Sugammadex (I call it Suggs) is a selective muscle relaxant-binding agent. As a result of its chemical structure, modified cyclodextrin compound with a hydrophilic outer surface and a lipophilic central cavity, sugammadex encapsulates both rocuronium and vecuronium.  This encapsulation creates a concentration gradient by which rocuronium or vecuronium leaves the neuromuscular junction for the plasma and then subsequently bound by sugammadex (think DigiFab).  The result is a dramatically shortened duration of effect of rocuronium or [...]

We want to meet you!I'd love to hear from any readers or followers at Midyear. Or just stop by to say hi.On Tuesday I will be at the PM residency showcase at the Trinity Mother Frances Hospital PGY 1 booth (6221).Later that day, blog contributor Adam Spaulding and myself will be speaking about the evolution of the indications for ketamine in the emergency department at 4:15 in room 293.Wednesday come check out the EM pearls [...]

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 [...]

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 [...]

It’s ok to give 1 gram of vancomycin. As long as they’re obese and the dosing interval is adjusted to follow the two compartment distribution model of vancomycin. Single, double or triple? In terms of vancomycin dosing kinetics, it’s an important question.  Pharmacokinetic teachings tell us to select the simplest model and fewest compartments necessary to describe the data adequately. Thus the single compartment model is frequently used in initial dosing of vancomycin.  For the [...]

Vasopressin has gone by the way of atropine in the updated ACLS guidelines.1 But is this a reason to sachet into your next resuscitation/critical care meeting and suggest vasopressin be removed from your hospital’s crash carts? No. Don’t do it. Don’t just read the guidelines; read the primary literature. First and foremost, when we’re comparing vasopressin to epinephrine, one must remember the comparison agent (epinephrine) has not been shown to improve patient oriented outcomes, ie, neurologically [...]

The FDA is wacky. Around every corner there seems to be another head scratching approval, denial, process or event. Answering a simple question took me down a new enlightening, and hilarious path. Now, this may sound Seinfeld-ish but ‘what’s the deal with controlled substances?’Lacosamide is a newer antiepileptic drug that you have likely seen on a medication reconciliation profile of a patient to two in your emergency department by now. With this newer drug, there [...]

October represents pharmacists’ month and we’ve just concluded pharmacy week. This time honored tradition of free hospital pens and PHARMA sponsored lunches gives us time to indulge our narcissistic tendencies as a profession.  At the same time, it serves as a rally call for continued efforts in our daily professional lives. These efforts, at least for hospital based pharmacists and particularly clinical pharmacists, are simultaneously our performance measures as well as justification for continued existence.  [...]

A couple of weeks ago, I had the privilege of attending the North American Congress of Clinical Toxicology (NACCT). This is the annual conference of the American Academy of Clinical Toxicology (AACT), a multidisciplinary organization focused on all things related to treatment and management of toxins, and offers plenty of opportunities for education and research related to clinical toxicology. It is certainly worth attending this conference, and if you have a strong interest in and/or [...]

Up until relatively recently, the concept of pre-treatment medications for rapid sequence intubation has remained uncontested. The acronym “LOAD” has often been proposed as a simple way to remember and apply this concept in clinical practice – lidocaine, opioids, atropine, and defasciculating doses of neuromuscular blocking agents. While most of these (classes) of agents have sparked controversy in the literature in recent years regarding their (f)utility as pre-treatment measures in rapid sequence intubation, it may [...]