The coagulation cascade, at least the way I learned it in pharmacy school, needs to be burned. The next time you’re looking at an adaptation of this pathway, point out the platelet. If you can’t, don’t continue to read that source. 66 year old male being discharged from the ED with diagnosis of DVT. Will be started on oral anticoagulation, and followed in clinic. Which DOAC is preferred and should there be any bridge with [...]
Anticoagulation Reversal Survey Help
EM PharmD Core - Acute Severe Asthma
Reflections on 10 years as a pharmacist.
Warm and wet just sounds weird to me. Not only does it allow the mind to drift to undesirable places, it also isn’t reflective of real practice. Whenever I open a pharmacy based text or review article regarding acute decompensated heart failure (ADHF), the first section invariably begins to discuss the Forrester Classification.[1] While it’s a useful visual learning tool, the routine dropping of Swan-Ganz catheters is no more. And who knew Frank Starling is [...]
Sir William Osler said it best, that learning medicine without books is like going to sea without a map, but learning medicine without patients is like not going to sea at all. Learning any aspect of medicine without the proper context of a real patient, is just learning facts then having to figure out how they fit together later. Similarly, without proper framing of what your role is, a given subject can become overwhelming. Breaking [...]
An 80-year-old male arrived at the Emergency Department (ED) in a serious condition: he was coughing up blood. Although he coughed up about three tablespoons (50cc/hr), he was hemodynamically stable. A physician approached me with an unfamiliar question: “Could we give him nebulized TXA?” I looked at him for a moment, nonplussed. “What?!” I exclaimed, “Hold on—let me look it up and get back to you.” Questions flooded my mind: Is it effective? Is it [...]
Nausea and vomiting is a common chief complaint in the ED, one I never really paid much attention to unless prompted (appropriate agent to use in pregnancy, which medication to use for a patient with a prolonged QTc, etc.) - at least, that was my practice before I began practicing in Miami. In one of the many unforgettable cases I have had in the ED, there was a young patient who presented with nausea and vomiting. [...]
We have all been there, a patient with so many complicating factors that it’s difficult to choose the least worst option to treat a urinary tract infection. For example: a patient with a CrCl ~22 ml/min, a prolonged QTc, sulfa allergy (described as immediate death), and amoxicillin allergy (also somehow described as immediate death) who absolutely refuses to try a cephalosporin. How is it this difficult to treat a simple urinary tract infection?!?!?! There is [...]
In two previous post, I outlined my impressions of High-Yield Med Reviews based on my experience going through the modules and webinar. While I still stand behind my evaluation of HYMR, my assessment was somewhat limited because it was all before the exam. Now that I have my scores, I feel I can give a more complete assessment of HYMR. In a nutshell: I passed, and highly recommend HYMR. In the final days before the exam, [...]
