One of the oldest posts on EMPharmD has finally received an update. One of the most prominent lessons I've learned since graduating residency years ago is that the more I learn, the more I realize I do not know, and seeking out help is not a sign of weakness, but a strength. Artist rendering of diltiazem formula investigationAs such, when I encountered a wall in trying to trace the origin of the diltiazem IV to PO [...]
In 2010, skin and soft tissue infections (SSTIs) accounted for approximately 4.2 million emergency department visits (1). With such a bread-and-butter emergency medicine encounter, one might not give a second thought as to whether the standard dosing is less than ideal. However, the nuance of appropriate pharmacokinetic dosing that drug references omit may be the more ideal approach. The most appropriate dosing regimen, based on pharmacokinetic parameters, may not be highlighted by tertiary drug resources [...]
Diabetic ketoacidosis in patients with presenting serum blood glucose less than 200 is not common. Particularly when practicing in the Bible/Diabetes belt of the United States. This euglycemic DKA (euDKA) is more often associated in patients with type 1 diabetes in conjunction with starvation and acute illness.[1] It's difficult to determine an incidence of euglycemic serum glucose among all DKA cases in the literature given the migration of the serum glucose cutoff from 300 or less [...]
Diabetic ketoacidosis in patients with presenting serum blood glucose less than 200 is not common. Particularly when practicing in the Bible/Diabetes belt of the United States. This euglycemic DKA (euDKA) is more often associated in patients with type 1 diabetes in conjunction with starvation and acute illness.[1] It's difficult to determine an incidence of euglycemic serum glucose among all DKA cases in the literature given the migration of the serum glucose cutoff from 300 or less [...]
Vitamin K antagonist therapy such as warfarin has been demonstrated to decrease the incidence of stroke by approximately sixty percent in patients with atrial fibrillation (1). Unfortunately, warfarin is an agent with a narrow therapeutic index that is sensitive to drug-drug interactions, changes in diet and overall patient compliance. The incidence of warfarin-induced hemorrhage can be life-threatening and often requires emergent reversal. Historically, fresh frozen plasma (FFP) has been utilized to reverse the effects of [...]
In the January/February issue of Epilepsy Currents, the American Epilepsy Society put forth a guideline on the management of convulsive status epilepticus (CSE) in adult and pediatric patients (1).While I do appreciate the efforts put forth by the authors who reviewed the available evidence related to CSE, some points from the guideline are worth addressing and further consideration. This is not an all-inclusive list by any means, but the points detailed below are those that [...]
When a stroke victim rolls into the emergency department (ED) we know we have a limited time window to administer alteplase (recombinant tissue-type plasminogen activator [r-tPA]). The pressure of this narrow therapeutic window often pressures hospital staff to administer the potentially brain-saving medication as early as possible. Often, administration is hastened by estimating patient weight as a basis for calculating the critical 0.9 mg/kg weight-based dose. However, the question remains if we are appropriately estimating [...]
With the opioid abuse epidemic that we clinicians in the emergency department encounter as part of our daily practice, the movement towards the use of alternative agents continues to evolve for the management of pain in our patients. In taking advantage of traditional and novel mechanisms of action of these agents, acute pain in patients in the emergency department may be managed appropriately without posing the risk of introducing opioid-naive patients to opioids or worse, [...]
Encountering patients in afib with RVR is a daily occurrence in the emergency department. Rate control with AV blocking drugs are standard approaches for stable patients and good ol’ electricity for those who are unstable. But there is a group in-between that presents a different challenge. Those who are in afib but are relatively hypotensive, by which I mean SBPs in the 90’s or low 100’s. In these patients, pharmacologic rate control may improve SBPs [...]
Say you have any one of the following three scenarios in a patient who requires local anesthesia for repairing a minor wound laceration in the emergency department: 1 – Documented allergy to “-caine” agents (now, before you grumble…the patient assures you that this is a true allergy; yes, the whole nine yards with full-blown anaphylaxis that occurred years ago with some “-caine”). 2 – Shortage of all forms of parenteral lidocaine 1% and 2% (not [...]