To me, writing this blog has been a quest to determine of the meaning of being an "EM pharmacist", a tool to improve my writing and motivation to continue to reading everything and anything.  In the months since we started, Nadia and I have received both praise and criticism that have helped us stay on point, and importantly, helped us frame arguments to establish everything FOAMed as an form of scholarly activity. Many of those [...]

A 35-year-old patient presents to your emergency department with complaints of right upper quadrant abdominal pain and nausea that has persisted for the past three days. He states that he came "straight to the ED after having just stepped off the plane" upon arriving back in the States from a week-long vacation in Mexico. He also states that he consumed quite a few alcoholic beverages on his flight home to help "stave off" some of [...]

"An IO for you, and an IO for me..." It is amazing how a series of tweets regarding a topic of interest can inspire a literature hunt leading to a blog post. Case in point:     This exchange led me to wonder about other medications, besides those that we typically use for cardiopulmonary resuscitation (CPR) that can be effectively administered via the intraosseous (IO) route. After conducting a rather extensive literature search on the [...]

In light of the JAMA and NEJM articles that have been recently published regarding outcomes associated with therapeutic hypothermia (TH) status post-cardiac arrest, I figured this would be a good time as any to cover complications associated with this phenomenon- namely, shivering. As we all know, the goal in TH status post-cardiac arrest is to reach a goal core body temperature between 32 and 34 degrees Celsius for a period of 12 to 24 hours in [...]

In light of the JAMA and NEJM articles that have been recently published regarding outcomes associated with therapeutic hypothermia (TH) status post-cardiac arrest, I figured this would be a good time as any to cover complications associated with this phenomenon- namely, shivering. As we all know, the goal in TH status post-cardiac arrest is to reach a goal core body temperature between 32 and 34 degrees Celsius for a period of 12 to 24 hours in [...]

In a story featured on NPR yesterday, news of additional warning information on labeling for oral emergnecy contraception in Europe has raised questions as to why similar label changes have not yet occured in the USA. The story focuses on a recent meta-analysis [1] that describes the effectiveness of the oral emergency contraceptives levonorgestrel (Plan B) and ulipristal acetate (Ella). In this case, I must agree with the FDA, that there is not enough data [...]

With all the controversy surrounding the questionable association of mortality associated with the use of etomidate for the purposes of induction in the septic patient, it only seems reasonable to recommend alternative agents in this setting...or design therapeutic analogues. Enter carboetomidate. Carboetomidate is a derivative of etomidate that contains a pyrrole ring in its structure, as opposed to an imidazole ring that is found in etomidate. What is the significance of this? It has been [...]

The first drug that I ever had clinical experience with was flumazenil. It was as a student during my final year of pharmacy school, and it occurred while I was on my clinical practice rotations. We had a patient on our ward service who had an MRI and was extremely lethargic following the procedure. We soon discovered that our patient received more lorazepam than he could tolerate prior to the procedure, which seemed to be [...]

Expanding on a previous post where we discussed the importance of IM administration of epinephrine for anaphylaxis (vs subcutaneous), I wanted to discuss epinephrine auto-injectors for in hospital use.The mechanism and effects of epinephrine for anaphylaxis is several fold.[1]  Through alpha-1 agonism, vasoconstriction followed by increased peripheral vascular resistance leads to increased blood pressure as well as limiting the degree of mucosal edema. Beta-1 agonism increases the inotropy and chronotropy, and beta-2 agonism leads to [...]

In an earlier post, the nuances associated with the administration of Kcentra was discussed. One point of contingency was associated with the dilution and rate of infusion of Kcentra. The package insert provides the following information with regards to the rate of administration: "Administer by intravenous infusion at a rate of 0.12 mL/kg/min (approximately 3 units/kg/min) up to a maximum rate of 8.4 mL/min (approximately 210 units/min)." The package insert also provides additional information with [...]