Article to be discussed:Driver BE, et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation, 2014; 85:1337-1341. [youtube https://www.youtube.com/watch?v=Zqkad-ZD-7w?version=3&f=user_uploads&c=google-webdrive-0&app=youtube_gdata&w=320&h=266]
As I have developed a method to my practice (and madness) as an emergency medicine pharmacist, there are certain medications that, for me, fall under one of two categories: those that I have grown to love…and those that I have grown to not be a fan of and can generally live without, even in the absence of drug shortages. For me, parenteral hydralazine falls under the latter category. Why? As many of us already know, [...]
This week I had an opportunity to waive my pharmaco-nerd flag with the online release of the ARISE trial. I could have bought myself a psych eval ticket the way I was running around my shared office with the other pharmacy faculty, printing off copies to share in the ED and asking everyone else what they thought of ARISE, ProCESS and what... oh God what will ProMISE show!? But my excitement aside, the paper should be read [...]
This week I had an opportunity to waive my pharmaco-nerd flag with the online release of the ARISE trial. I could have bought myself a psych eval ticket the way I was running around my shared office with the other pharmacy faculty, printing off copies to share in the ED and asking everyone else what they thought of ARISE, ProCESS and what... oh God what will ProMISE show!? But my excitement aside, the paper should be read [...]
Chan EW, et al. Intravenous Droperidol or Olanzapine as an Adjunct to Midazolam for the Acutely Agitated Patient: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Ann Emerg Med. 2013 Jan;61(1):72-81. https://youtube.googleapis.com/v/Uw3eaTUx3DA&source=uds
In an earlier post, the nuances associated the abuse potential of tramadol and its new schedule IV status, a decision made by the Drug and Enforcement Agency, was discussed. The safety of tramadol in terms of its risk for inducing seizures is a topic that is not clearly understood. Tramadol can cause seizures in overdoses because of the possible induction of serotonin syndrome and/or the modulation of monoamine reuptake inhibition. Tramadol does so by acting [...]
Background:Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac abnormality that manifests itself as a conduction irregularity found between the sinoatrial (SA) and atrioventricular (AV) nodes. In an otherwise healthy heart, electrical conduction begins at the SA node, which is located in the right atrium. An electrical pulse is then sent downward causing the atrium to contract and subsequently reaching the AV node, which acts as the connecting catalyst to allow the electrical pulse to reach the [...]
Note: An edited version of this post has been featured on MedPage Today. As much as it is may be difficult to ignore the fact that traditional systematic reviews and meta-analyses are full of flaws, they have become the bread and butter for not only the purposes of referencing, but also the very basis of why most of us clinicians practice the way we that we do. It becomes very easy to state, “In a meta-analysis conducted [...]
Listen to the podcast by clicking on the link below (link on iTunes available here): EMPOWER Episode 4 - Rapid Oral Loading of Antiepileptic Drugs (AEDs) in the Emergency Department Show Notes: Core content from this episode discussed in: DiPiro's Pharmacotherapy, 9th Edition, Chapter 40 Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition, Chapter 21 Selection portions of Winter's Basic Clinical Pharmacokinetics, 3rd Edition ACEP Clinical Policy (updated in 2014): Huff JS, Melnick [...]
Flecainide and propafenone are the only Class Ic antiarrhythmic drugs (AADs) available in the United States. These agents block the fast sodium channels within cardiomyocytes, thereby decreasing the rate of rise and magnitude of the action potential. This causes a slowing of conduction velocity, without increasing the effective refractory period. While these agents are particularly useful for atrial fibrillation (AF) and atrial flutter, utilization remains low because their contraindications exclude many patients who would otherwise [...]