Standard technique for transferring a medication from a glass ampule involves swabbing the ampule with isopropyl alcohol and breaking the neck of the ampule with the alcohol pad or gauze. The problem that many can attest to is the glass breaking in a way that punctures through the pad or gauze and cuts into one’s digits.Not only is this a painful issue, but there are other considerations when a member of the team cuts themselves: [...]

In my opinion, pharmacist "interventions" are a bad thing. While there are many reasons behind this, but I prefer creating a culture of open, prospective discussion rather than reactive drug policing. If I approach a prescriber in the ED, I'm greeted with "What did I do now?" I'm doing something wrong. Discussing new papers, institutional protocols, sharing interesting patient cases, or you know, general human-to-human conversations are great opportunities for taking about drug therapy approaches, new [...]

There are two kinds of people in the emergency department: those who are advocates of intravenous tPA for the treatment of acute ischemic stroke, and those who aren’t. Among twelve large clinical trials, only two have demonstrated statistically beneficial results of systemic thrombolytics in the setting of acute ischemic stroke: NINDS and ECASS III [1,2,3]. Despite the lack of robust high quality evidence, current American Heart Association/American Stroke Association guidelines recommend the administration of intravenous [...]

Diabetic ketoacidosis in patients with presenting serum blood glucose less than 200 is not common. Particularly when practicing in the Bible/Diabetes belt of the United States. This euglycemic DKA (euDKA) is more often associated in patients with type 1 diabetes in conjunction with starvation and acute illness.[1] It's difficult to determine an incidence of euglycemic serum glucose among all DKA cases in the literature given the migration of the serum glucose cutoff from 300 or less [...]

Ondansetron is the most documented medication given in emergency departments throughout the United States.1 We have all heard someone ask, “Can I get an order for 4 and 4 for this patient?” in reference to 4 milligram (mg) of intravenous (IV) morphine and 4 mg of IV ondansetron. It has become common practice in many institutions to provide a prophylactic antiemetic prior to administering an IV opiate. All opiates carry a FDA warning that nausea [...]

Say you have a patient who consumed almost an entire gallon of antifreeze over a span of 24 hours. Even Animal House’s Blutowski would be concerned, given that an adult who inadvertently sips 10-30 mL of antifreeze should be referred to the emergency department for evaluation of potential toxicity [1]. Initial lab results reveal an ethylene glycol (EG) level of 76 mg/dL, arterial pH of 6.9, and a serum bicarbonate level of 7 mmol/L. The [...]

This week I had an opportunity to waive my pharmaco-nerd flag with the online release of the ARISE trial.  I could have bought myself a psych eval ticket the way I was running around my shared office with the other pharmacy faculty, printing off copies to share in the ED and asking everyone else what they thought of ARISE, ProCESS and what... oh God what will ProMISE show!? But my excitement aside, the paper should be read [...]