Originating in anesthesia, promoted in emergency medicine by EMCrit.org and EMRAP, the utilization of push dose pressors has been growing. While there doesn’t exist much data to back up its use, I think the clinical experience speaks for itself.  In my experience has been generally good with recommending push dose phenylephrine aka. “Neostick,” if the dose is appropriate (80-100 mcg, not 20mcg) and the timing is appropriate (not after hours of hypotension).  Likewise, expectations of [...]

A patient is wheeled into your trauma bay after a nasty head-on collision on a major highway. According to the paramedics, the downtime and length of anoxia in the patient is unknown, and because of this, the patient is intubated. Vital signs are unobtainable, and pulses are lost on the scene. The patient is now in pulseless electrical activity (PEA), and cardiopulmonary resuscitation is initiated. The decision is made to perform an emergent thoracotomy. The [...]

A patient is wheeled into your trauma bay after a nasty head-on collision on a major highway. According to the paramedics, the downtime and length of anoxia in the patient is unknown, and because of this, the patient is intubated. Vital signs are unobtainable, and pulses are lost on the scene. The patient is now in pulseless electrical activity (PEA), and cardiopulmonary resuscitation is initiated. The decision is made to perform an emergent thoracotomy. The [...]

Very little of what we do on a daily basis, as pharmacists, fit into discrete silos.  In contrast to our didactic education (or mine, at least), chapters are studied focusing on specific disease states, medication classes are analyzed individually and cases are discussed with rarely more than one problem.  Of course learning to walk before you run through study and comprehension of the basic components and methods of problem solving is critical. However, it leaves [...]

Let us say that you have a patient who presents with cardiac arrest with a rhythm of pulseless electrical activity. After going through a mental checklist of the 6Hs and 6Ts, you are highly suspicious that the patient has experienced a pulmonary embolism, and the decision is made to administer alteplase. You are informed that the rectal temperature of the patient is 32°C.  An interesting question can be posed from this situation. What bearing do [...]

While in pharmacy school, I was fortunate enough to have an athletic scholarship. Balancing the responsibility to workout before and after class four days per week, compete on the weekend and study in-between was certainly challenging. But being a pharmacy student-athlete, I found, to be more interesting and though provoking by marrying the two together: pharmacy and athletics - drug/supplements and performance.Most athletes competing at a high level are focused on improving themselves, through both [...]

Reaching for that vial (or two) of glucagon to manage the patient who presents to your emergency department with an esophageal foreign body obstruction (EFBO)? Think again. The first reports of its use for managing patients with EFBOs came about in the 1970s, when it was first discovered that glucagon had direct relaxation properties on the lower esophageal sphincter (LES), which is comprised of smooth muscle. This, in turn, will help decrease the resting pressure [...]

Let us take a trip down memory lane. The year: 2011 The month: January The event: Onsite interview for a PGY-1 pharmacy residency program The place: Swanky office of the residency program director It was very early in the morning, and I had a full day ahead, with back-to-back meetings with various preceptors and residents of the pharmacy residency program. It was my very first interview of several, and so I was understandably very nervous. [...]

Let us take a trip down memory lane. The year: 2011 The month: January The event: Onsite interview for a PGY-1 pharmacy residency program The place: Swanky office of the residency program director It was very early in the morning, and I had a full day ahead, with back-to-back meetings with various preceptors and residents of the pharmacy residency program. It was my very first interview of several, and so I was understandably very nervous. [...]

Even with all the therapies available for the management of septic shock, there still remains a great incidence of morbidity and mortality associated with this condition. One therapeutic agent that has been advocated for refractory septic shock is methylene blue (MB). Yes, you read that right...the same agent used as an antidote for the treatment of methemoglobinemia. Here is the low down. Nitric oxide (NO) is thought to be one of the major culprits for [...]