A History of Gonococcal Resistance: Are We Screwed? Gonococcal infection is a growing public health problem that continues to remain of concern in the United States. Infection can occur in a number of anatomical sites, including the urethra, rectum, oropharynx, eye, and endocervical canal. Complications of untreated infection may lead to damage of reproductive organs, which may include pelvic inflammatory disease, infertility, and ectopic pregnancy in females, as well as disseminated gonococcal infection and conjunctivitis [...]

Protamine Sulfate for Low Molecular Weight Heparin There is much discussion lately regarding new reversal strategies of oral anticoagulants that are rapidly growing in popularity.  While the data to support the use of agents like PCC and aPCCs are limited, our clinical experience is also lacking.  So-called ‘old school’ reversal agents, though infrequently used, still have a place for patients who receive parenteral anticoagulation.   Protamine sulfate, our favorite salmon sperm derived drug, was (and [...]

Pyridoxine (B6) for Refractory Status Epilepticus: "Fly Like A G6" The case: TR is a one-year-old infant who presents to your emergency department with a tonic-clonic seizure. According to the paramedics, the seizure has lasted for approximately 10 minutes. She has no known past medical history. Vital signs are relatively stable, and a bedside blood glucose is performed, revealing a level of 105 mg/dL. She has a weight of 10 kg. IV access is established [...]

Need to know medications for EM residents Unfortunately not every ED has a pharmacist (yet), and most of the graduating EM residents will be leaving for institutions without pharmacists in the ED.  To make sure that the residents will be prepared,  I was asked to compile a list of medications and doses that the they must know without looking at a reference or asking a pharmacist.  While trying to stick to 25-30 meds, below is [...]

Milking It: Propofol for Migraine Headache An 18-year-old female patient presents to your emergency department with complaints of having "the worst migraine headache ever." She states that the migraine headache with associated photophobia started about three days ago, and symptoms have gotten progressively worse ever since. She has a history of migraine headaches, and as an outpatient, she is on sumatriptan at home, which she states she has not used in the past year. Prior [...]

Three factor or four factor PCC: What are we measuring? 3 factor vs 4 factors... Aside from the excitement of the recently FDA approved four-factor PCC product in the USA, a somewhat obvious, yet important question exists: is why are four factor PCCs better than three factor PCCs?1 Unfortunately in the literature, there is no direct head-to-head data to compare these two classes of PCC. From this broad of a view, it would appear that [...]

Fast Facts About Kcentra Here are some fast facts clinicians should be aware of regarding Kcentra: Kcentra is marketed in over 25 countries around the world by CSL Behring as Beriplex® or Confidex®. It is four-factor PCC, containing factors II, VII, IX, and X, in varying amounts, based on the size of the vial. It also contains Proteins C and S as well as heparin and antithrombin III. The table below provides a breakdown of [...]