Note: This post has been featured on MedPage Today, with personal commentary provided within the piece.For those of you who may have missed it on Twitter yesterday, the Drug Enforcement Administration (DEA) has officially classified tramadol as a Schedule IV substance within the United States under the Controlled Substance Act, which will be effective as of August 18 of this year. You may be wondering, “So, what’s the big fuss about tramadol that led to [...]

I am generally pretty good about not letting my personal life affect my work environment. As we all know, the combination is not usually a great one, especially if things occurring your personal life impact your approach to work, your attitude with others that you are working with, and the work being produced. However, once a year, without fail, the creep of my personal life into my work and professional life occurs. No matter how [...]

Listen to the podcast by clicking on the link below (listen to iTunes here): Episode 2: Counting Stars, Not Dollars: EMP Interventions Show Notes: From the ASHP Guidelines on Emergency Medicine Pharmacy Services (my emphasis in bold): Research on pharmacist interventions in the inpatient setting has demonstrated improvement in patient outcomes through optimized pharmacotherapy regimens, improved monitoring of medication therapy, and avoidance of adverse medication events. In addition, pharmacist participation in patient care has been shown to significantly reduce the costs associated with [...]

The link to the podcast in iTunes is here.Episode 1: The Next Step in Upstairs Care, DownstairsShow Notes:The research and evidence for emergency medicine pharmacists is out there in mass quantity. The ASHP Emergency Care section has done the most complete collection of the existing data and links to the manuscripts.(http://www.ashp.org/emergencycare)Selected citations:Medication errors occur in up to 60% of ED patients - Patanwala AE, Warholak TL, Sanders AB, et al. A prospective observational study of medication [...]

Drug delivery has always been a fascinating subject for me. Some of us may take for granted the countless hours dedicated toward the research, design, and development of new drugs and delivery systems in order to optimize the ability for a drug is able to reach its site of action; essentially, to make sure that the drug that we think will work will actually "do its thing." One such mechanism of enhancing drug delivery is [...]

Part of my responsibility as a pharmacist for the ED includes reviewing medication-related incident reports. I recently came across one case in which a nurse administered 0.3 mg of 1:1000 epinephrine for an anaphylactic reaction by the intravenous (IV) route instead of the intended intramuscular (IM) route. The nurse that gave the medication immediately recognized the error, called the ED attending physician to the bedside, and the patient was closely monitored until the effects of [...]

Pharmacists exist in somewhat of a gray area in terms of the care of emergency department patients. In no other environment are pharmacists generally absent in the medication use process as in emergency departments. Yet, the very nature of the atmosphere of emergency medicine can produce significant and unnoticed medication errors. As pharmacists practicing in the emergency department, we tend to have a different point of view from other clinicians on the team. While the [...]

Medical education is currently undergoing a period of transition. The idea that the current system in place in the way we educate students needs improvement is catching on. Whether some folks like it (or not), the "traditional" ways in which we educate students is simply not working. Hours of homework, long lectures in the didactic setting, and memorizing information only to be regurgitated for the purposes of an examination...how does this benefit our students? In [...]

Many clinicians in institutions across the country are still struggling with the after effects of the IV nitroglycerin (NTG) shortage and are seeking alternative treatment options. We provided an extensive review of a number of agents that can be used as alternatives to IV NTG: topical NTG paste (with a dose conversion from IV NTG to inches of paste), nesiritide, and nicardipine. However, there was one agent noticeably absent from our review. Until now.  Sodium [...]

The bat phone rang. I went around the corner to take a listen. The medics proceeded with their story of a 53-year-old female who experienced an acute onset of nausea, vomiting, near syncope with diffuse itching and a growing erythematous rash after taking prednisone. ABCs were maintained, and vital signs included a blood pressure of 153/80, pulse of 65, respiratory rate of 16, and oxygen saturation of 95% with 4 L of oxygen via nasal [...]