Reaching for that vial (or two) of glucagon to manage the patient who presents to your emergency department with an esophageal foreign body obstruction (EFBO)? Think again. The first reports of its use for managing patients with EFBOs came about in the 1970s, when it was first discovered that glucagon had direct relaxation properties on the lower esophageal sphincter (LES), which is comprised of smooth muscle. This, in turn, will help decrease the resting pressure [...]

Let us take a trip down memory lane. The year: 2011 The month: January The event: Onsite interview for a PGY-1 pharmacy residency program The place: Swanky office of the residency program director It was very early in the morning, and I had a full day ahead, with back-to-back meetings with various preceptors and residents of the pharmacy residency program. It was my very first interview of several, and so I was understandably very nervous. [...]

Let us take a trip down memory lane. The year: 2011 The month: January The event: Onsite interview for a PGY-1 pharmacy residency program The place: Swanky office of the residency program director It was very early in the morning, and I had a full day ahead, with back-to-back meetings with various preceptors and residents of the pharmacy residency program. It was my very first interview of several, and so I was understandably very nervous. [...]

Even with all the therapies available for the management of septic shock, there still remains a great incidence of morbidity and mortality associated with this condition. One therapeutic agent that has been advocated for refractory septic shock is methylene blue (MB). Yes, you read that right...the same agent used as an antidote for the treatment of methemoglobinemia. Here is the low down. Nitric oxide (NO) is thought to be one of the major culprits for [...]

Perspective is everything. Changing your perspective when learning can help gain a higher understanding; likewise in teaching, altering your perspective can help make a point. Take for, example, this recent article in NEJM[1] regarding the true incidence of bleeding associated with dabigatran.  Take a step back from the usual perspective of dabigatran being the spawn of Satan, if only for a moment. In this article, the authors propose that the reported incidence of bleeding as [...]

Very early on in my residency when I had my first experiences with rapid sequence intubation, my program director emphasized the importance of knowing the pregnancy categories and safety of these medications to "prevent getting burned" should such a situation arise. Here is a chart that I made adapted from two references1,2 that I have kept handy ever since: A previous post discussed the potential benefits of suggamadex as a reversal agent for vecuronium and [...]

The threat of multi-drug resistant pathogens is nothing new. Over the years, as we’ve developed antimicrobial agents to attack these pathogens, they’ve responded by evolving and mounting resistance mechanisms to stay alive.  Either alone or in combination, the mechanism are typically altering the binding site for the antimicrobial drug, reducing the intracellular antimicrobial concentration through efflux pumps, modifying the antimicrobial agent itself or altering one or more metabolic pathways to circumvent the action of the [...]

The case: A 65-year-old male presents to the emergency department today after a witnessed fall on his head by his wife. He was diagnosed with non-valvular atrial fibrillation two months ago and was placed on dabigatran 150 mg PO BID. He has fallen several times in the past week. His last dose of dabigatran was 6 hours ago. CT scan of the head shows a small right subdural hematoma with a 6-mm leftward midline shift. [...]

Deaths related to the abuse of prescribed opioid analgesics are undoubtedly a momentous concern in North America.  A recent article published in JAMA (JAMA. 2013;309(7):657-659) highlights the scope of the problem: seventy-five percent of deaths related to pharmaceutical overdoses are attributed to opioid analgesics.  While troubling, this figure has, in fact, been steadily rising over the past 11 years with no end in sight. Complicating the matter is a new focus in health care in the USA; [...]

I made a comment once on Twitter that if I ever became a physician, the specialty I would go into would be anesthesiology. Why? Anesthesiologists have time and again done such innovative things with medications in the operating room that have made their way into the practice of emergency medicine. One example that comes to mind is the use of intravenous lipid emulsion therapy for the treatment of various toxicological emergencies. Another instance is the [...]