Chan EW, et al. Intravenous Droperidol or Olanzapine as an Adjunct to Midazolam for the Acutely Agitated Patient: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial.  Ann Emerg Med. 2013 Jan;61(1):72-81.   https://youtube.googleapis.com/v/Uw3eaTUx3DA&source=uds

In an earlier post, the nuances associated the abuse potential of tramadol and its new schedule IV status, a decision made by the Drug and Enforcement Agency, was discussed. The safety of tramadol in terms of its risk for inducing seizures is a topic that is not clearly understood. Tramadol can cause seizures in overdoses because of the possible induction of serotonin syndrome and/or the modulation of monoamine reuptake inhibition. Tramadol does so by acting [...]

Background:Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac abnormality that manifests itself as a conduction irregularity found between the sinoatrial (SA) and atrioventricular (AV) nodes.  In an otherwise healthy heart, electrical conduction begins at the SA node, which is located in the right atrium.  An electrical pulse is then sent downward causing the atrium to contract and subsequently reaching the AV node, which acts as the connecting catalyst to allow the electrical pulse to reach the [...]

Note: An edited version of this post has been featured on MedPage Today. As much as it is may be difficult to ignore the fact that traditional systematic reviews and meta-analyses are full of flaws, they have become the bread and butter for not only the purposes of referencing, but also the very basis of why most of us clinicians practice the way we that we do. It becomes very easy to state, “In a meta-analysis conducted [...]

Listen to the podcast by clicking on the link below (link on iTunes available here):  EMPOWER Episode 4 - Rapid Oral Loading of Antiepileptic Drugs (AEDs) in the Emergency Department Show Notes: Core content from this episode discussed in: DiPiro's Pharmacotherapy, 9th Edition, Chapter 40 Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition, Chapter 21 Selection portions of Winter's Basic Clinical Pharmacokinetics, 3rd Edition ACEP Clinical Policy (updated in 2014): Huff JS, Melnick [...]

Flecainide and propafenone are the only Class Ic antiarrhythmic drugs (AADs) available in the United States. These agents block the fast sodium channels within cardiomyocytes, thereby decreasing the rate of rise and magnitude of the action potential. This causes a slowing of conduction velocity, without increasing the effective refractory period. While these agents are particularly useful for atrial fibrillation (AF) and atrial flutter, utilization remains low because their contraindications exclude many patients who would otherwise [...]

Topical antibiotic therapy for ear infections isn’t something you’re going to see as an earth shaking presentation at a good conference, or in a heated debate between the Swami and anyone who dare challenge him. It’s not even something that you would think is driven by dogma and anecdote rather than evidence.  Rarely is it even a thought that is questioned upon reviewing an order or writing a prescription. Generally, the whole subject is held [...]

For those of you who participated in the EM PharmD JC, thank you!Here is the video of the Google Hangout. If you have any questions or comments for the JC or to add to the discussion, please feel free to write in the comments in the Google+ feed of the event page or Twitter using the #EMPharmD hashtag. The citations for the articles again were:Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid [...]

Please join us tomorrow (Wednesday, August 13th) at 2:00 PM EST for the EMPharmD JC.  We will be discussing the following articles:Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009 Jul 25;374(9686):293-300. PMID: 19573904ANDCohen L et al. The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic Review. Ann Emerg Med. 2014 Jul [...]

So you have a patient who presents to your emergency department after being brought in by EMS with a three-day history of nausea and vomiting. The patient has had what he describes as a “pretty rough weekend” and admits to have consumed large quantities of alcoholic beverages. While you are examining the patient, the patient has two episodes of tonic-clonic seizures, both episodes subsiding with administration of benzodiazepines. Labs are collected, and the complete metabolic [...]