starting rivaroxaban for atrial fibrillation, the patient developed a life-threatening cardiac tamponade leading to shock and multiorgan failure. After urgent pericardiocentesis/drainage, the patient recovered. This case highlights the necessity of larger clinical trials and consensus guideline on monitoring the effects of novel oral anticoagulants and development of an antidote for reversal in cases of major bleeding events.

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R-134a (1,1,1,2-tetrafluoroethane) is widely used as a refrigerant and as an aerosol propellant. Inhalation of R-134a can lead to asphyxia, transient confusion, and cardiac arrhythmias. We report a case of reactive airways dysfunction syndrome secondary to R-134a inhalation. A 60-year-old nonsmoking man without a history of lung disease was exposed to an air conditioner refrigerant spill while performing repairs beneath a school bus. Afterward, he experienced worsening shortness of breath with minimal exertion, a productive cough, and wheezing. He was also hypoxic. He was admitted to the hospital for further evaluation. Spirometry showed airflow obstruction with an FEV1 1.97 L (45% predicted). His respiratory status improved with bronchodilators and oral steroids. A repeat spirometry 2 weeks later showed improvement with an FEV1 2.5 L (60% predicted). Six months after the incident, his symptoms had improved, but he was still having shortness of breath on exertion and occasional cough.

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