Bringing the OR to the ER: Administration of Nicardipine as an IV Bolus I made a comment once on Twitter that if I ever became a physician, the specialty I would go into would be anesthesiology. Why? Anesthesiologists have time and again done such innovative things with medications in the operating room that have made their way into the practice of emergency medicine. One example that comes to mind is the use of intravenous lipid [...]
Smoke and Mirrors: Lidocaine Pre-RSI for ICP Reduction It's one of those things that gets hammered into the head of nearly every EM resident by their attendings during their training. That little nugget of information related to rapid sequence intubation (RSI) that is woven into the curriculum and gets passed on from class to class of EM residents who will go on to advocate it when they become EM attending physicians. We cannot help it...it [...]
Rocuronium and Sugammadex If anyone remembers studying for their SAT’s back in the day, complete this sequence: If SUX sucks, and ROC rocks, then Sugammedex _________. In a word, “unavailable.” Sugammadex 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 [...]
Managing A Bloody Mess: Octreotide for Undifferentiated Gastrointestinal Bleed An elderly female patient rolls into the emergency department as a trauma. The story from the paramedics is that she had a witnessed fall, and she was initially alert and answering questions appropriately. However, en route to the hospital, her mental status became altered and she began to go "in and out." She became combative and because the paramedics feared that her airway would become unprotected, [...]
Double coverage aminoglycosides or fluoroquinolones The empiric use of two antimicrobial agents with a similar spectrum of coverage (aka double coverage) is often fancied for a few reasons: Synergy, either clinical or pharmacokinetic, between two antimicrobial agents. Differing resistance patters to increase likelihood of adequate coverage of the suspected organism. Prevention of the development of resistance. Often, the second agent to be considered is either a fluoroquinolone (cipro/levo/moxi) or an aminoglycoside (amikacin/gentamicin/tobramycin). There is little, [...]
