Changing Paradigms in Stress Ulcer Prophylaxis

Obviously any patient that requires mechanical ventilation for 48 hours or has "coagulopathy" should get stress ulcer prophylaxis (SUP) right? maybe not....when the above risk factors where identified in 1994 by Deborah Cook (N Engl J Med. 1994;330(6):377-81.) and studies validating SUP as an effective means of preventing GI bleeding in critically ill patients were published (Crit Care Med.1993;21:1844-9. and Crit Care Med. 1993;21:19-30 - btw, cimetidine continuous infusion, really?) critical care was quite different [...]

By |2019-11-24T17:38:24-05:00May 25th, 2018|EM PharmD|0 Comments

What is the INR of FFP

What is the INR of FFP is a guest post by Jerry Altshuler, PharmD, BCCCP So fresh and so clean I frequently encounter people touting that "The INR of FFP is like 1.6 or something". Indeed I learned something similar myself at some point. It turns out however that the mean INR of FFP is actually 1.1 (Transfusion 2005;45:1234-5.). So why does it seem like no matter how much FFP you tend to give, it [...]

By |2019-11-24T17:38:24-05:00May 21st, 2018|EM PharmD|0 Comments

Balanced Crystalloids and Hyperkalemia

Balanced Crystalloids and Hyperkalemia is a guest post by Jerry Altshuler, Pharm.D., BCPS, BCCCP. With the recent publication of the SMART and SALT-ED trials, the chloride rich vs poor (balanced/buffered) crystalloid debate is back in the spotlight after a break post the original Yunos JAMA 2012 and SPLIT JAMA 2015. Something I commonly hear from internal medicine residents, however, is that LR and plasma-Lyte should DEFINITELY be avoided in the setting of hyperkalemia since they [...]

By |2019-11-24T17:38:24-05:00May 15th, 2018|EM PharmD|0 Comments

Acidosis Decreases Response to Vasopressors?

Acidosis Decreases Response to Vasopressors is a guest post by Jerry Altshuler, PharmD, BCPS, BCCCP One question I commonly encounter on rounds is "does acidosis reduce the activity of catecholamines?" While I think that at this point it is relatively clear that acidosis likely reduces LV contractility due to reduced intracellular calcium entry as well as H+ competition for calcium binding sites on myocardial troponin, I think that the notion that catecholamines "don't work as [...]

By |2019-11-24T17:38:24-05:00May 11th, 2018|EM PharmD|0 Comments