Although there are several studies evaluating the use of LEV in seizure prophylaxis, these trials often include patients with a variety of neurologic pathologies, so its important to recognize that the results of a trial evaluating patient with primary ICH or SAH may not be applicable to TBI. So considering we’re just looking at studies involving TBI patients, we’re not left with a whole lot of data.Two of the most recent studies I’ve highlighted here [...]

Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency characterized by severe metabolic abnormalities that occur secondary to rapid lysis of malignant cells that often manifests in patients with malignancies with a high tumor burden that are highly proliferative and chemosensitive. Metabolic derangements include hyperkalemia, hyperphosphatemia, secondary hypocalcemia, and hyperuricemia, which can lead to complications such as acute renal failure and cardiac arrhythmias that if not promptly recognized and treated, can progress to seizures and [...]

Our current therapeutic interventions that are directed at mitigating the damage of secondary injuries after TBI (ischemia, brain edema, vasospasm and seizures) lack robust data supporting their use. For clinicians in the ED, it’s difficult to make sound therapeutic decisions to help the patient and the team.  Although these are difficult areas to study, we never the less still need to make the best decisions we can. Posttraumatic seizures (PTS) are seizures that occur after [...]

Look out, Tox/EM/Pharm World: there is a new antidote for cyanide toxicity coming soon to an ED near you. It goes by the name of sulfanegen. The compound is being developed as a joint collaborative effort between the University of Minnesota and a startup pharmaceutical company called Vytacera Pharma, Inc. In terms of how sulfanegen exerts its antidotal effects in the setting of cyanide toxicity, it is actually a water-soluble prodrug of 3-mercaptopyruvate (3-MPV). The [...]

Over the holiday, I began reading one of the William Osler biographies. While reading his inspiring and influential journey, which to this day continues to guide and lead others, I paused to reflect on my own profession. Although I’m searching for the pharmacy equivalent to such influential figures in medicine, our education methods are far more interesting.Though books and lectures were a component of late 19th century and early 20th century medical education, Osler saw [...]

No posts this week folks. Have a happy holiday!

It seems as though the traditional "go-to" management of atrial fibrillation in the setting of rapid ventricular response in the emergency department involves rate control and anticoagulation. Can we break this tradition and consider alternative therapeutic management in certain subpopulations of patients with dysrhythmias? Recently, there has been some discussion regarding the use of rhythm control for new-onset atrial fibrillation, particularly procainamide, which used to be used back in the day and has started to [...]

Here is my attempt at a trick of the trade. This one is focused at the intubated STEMI patient in whom the EMS crew couldn’t get the 324mg of aspirin on board, and the cardiologist wants to load with clopidogrel 600mg as well as atorvastatin 80mg. Provided we can drop an OG tube before the patient gets sent to the cath-lab, this is how we get the meds into the patient:Grab a Toomey Tip 60mL [...]

My residency program director once made the following statement: "Pregnancy is the worst STD that anyone can get." At the time, I laughed when he said this, and I asked him to clarify this somewhat startling observation. We then had a brief discussion and came to the conclusion that pregnancy is associated with many comorbidities that otherwise would not typically occur in the non-pregnant patient. These include conditions of pregnancy that we commonly think of [...]

As I was preparing a post discussing antimicrobial double coverage, I was describing the utility of a hospital antibiogram in aiding in the selection empiric therapy.  Let’s just say I’m glad I have had teachers and mentors whose favorite question was “why.”  While trying to answer that simple question, I came across this article from 2007 [1] that did an excellent job describing the limitations of antibiograms. Although I was aware of certain limitations of [...]