Unfortunately not every ED has a pharmacist (yet), and most of the graduating EM residents will be leaving for institutions without pharmacists in the ED. To make sure that the residents will be prepared, I was asked to compile a list of medications and doses that the they must know without looking at a reference or asking a pharmacist. While trying to stick to 25-30 meds, below is what I came up with. I would [...]
An 18-year-old female patient presents to your emergency department with complaints of having "the worst migraine headache ever." She states that the migraine headache with associated photophobia started about three days ago, and symptoms have gotten progressively worse ever since. She has a history of migraine headaches, and as an outpatient, she is on sumatriptan at home, which she states she has not used in the past year. Prior to her arrival, she took ibuprofen [...]
3 factor vs 4 factors...Aside from the excitement of the recently FDA approved four-factor PCC product in the USA, a somewhat obvious, yet important question exists: is why are four factor PCCs better than three factor PCCs?1 Unfortunately in the literature, there is no direct head-to-head data to compare these two classes of PCC. From this broad of a view, it would appear that there is no difference. However, upon further investigation, there are important [...]
Here are some fast facts clinicians should be aware of regarding Kcentra: Kcentra is marketed in over 25 countries around the world by CSL Behring as Beriplex® or Confidex®. It is four-factor PCC, containing factors II, VII, IX, and X, in varying amounts, based on the size of the vial. It also contains Proteins C and S as well as heparin and antithrombin III. The table below provides a breakdown of the contents per 500 [...]
Here are some fast facts clinicians should be aware of regarding Kcentra: Kcentra is marketed in over 25 countries around the world by CSL Behring as Beriplex® or Confidex®. It is four-factor PCC, containing factors II, VII, IX, and X, in varying amounts, based on the size of the vial. It also contains Proteins C and S as well as heparin and antithrombin III. The table below provides a breakdown of the contents per 500 [...]
In the coming weeks we will live update how we will incorporate the new 4-factor PCC products into our institutional formulary and practice.Exciting developments to come!
Drug shortages continue to wreak havoc on health care in US hospitals. It seems every day there is yet another drug, more critical to medicine than the last, that’s unavailable due to shortages. Over the past few weeks, nimodipine has been going, going, gone. Now reaching for alternatives, in this case, is proving difficult as a result of limited data on alternatives leaving many in a troubling situation. Nicardipine, diltiazem, magnesium and other investigational agents [...]
We all know that the effects produced from the toxic ingestion of cocaine and alcohol as separate entities are excessive stimulation and pronounced depression, respectively. So what are the effects of the toxic ingestion of both compounds together? Enter cocaethylene...and it is far from the Coca-Cola produced during your great grandmother's time. Cocaethylene (also known as ethylbenzoylecgonine) is produced from the concomitant ingestion of cocaine and alcohol. It is formed by the liver through a [...]
Originating in anesthesia, promoted in emergency medicine by EMCrit.org and EMRAP, the utilization of push dose pressors has been growing. While there doesn’t exist much data to back up its use, I think the clinical experience speaks for itself. In my experience has been generally good with recommending push dose phenylephrine aka. “Neostick,” if the dose is appropriate (80-100 mcg, not 20mcg) and the timing is appropriate (not after hours of hypotension). Likewise, expectations of [...]
A patient is wheeled into your trauma bay after a nasty head-on collision on a major highway. According to the paramedics, the downtime and length of anoxia in the patient is unknown, and because of this, the patient is intubated. Vital signs are unobtainable, and pulses are lost on the scene. The patient is now in pulseless electrical activity (PEA), and cardiopulmonary resuscitation is initiated. The decision is made to perform an emergent thoracotomy. The [...]