StoweEM18 day 2 (Part 1) AudioAlso available on iTunesCredit:Meghan Groth, PharmD BCPS @EMpharmgirlKyle DeWitt, PharmD, BCPS @EmergPharmBlake Porter, PharmD, BCPS @RxEmergencyShow notes:https://www.ncbi.nlm.nih.gov/pubmed/18045891https://emcrit.org/pulmcrit/magnesium-infusions-for-atrial-fibrillation-torsade/https://academic.oup.com/eurheartj/article/37/38/2893/2334964https://www.ncbi.nlm.nih.gov/pubmed/10736125https://emcrit.org/pulmcrit/phenobarbital-monotherapy-for-alcohol-withdrawal-simplicity-and-power/https://www.ncbi.nlm.nih.gov/pubmed/?term=28418482http://thesgem.com/2018/01/sgem203-let-me-clear-my-sore-throat-with-a-corticosteroid/

The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) convened a group of experts to publish an update to their 2010 C.difficile infection (CDI) guidelines. Below is a summary of the new guidelines from the perspective of an emergency medicine (EM) pharmacist.Clostridioides is the new ClostridiumWhile the new guidelines use the nomenclature Clostridium difficile, the Clinical & Laboratory Standards Institute Antimicrobial Susceptibility Testing documents have been updated to Clostridioides [...]

Amiodarone is one of the most pimpable drugs for pharmacy residents/students. From its pharmacology to excipients, there are so many nuances, important points, and pharmacy trivia. In terms of administration, we’re all taught to dilute and filter while administering amiodarone intravenously. In almost all circumstances, this is referring to administration of amiodarone to patients with a pulse. But when we’re at the bedside of a patient with pulseless ventricular tachycardia or fibrillation (pVT/VF) the question [...]

ID in the EDQuick and dirty review: LinezolidDrug shortages and intravenous fluid shortages are reaching critical mass. Pharmacotherapeutic decisions are being forced, and unusual therapeutic strategies are being implemented. One of these scenarios is the substitution of vancomycin for linezolid for empiric treatment of various infectious disease indications. While a detailed therapeutic review would be more fitting for general practice, the bizzaro world of drug shortages is anything but general. So let’s review linezolid for [...]

//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js (adsbygoogle = window.adsbygoogle || []).push({ google_ad_client: "ca-pub-7409520543460672", enable_page_level_ads: true }); Angiotensin-II (Ang2) is now an FDA approved vasopressor. With this new addition to the available options, experts are combing over the available literature to determine whether or not to incorporate it into their daily practice. The ATHOS-3 trial has demonstrated that Ang2 is, at minimum, safe and effective when added to norepinephrine (or other similarly dosed vasopressor).1 While this trial should be critically appraised, [...]

There have been two recent FOAMed posts on the topic of endocarditis by REBEL EM and EMDocs. Both posts do a great job discussing risk factors, pathophysiology, signs and symptoms, and the diagnosis of endocarditis. However, we believe a more in-depth review of appropriate empiric antibiotic selection is prudent. As the ED pharmacist, we are ultimately responsible for making sure our patients get the most appropriate antibiotics. Additionally, whatever regimen is started downstairs is commonly continued [...]

Many institutions have implemented antimicrobial restriction programs where specific agents, based on toxicity, cost, or broad-spectrum of activity, require special permission for use. Often a page is required to initiate the request. During my infectious diseases PGY-2 I carried this antimicrobial approval pager, either approving the use of restricted agents or offering suggesting on alternative therapy. Fluoroquinolones (FQs) were by far, the most requested restricted antimicrobials, and also the most denied. In emergency departments without [...]

The last post on EMPharmD concerning fixed-dose Kcentra was way back in June, 2015 and discussed a newly published article by Klein et al. examining 1500 units of 4-factor prothrombin complex concentrate (4PCC) for warfarin reversal.(1)  Since that post, only one additional article has been published regarding fixed-dose 4PCC, and unfortunately, Abdoellakhan et al. only used 1000 units per dose as part of their protocol. As to be expected with the lower dosing, achievement of [...]

In the process of caring for patients suffering from acute ischemic stroke (AIS), a cognitive bias shifts the focus of our typical approach to drug therapy selection. Rather than approach a problem and determine whether a drug is going to help, in the case of alteplase for AIS, we often look for reasons not to give this drug (contraindications) and fail to ask whether the given patient will benefit. Fewer still will ask, what is [...]