So long ratios!We've covered epinephrine use and misadventures on this blog numerous times. (Megan's post here, Nadia's here, mine here). One thing that they all have in common is brining up the risk of dosing errors as a result of it unique ratio expression format for its concentration. But those days are numbered.Starting in May 2016, the ratio expression format for drug concentrations will no longer be permitted according to the December 2015 ISMP Acute Care [...]
As if you needed another reason to like rocuronium. I'm certain many of you are aware of this neat trick but I just discovered it while restocking the RSI kit. Good guy rocuronium wants you to reduce medication errors by labeling your syringes!Take a look: on this particular manufacturer's vial the label has an arrow in the top right corner of the orange area. Until literally 5 minutes ago, I thought it was nothing. But [...]
When we reach the end of any year, it is generally a time for personal reflection. We reflect on major milestones that we have achieved, which includes moments that have defined us as well as moments that may have temporarily broken us, but we managed to pick ourselves up and keep running. During these times, we set out to accomplish any list of goals for the coming year, knowing in the back of our minds [...]
2015 was such a great year at EMPharmD with so many new authors proividing amazing content. I encourage any readers who have a great idea for a blog topic or want to write a post yourself to submit it to myself or Nadia for review. As you can see below, some of the best content is from guest authors!Here are the top 10 posts from this past year. Three Reasons Not to Prescribe TramadolMatthew DeLaney, [...]
Sugammadex (I call it Suggs) is a selective muscle relaxant-binding agent. As a result of its chemical structure, modified cyclodextrin compound with a hydrophilic outer surface and a lipophilic central cavity, sugammadex encapsulates both rocuronium and vecuronium. This encapsulation creates a concentration gradient by which rocuronium or vecuronium leaves the neuromuscular junction for the plasma and then subsequently bound by sugammadex (think DigiFab). The result is a dramatically shortened duration of effect of rocuronium or [...]
We want to meet you!I'd love to hear from any readers or followers at Midyear. Or just stop by to say hi.On Tuesday I will be at the PM residency showcase at the Trinity Mother Frances Hospital PGY 1 booth (6221).Later that day, blog contributor Adam Spaulding and myself will be speaking about the evolution of the indications for ketamine in the emergency department at 4:15 in room 293.Wednesday come check out the EM pearls [...]
Ondansetron is the most documented medication given in emergency departments throughout the United States.1 We have all heard someone ask, “Can I get an order for 4 and 4 for this patient?” in reference to 4 milligram (mg) of intravenous (IV) morphine and 4 mg of IV ondansetron. It has become common practice in many institutions to provide a prophylactic antiemetic prior to administering an IV opiate. All opiates carry a FDA warning that nausea [...]
Ondansetron is the most documented medication given in emergency departments throughout the United States.1 We have all heard someone ask, “Can I get an order for 4 and 4 for this patient?” in reference to 4 milligram (mg) of intravenous (IV) morphine and 4 mg of IV ondansetron. It has become common practice in many institutions to provide a prophylactic antiemetic prior to administering an IV opiate. All opiates carry a FDA warning that nausea [...]
It’s ok to give 1 gram of vancomycin. As long as they’re obese and the dosing interval is adjusted to follow the two compartment distribution model of vancomycin. Single, double or triple? In terms of vancomycin dosing kinetics, it’s an important question. Pharmacokinetic teachings tell us to select the simplest model and fewest compartments necessary to describe the data adequately. Thus the single compartment model is frequently used in initial dosing of vancomycin. For the [...]
Vasopressin has gone by the way of atropine in the updated ACLS guidelines.1 But is this a reason to sachet into your next resuscitation/critical care meeting and suggest vasopressin be removed from your hospital’s crash carts? No. Don’t do it. Don’t just read the guidelines; read the primary literature. First and foremost, when we’re comparing vasopressin to epinephrine, one must remember the comparison agent (epinephrine) has not been shown to improve patient oriented outcomes, ie, neurologically [...]