A number of retrospective studies have demonstrated conflicting data regarding the association of morbidity and mortality secondary to intracerebral hemorrhage (ICH) in patients being treated with antiplatelet agents.1-4 In addition, an association between the severity of ICH as well as the conversion of a minor head trauma to an ICH secondary to the prehospital use of antiplatelet agents has yet to be determined. I was intrigued by this and evaluated a number of institutional protocols [...]

In the recently published guidelines for management of pain, agitation, and delirium (PAD) in adult ICU patients, several key changes to the way PAD is approached were discussed.  Over the next few posts, I will go into depth into each one and tie in how we, in the ED, can help provide optimal PAD - another step towards the theory of "upstairs care, downstairs."But first, I wanted to point out the first three authors credited [...]

Let's say you have a male patient who presents to the emergency department with an abscess in the right axilla. The patient appears to be a relatively healthy gentleman with no significant past medical history (other than the heartburn that develops when he socially drinks on the weekends every now and then). He has not been hospitalized for any previous infection or recent surgery within the past year, and he denies the use of IV [...]

Let's say you have a male patient who presents to the emergency department with an abscess in the right axilla. The patient appears to be a relatively healthy gentleman with no significant past medical history (other than the heartburn that develops when he socially drinks on the weekends every now and then). He has not been hospitalized for any previous infection or recent surgery within the past year, and he denies the use of IV [...]

Although there are several studies evaluating the use of LEV in seizure prophylaxis, these trials often include patients with a variety of neurologic pathologies, so its important to recognize that the results of a trial evaluating patient with primary ICH or SAH may not be applicable to TBI. So considering we’re just looking at studies involving TBI patients, we’re not left with a whole lot of data.Two of the most recent studies I’ve highlighted here [...]

Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency characterized by severe metabolic abnormalities that occur secondary to rapid lysis of malignant cells that often manifests in patients with malignancies with a high tumor burden that are highly proliferative and chemosensitive. Metabolic derangements include hyperkalemia, hyperphosphatemia, secondary hypocalcemia, and hyperuricemia, which can lead to complications such as acute renal failure and cardiac arrhythmias that if not promptly recognized and treated, can progress to seizures and [...]

Our current therapeutic interventions that are directed at mitigating the damage of secondary injuries after TBI (ischemia, brain edema, vasospasm and seizures) lack robust data supporting their use. For clinicians in the ED, it’s difficult to make sound therapeutic decisions to help the patient and the team.  Although these are difficult areas to study, we never the less still need to make the best decisions we can. Posttraumatic seizures (PTS) are seizures that occur after [...]

Look out, Tox/EM/Pharm World: there is a new antidote for cyanide toxicity coming soon to an ED near you. It goes by the name of sulfanegen. The compound is being developed as a joint collaborative effort between the University of Minnesota and a startup pharmaceutical company called Vytacera Pharma, Inc. In terms of how sulfanegen exerts its antidotal effects in the setting of cyanide toxicity, it is actually a water-soluble prodrug of 3-mercaptopyruvate (3-MPV). The [...]

Over the holiday, I began reading one of the William Osler biographies. While reading his inspiring and influential journey, which to this day continues to guide and lead others, I paused to reflect on my own profession. Although I’m searching for the pharmacy equivalent to such influential figures in medicine, our education methods are far more interesting.Though books and lectures were a component of late 19th century and early 20th century medical education, Osler saw [...]

No posts this week folks. Have a happy holiday!