The FDA is wacky. Around every corner there seems to be another head scratching approval, denial, process or event. Answering a simple question took me down a new enlightening, and hilarious path. Now, this may sound Seinfeld-ish but ‘what’s the deal with controlled substances?’Lacosamide is a newer antiepileptic drug that you have likely seen on a medication reconciliation profile of a patient to two in your emergency department by now. With this newer drug, there [...]

October represents pharmacists’ month and we’ve just concluded pharmacy week. This time honored tradition of free hospital pens and PHARMA sponsored lunches gives us time to indulge our narcissistic tendencies as a profession.  At the same time, it serves as a rally call for continued efforts in our daily professional lives. These efforts, at least for hospital based pharmacists and particularly clinical pharmacists, are simultaneously our performance measures as well as justification for continued existence.  [...]

A couple of weeks ago, I had the privilege of attending the North American Congress of Clinical Toxicology (NACCT). This is the annual conference of the American Academy of Clinical Toxicology (AACT), a multidisciplinary organization focused on all things related to treatment and management of toxins, and offers plenty of opportunities for education and research related to clinical toxicology. It is certainly worth attending this conference, and if you have a strong interest in and/or [...]

Up until relatively recently, the concept of pre-treatment medications for rapid sequence intubation has remained uncontested. The acronym “LOAD” has often been proposed as a simple way to remember and apply this concept in clinical practice – lidocaine, opioids, atropine, and defasciculating doses of neuromuscular blocking agents. While most of these (classes) of agents have sparked controversy in the literature in recent years regarding their (f)utility as pre-treatment measures in rapid sequence intubation, it may [...]

A common controversy of late has been whether lower doses of proton pump inhibitors (PPIs) can be used in the high-risk upper gastrointestinal bleeding (UGIB) patient after endoscopy instead of the standard high-dose PPI bolus, followed by a 72-hour continuous infusion. The continuous infusion use stems from  guidelines formed after an international consensus conference on nonvariceal UGIB management that were published in 2010.1 There is the additional question of whether we should even be using [...]

Probably not.Ketamine, as we all know, is a popular yet polarizing drug in emergency medicine. For some, it's the drug of choice for any and every indication in the ED. For others, it's avoided at all costs since it causes brains, hearts and eyes to explode. With regards to exploding hearts, providers are often concerned that the drug should never be used in patients with cardiovascular disease because of the FACT that ketamine is a sympathomimetic. However, this FACT, often [...]

Take the case of a 34-year-old female with a psychiatric history who presents to your emergency department with a chief complaint of lightheadedness. As you, the pharmacist, and the emergency medicine physician are at the bedside examining the patient and asking her questions about her present symptoms and past medical history, you observe that the patient becomes short of breath, and you notice that the EKG monitor suddenly changes from normal sinus rhythm to ventricular [...]

A physician I work with in the ED makes it his personal mission to send me on a literature search at least once during each of his shifts. He recently told me that he had “heard something on a podcast” about giving corticosteroids for symptomatic relief in pharyngitis, and wanted to know if there was any validity to it. I wasn’t immediately familiar with the podcast in question, so I set out to do some [...]

Four-factor prothrombin complex concentrate (4FPCC) has been available in the United States for the past two years. We first broke news of its approval by the FDA in the branded form of Kcentra on this blog, and now that we have had clinical experience with it in its use for warfarin-associated bleeding (as well as its off-label use for management of target specific oral anticoagulants as we await the highly anticipated pipeline antidotes of these [...]

Say you have a patient who consumed almost an entire gallon of antifreeze over a span of 24 hours. Even Animal House’s Blutowski would be concerned, given that an adult who inadvertently sips 10-30 mL of antifreeze should be referred to the emergency department for evaluation of potential toxicity [1]. Initial lab results reveal an ethylene glycol (EG) level of 76 mg/dL, arterial pH of 6.9, and a serum bicarbonate level of 7 mmol/L. The [...]