In an earlier post, I discussed some of the nuances associated with the administration of opioid analgesics (particularly morphine and hydromorphone) in the emergency department. This post will review some of the studies that have been recently conducted to evaluate the safety and efficacy of these agents for acute pain management in patients who present to the emergency department.  Hydromorphone:Chang AK et al.; Ann Emerg Med 2013: This was a prospective study that evaluated the safety and [...]

Very quietly, an article that many EM clinicians have been waiting for was recently e-published in the journal Circulation and with no fanfare and no fancy acronym in the title. I am referring to the new [to the United States] and hot drug that has gotten a lot of press in terms of its potential for use in the emergency department that has been cited in the package insert since it first was approved by [...]

After the inclusion of Kcentra to the armamentarium for acute reversal of anticoagulation, a few practical issues have come up that are worth sharing. 1) Product contents:Depending on the products previously used at a given institution (here it was Profilnine), there are several differences in the contents compared to Kcentra. One particular of note is that Kcentra contains approximately 40 units of heparin for every 500 FIX units.  Therefore a patient could receive anywhere from [...]

http://www.pharmacytimes.com/contributor/craig-cocchio-pharmd/2014/10/classifying-the-safety-of-drugs-in-pregnancy

When I was a little kid, I was always asked the question, “So what do you want to be when you grow up?” I would answer emphatically, “That’s easy- a journalist.” Why? I have always found the profession to be quite fascinating. The work that it entails- researching and writing to deliver a news story to be shared with an audience of readers, listeners, and viewers- is right up my alley. Even as a kid, [...]

When I was a little kid, I was always asked the question, “So what do you want to be when you grow up?” I would answer emphatically, “That’s easy- a journalist.” Why? I have always found the profession to be quite fascinating. The work that it entails- researching and writing to deliver a news story to be shared with an audience of readers, listeners, and viewers- is right up my alley. Even as a kid, [...]

The case: TR is a 55-year-old African American male who is sent to your emergency department after his primary care physician receives the results of recent routine bloodwork performed earlier that day, revealing a white blood cell count (WBC) of 2700 and an absolute neutrophil count (ANC) of 1350. He has a past medical history of paranoid schizophrenia, and for this, he is currently taking clozapine 150 mg by mouth twice daily as an outpatient. [...]

The risk of contrast induced nephropathy (CIN) in cardiac patients undergoing primary cardiac catheterization is approximately 5%.[1] With associated risk factors (Table), that risk can jump to 50%.  Pertaining to cardiac cath, administration of high volumes of contrast intra-arterially confers a higher risk compared to patient populations such as trauma patients who require radiologic imaging with contrast.[2]  Additionally, while similar risk factors may be present, trauma patients tend to be younger and generally healthier compared [...]