With the recent publication of the SMART and SALT-ED trials, the chloride rich vs poor (balanced/buffered) crystalloid debate is back in the spotlight after a break post the orginal Yunos JAMA 2012 and SPLIT JAMA 2015. Something I commonly hear from internal medicine residents however is that LR and plasma-lyte should DEFINITELY be avoided in the setting of hyperkalemia, since they contain 4 and 5 meq/L of potassium respectively.It turns out however that normal saline [...]

One question I commonly encounter on rounds is "does acidosis reduce the activity of catecholamines?" While I think that at this point it is relatively clear that acidosis likely reduces LV contractility due to reduced intracellular calcium entry as well as H+ competition for calcium binding sites on myocardial troponin, I think that the notion that catecholamines "don't work as well in acidosis" is less clear. The bulk of the data that comprises this idea [...]

In pharmacy school, there were times where mountains of material coincided with a flurry of exams. Such extreme circumstances called for masterclass test taking skills. For example, when a hundred page packet would account for 10 questions on an exam, and a 20 page packet also accounting for 10 questions, the logical studying strategy would focus on maximizing the number of points from the lower quantity material. Fast forward a decade after these exams and [...]

I’ve always been a huge fan of stand up comedy. For the longest time, I admired the ability of comedians to be able to speak so conversationally, and naturally while being hilarious. Over time, I’ve come to learn that some of my favorite comedians (Jerry Seinfeld, Jim Gaffigan, Tom Papa) extensively plan out every minute detail of their jokes, practice like crazy and never stop trying to improve. The grand illusion that most professional comedians [...]

StoweEM18 Day 3 audioAlso available on iTunes Credit:Meghan Groth, PharmD BCPS @EMpharmgirlKyle DeWitt, PharmD, BCPS @EmergPharmBlake Porter, PharmD, BCPS @RxEmergencyShow notes:https://www.ncbi.nlm.nih.gov/pubmed/27276234

StoweEM18 day 2 (Part 2) AudioAlso available on iTunesCredit:Meghan Groth, PharmD BCPS @EMpharmgirlKyle DeWitt, PharmD, BCPS @EmergPharmBlake Porter, PharmD, BCPS @RxEmergencyShow notes:https://www.ncbi.nlm.nih.gov/pubmed/27178479https://www.ncbi.nlm.nih.gov/pubmed/10931122https://www.ncbi.nlm.nih.gov/pubmed/25577622https://www.ncbi.nlm.nih.gov/pubmed/11692118https://www.ncbi.nlm.nih.gov/pubmed/24239340https://www.ncbi.nlm.nih.gov/pubmed/25820033https://www.ncbi.nlm.nih.gov/pubmed/24718923

StoweEM18 day 2 (Part 1) AudioAlso available on iTunesCredit:Meghan Groth, PharmD BCPS @EMpharmgirlKyle DeWitt, PharmD, BCPS @EmergPharmBlake Porter, PharmD, BCPS @RxEmergencyShow notes:https://www.ncbi.nlm.nih.gov/pubmed/18045891https://emcrit.org/pulmcrit/magnesium-infusions-for-atrial-fibrillation-torsade/https://academic.oup.com/eurheartj/article/37/38/2893/2334964https://www.ncbi.nlm.nih.gov/pubmed/10736125https://emcrit.org/pulmcrit/phenobarbital-monotherapy-for-alcohol-withdrawal-simplicity-and-power/https://www.ncbi.nlm.nih.gov/pubmed/?term=28418482http://thesgem.com/2018/01/sgem203-let-me-clear-my-sore-throat-with-a-corticosteroid/

The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) convened a group of experts to publish an update to their 2010 C.difficile infection (CDI) guidelines. Below is a summary of the new guidelines from the perspective of an emergency medicine (EM) pharmacist.Clostridioides is the new ClostridiumWhile the new guidelines use the nomenclature Clostridium difficile, the Clinical & Laboratory Standards Institute Antimicrobial Susceptibility Testing documents have been updated to Clostridioides [...]

Amiodarone is one of the most pimpable drugs for pharmacy residents/students. From its pharmacology to excipients, there are so many nuances, important points, and pharmacy trivia. In terms of administration, we’re all taught to dilute and filter while administering amiodarone intravenously. In almost all circumstances, this is referring to administration of amiodarone to patients with a pulse. But when we’re at the bedside of a patient with pulseless ventricular tachycardia or fibrillation (pVT/VF) the question [...]