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 [...]

I must admit that I rarely read the primary publication in the pharmacy world (Pharmacotherapy) because of its general lack of anything new or interesting.  Ground breaking clinical research is simply not published in this journal, but it does have excellent review articles that are so over the top, hyper-detail oriented and nauseatingly thorough and make obsessive clinical pharmacists drool.  The latest review (Management of Extravasation Injuries: A Focused Evaluation of Noncytotoxic Medications) is a [...]

In a post on this blog last week, the topic of the nitroglycerin shortage was discussed, with the alternative of nesiritide as offered as a potential option in the setting of this shortage for patients with acute decompensated heart failure, and the data surrounding the use of nesiritide for this indication was reviewed.Interestingly enough, we received a comment on the post that alluded to the fact that nicardipine could potentially be utilized as an alternative [...]

National drug shortages are presenting a new and unique way of considering alternative drug therapies for various disease states. Of note, the most recent drug shortage impacting EDs and sparking new debate and rehashing of old data is intravenous nitroglycerin.   IV Nitro is used ubiquitously in EDs and pre-hospital settings primarily for acute coronary syndromes and acute decompensated heart failure/acute pulmonary edema.  While other dosage forms of nitroglycerin exist, and can be applied (both practically, [...]

The blackout of the Eastern United States and Canada in August 2003. Hurricane Sandy in October 2012. The horrific events of the Boston Marathon in April 2013. What do all of these events have in common? These mass casualty events affected numerous individuals, and institutions in these affected areas had to suddenly respond to patients impacted by these events in addition to handling patients who had already been hospitalized at the time that these events [...]

Lately I’ve been on a kick of nurturing my inner Canadian by reading a few books by notable figures from the Great White North.  The first was the latest autobiography of Dr. David Suzuki (any respectable Canadian should need no explanation of who he is) and the second was a book (An Astronauts Guide To Life On Earth) written by a Canadian astronaut, Dr. Chris Hadfield, about his journey to becoming the first Canadian to [...]

Let us say that you have a 50-year-old female patient who presents to the emergency department with a history of pulmonary arterial hypertension and signs and symptoms consistent with acute decompensated heart failure. The patient presents with acute shortness of breath and is in severe respiratory distress. Vital signs include blood pressure of 182/90 and heart rate of 110. A beside ultrasound is performed, confirming the presence of significant pulmonary congestion. Non-invasive ventilation is initated [...]