When a stroke victim rolls into the emergency department (ED) we know we have a limited time window to administer alteplase (recombinant tissue-type plasminogen activator [r-tPA]). The pressure of this narrow therapeutic window often pressures hospital staff to administer the potentially brain-saving medication as early as possible. Often, administration is hastened by estimating patient weight as a basis for calculating the critical 0.9 mg/kg weight-based dose. However, the question remains if we are appropriately estimating [...]

With the opioid abuse epidemic that we clinicians in the emergency department encounter as part of our daily practice, the movement towards the use of alternative agents continues to evolve for the management of pain in our patients. In taking advantage of traditional and novel mechanisms of action of these agents, acute pain in patients in the emergency department may be managed appropriately without posing the risk of introducing opioid-naive patients to opioids or worse, [...]

Encountering patients in afib with RVR is a daily occurrence in the emergency department. Rate control with AV blocking drugs are standard approaches for stable patients and good ol’ electricity for those who are unstable. But there is a group in-between that presents a different challenge. Those who are in afib but are relatively hypotensive, by which I mean SBPs in the 90’s or low 100’s. In these patients, pharmacologic rate control may improve SBPs [...]

Say you have any one of the following three scenarios in a patient who requires local anesthesia for repairing a minor wound laceration in the emergency department: 1 – Documented allergy to “-caine” agents (now, before you grumble…the patient assures you that this is a true allergy; yes, the whole nine yards with full-blown anaphylaxis that occurred years ago with some “-caine”). 2 – Shortage of all forms of parenteral lidocaine 1% and 2% (not [...]

So long ratios!We've covered epinephrine use and misadventures on this blog numerous times. (Megan's post here, Nadia's here, mine here). One thing that they all have in common is brining up the risk of dosing errors as a result of it unique ratio expression format for its concentration. But those days are numbered.Starting in May 2016, the ratio expression format for drug concentrations will no longer be permitted according to the December 2015 ISMP Acute Care [...]

As if you needed another reason to like rocuronium. I'm certain many of you are aware of this neat trick but I just discovered it while restocking the RSI kit. Good guy rocuronium wants you to reduce medication errors by labeling your syringes!Take a look: on this particular manufacturer's vial the label has an arrow in the top right corner of the orange area. Until literally 5 minutes ago, I thought it was nothing. But [...]

When we reach the end of any year, it is generally a time for personal reflection. We reflect on major milestones that we have achieved, which includes moments that have defined us as well as moments that may have temporarily broken us, but we managed to pick ourselves up and keep running. During these times, we set out to accomplish any list of goals for the coming year, knowing in the back of our minds [...]

2015 was such a great year at EMPharmD with so many new authors proividing amazing content. I encourage any readers who have a great idea for a blog topic or want to write a post yourself to submit it to myself or Nadia for review. As you can see below, some of the best content is from guest authors!Here are the top 10 posts from this past year. Three Reasons Not to Prescribe TramadolMatthew DeLaney, [...]

Sugammadex (I call it Suggs) is a selective muscle relaxant-binding agent. As a result of its chemical structure, modified cyclodextrin compound with a hydrophilic outer surface and a lipophilic central cavity, sugammadex encapsulates both rocuronium and vecuronium.  This encapsulation creates a concentration gradient by which rocuronium or vecuronium leaves the neuromuscular junction for the plasma and then subsequently bound by sugammadex (think DigiFab).  The result is a dramatically shortened duration of effect of rocuronium or [...]

We want to meet you!I'd love to hear from any readers or followers at Midyear. Or just stop by to say hi.On Tuesday I will be at the PM residency showcase at the Trinity Mother Frances Hospital PGY 1 booth (6221).Later that day, blog contributor Adam Spaulding and myself will be speaking about the evolution of the indications for ketamine in the emergency department at 4:15 in room 293.Wednesday come check out the EM pearls [...]