National drug shortages are presenting a new and unique way of considering alternative drug therapies for various disease states. Of note, the most recent drug shortage impacting EDs and sparking new debate and rehashing of old data is intravenous nitroglycerin.   IV Nitro is used ubiquitously in EDs and pre-hospital settings primarily for acute coronary syndromes and acute decompensated heart failure/acute pulmonary edema.  While other dosage forms of nitroglycerin exist, and can be applied (both practically, [...]

The blackout of the Eastern United States and Canada in August 2003. Hurricane Sandy in October 2012. The horrific events of the Boston Marathon in April 2013. What do all of these events have in common? These mass casualty events affected numerous individuals, and institutions in these affected areas had to suddenly respond to patients impacted by these events in addition to handling patients who had already been hospitalized at the time that these events [...]

Lately I’ve been on a kick of nurturing my inner Canadian by reading a few books by notable figures from the Great White North.  The first was the latest autobiography of Dr. David Suzuki (any respectable Canadian should need no explanation of who he is) and the second was a book (An Astronauts Guide To Life On Earth) written by a Canadian astronaut, Dr. Chris Hadfield, about his journey to becoming the first Canadian to [...]

Let us say that you have a 50-year-old female patient who presents to the emergency department with a history of pulmonary arterial hypertension and signs and symptoms consistent with acute decompensated heart failure. The patient presents with acute shortness of breath and is in severe respiratory distress. Vital signs include blood pressure of 182/90 and heart rate of 110. A beside ultrasound is performed, confirming the presence of significant pulmonary congestion. Non-invasive ventilation is initated [...]

To me, writing this blog has been a quest to determine of the meaning of being an "EM pharmacist", a tool to improve my writing and motivation to continue to reading everything and anything.  In the months since we started, Nadia and I have received both praise and criticism that have helped us stay on point, and importantly, helped us frame arguments to establish everything FOAMed as an form of scholarly activity. Many of those [...]

A 35-year-old patient presents to your emergency department with complaints of right upper quadrant abdominal pain and nausea that has persisted for the past three days. He states that he came "straight to the ED after having just stepped off the plane" upon arriving back in the States from a week-long vacation in Mexico. He also states that he consumed quite a few alcoholic beverages on his flight home to help "stave off" some of [...]

"An IO for you, and an IO for me..." It is amazing how a series of tweets regarding a topic of interest can inspire a literature hunt leading to a blog post. Case in point:     This exchange led me to wonder about other medications, besides those that we typically use for cardiopulmonary resuscitation (CPR) that can be effectively administered via the intraosseous (IO) route. After conducting a rather extensive literature search on the [...]

In light of the JAMA and NEJM articles that have been recently published regarding outcomes associated with therapeutic hypothermia (TH) status post-cardiac arrest, I figured this would be a good time as any to cover complications associated with this phenomenon- namely, shivering. As we all know, the goal in TH status post-cardiac arrest is to reach a goal core body temperature between 32 and 34 degrees Celsius for a period of 12 to 24 hours in [...]

In light of the JAMA and NEJM articles that have been recently published regarding outcomes associated with therapeutic hypothermia (TH) status post-cardiac arrest, I figured this would be a good time as any to cover complications associated with this phenomenon- namely, shivering. As we all know, the goal in TH status post-cardiac arrest is to reach a goal core body temperature between 32 and 34 degrees Celsius for a period of 12 to 24 hours in [...]

In a story featured on NPR yesterday, news of additional warning information on labeling for oral emergnecy contraception in Europe has raised questions as to why similar label changes have not yet occured in the USA. The story focuses on a recent meta-analysis [1] that describes the effectiveness of the oral emergency contraceptives levonorgestrel (Plan B) and ulipristal acetate (Ella). In this case, I must agree with the FDA, that there is not enough data [...]