At the 2016 Midyear Clinical Meeting of the American Society of Health-Systems Pharmacists (ASHP), my colleague Bryan Hayes (@PharmERToxGuy) and I presented a continuing education program on debates in the management of hyperkalemia. The learning objectives from our session are below: Evaluate recommendations for dosing and administration of parenteral calcium in the treatment of hyperkalemia.  Apply practical methods for co-administration of insulin and dextrose in the management of hyperkalemia. Discuss evidence-based literature surrounding administration of [...]

It sometimes is a bit wondrous how our past actions can influence how our future pursuits. I have discussed how #FOAMed has made an impact on research, discovery, and my professional pursuits here and here. To be quite frank, I can't imagine how my life would be if I was not engaged in social media. But obviously, at one point, I did, and I may have predicted my own engagement in #FOAMed without even realizing [...]

In my opinion, pharmacist "interventions" are a bad thing. While there are many reasons behind this, but I prefer creating a culture of open, prospective discussion rather than reactive drug policing. If I approach a prescriber in the ED, I'm greeted with "What did I do now?" I'm doing something wrong. Discussing new papers, institutional protocols, sharing interesting patient cases, or you know, general human-to-human conversations are great opportunities for taking about drug therapy approaches, new [...]

In my opinion, pharmacist "interventions" are a bad thing. While there are many reasons behind this, but I prefer creating a culture of open, prospective discussion rather than reactive drug policing. If I approach a prescriber in the ED, I'm greeted with "What did I do now?" I'm doing something wrong. Discussing new papers, institutional protocols, sharing interesting patient cases, or you know, general human-to-human conversations are great opportunities for taking about drug therapy approaches, new [...]

We waited with bated breath for idarucizumab, the antidote for dabigatran, to be approved by the FDA. We heard whispers that it was coming for a number of years, even during those rough first few relatively recent years following the approval and widespread use of dabigatran, during which time patients presented to emergency departments across the globe with life-threatening bleeding secondary to dabigatran. Craig and I discussed it in our podcast episode on pipeline reversal [...]

The acquisition cost of isoproterenol (Isuprel®) has dramatically increased from approximately $60 per vial in 2012 to over $2,150 per vial today, a nearly 4000% increase. In order to minimize costs associated with therapy, the following represents alternative agents that may be utilized in the management of bradyarrhythmia:Recommendations for the management of bradyarrhythmia based on the Advanced Cardiovasular Life Support guidelines are as follows (1):Patients who are asymptomatic from their bradycardia typically do not need aggressive [...]

There are two kinds of people in the emergency department: those who are advocates of intravenous tPA for the treatment of acute ischemic stroke, and those who aren’t. Among twelve large clinical trials, only two have demonstrated statistically beneficial results of systemic thrombolytics in the setting of acute ischemic stroke: NINDS and ECASS III [1,2,3]. Despite the lack of robust high quality evidence, current American Heart Association/American Stroke Association guidelines recommend the administration of intravenous [...]

There are two kinds of people in the emergency department: those who are advocates of intravenous tPA for the treatment of acute ischemic stroke, and those who aren’t. Among twelve large clinical trials, only two have demonstrated statistically beneficial results of systemic thrombolytics in the setting of acute ischemic stroke: NINDS and ECASS III [1,2,3]. Despite the lack of robust high quality evidence, current American Heart Association/American Stroke Association guidelines recommend the administration of intravenous [...]

For a while now, there has been a lot of discussion among folks in the free open access medical education (FOAMed) community related to the acknowledgement and recognition in the academic realm. Recently, one major academic institution that has now set the stage for the recognition of FOAMed as scholarly activity for the purposes of promotion and tenure: The Mayo Clinic. This unprecedented move should surely serve as a stepping stone for other academic institutions [...]

A 78-year-old female with acute onset of right-sided weakness, facial droop, and slurred speech presents via ambulance to your emergency department (ED). After CT and labs are completed, the neurology team decides to administer alteplase (tPA) for acute ischemic stroke and the pharmacist begins reconstituting the medication. However, the family arrives and states they do not want the patient to receive tPA. What should you do with the reconstituted product that is now not to [...]