There are two kinds of people in the emergency department: those who are advocates of intravenous tPA for the treatment of acute ischemic stroke, and those who aren’t. Among twelve large clinical trials, only two have demonstrated statistically beneficial results of systemic thrombolytics in the setting of acute ischemic stroke: NINDS and ECASS III [1,2,3]. Despite the lack of robust high quality evidence, current American Heart Association/American Stroke Association guidelines recommend the administration of intravenous [...]

There are two kinds of people in the emergency department: those who are advocates of intravenous tPA for the treatment of acute ischemic stroke, and those who aren’t. Among twelve large clinical trials, only two have demonstrated statistically beneficial results of systemic thrombolytics in the setting of acute ischemic stroke: NINDS and ECASS III [1,2,3]. Despite the lack of robust high quality evidence, current American Heart Association/American Stroke Association guidelines recommend the administration of intravenous [...]

For a while now, there has been a lot of discussion among folks in the free open access medical education (FOAMed) community related to the acknowledgement and recognition in the academic realm. Recently, one major academic institution that has now set the stage for the recognition of FOAMed as scholarly activity for the purposes of promotion and tenure: The Mayo Clinic. This unprecedented move should surely serve as a stepping stone for other academic institutions [...]

A 78-year-old female with acute onset of right-sided weakness, facial droop, and slurred speech presents via ambulance to your emergency department (ED). After CT and labs are completed, the neurology team decides to administer alteplase (tPA) for acute ischemic stroke and the pharmacist begins reconstituting the medication. However, the family arrives and states they do not want the patient to receive tPA. What should you do with the reconstituted product that is now not to [...]

One of the oldest posts on EMPharmD has finally received an update. One of the most prominent lessons I've learned since graduating residency years ago is that the more I learn, the more I realize I do not know, and seeking out help is not a sign of weakness, but a strength.  Artist rendering of diltiazem formula investigationAs such, when I encountered a wall in trying to trace the origin of the diltiazem IV to PO [...]

In 2010, skin and soft tissue infections (SSTIs) accounted for approximately 4.2 million emergency department visits (1). With such a bread-and-butter emergency medicine encounter, one might not give a second thought as to whether the standard dosing is less than ideal. However, the nuance of appropriate pharmacokinetic dosing that drug references omit may be the more ideal approach. The most appropriate dosing regimen, based on pharmacokinetic parameters, may not be highlighted by tertiary drug resources [...]

Diabetic ketoacidosis in patients with presenting serum blood glucose less than 200 is not common. Particularly when practicing in the Bible/Diabetes belt of the United States. This euglycemic DKA (euDKA) is more often associated in patients with type 1 diabetes in conjunction with starvation and acute illness.[1] It's difficult to determine an incidence of euglycemic serum glucose among all DKA cases in the literature given the migration of the serum glucose cutoff from 300 or less [...]

Diabetic ketoacidosis in patients with presenting serum blood glucose less than 200 is not common. Particularly when practicing in the Bible/Diabetes belt of the United States. This euglycemic DKA (euDKA) is more often associated in patients with type 1 diabetes in conjunction with starvation and acute illness.[1] It's difficult to determine an incidence of euglycemic serum glucose among all DKA cases in the literature given the migration of the serum glucose cutoff from 300 or less [...]

Vitamin K antagonist therapy such as warfarin has been demonstrated to decrease the incidence of stroke by approximately sixty percent in patients with atrial fibrillation (1). Unfortunately, warfarin is an agent with a narrow therapeutic index that is sensitive to drug-drug interactions, changes in diet and overall patient compliance. The incidence of warfarin-induced hemorrhage can be life-threatening and often requires emergent reversal. Historically, fresh frozen plasma (FFP) has been utilized to reverse the effects of [...]

In the January/February issue of Epilepsy Currents, the American Epilepsy Society put forth a guideline on the management of convulsive status epilepticus (CSE) in adult and pediatric patients (1).While I do appreciate the efforts put forth by the authors who reviewed the available evidence related to CSE, some points from the guideline are worth addressing and further consideration. This is not an all-inclusive list by any means, but the points detailed below are those that [...]