ESETT - EM PharmD Podcast Episode 2 ESETT: A response-adaptive comparative effectiveness study of patients with generalized convulsive seizures not responding to initial benzos at 57 hospital emergency departments across the United States.    After sub-optimal but real-world relevant benzodiazepine dose patients who were still seizing were randomized to receive: Levetiracetam 60 mg/kg (Up to 4500mg) Valproate 40 mg/kg (Up to 3000mg) Fosphenytoin 20 mg/kg (Up to 1500mg)   The primary outcome was the absence [...]

Anavip versus Crofab - The ultimate debate. You may think this only applies to folks in the south, but there are venomous snakes in every state. Having at least a basic knowledge of antivenoms can be incredibly useful information. Over the past few months I've been working with Jami Johnson and Shari Clifton on a comprehensive review of North American Pit Viper antivenins. And its finally published! Review of North American pit viper antivenoms Although [...]

Screw up Kcentra reconstitution? Yea, I do it too. Kcentra, our beloved four-factor prothrombin complex concentrate comes packaged as a lyophilized powder from the manufacturer. When needed, it is reconstituted with its accompanying diluent and handy-dandy transfer device. Then, the transfer device becomes a port to withdraw the now reconstituted drug from and either into an empty bag, or syringe for administration. In real life, that process can sometimes go awry. Or you could just [...]

  Do you think we should use Vitamin C + Thiamine + Hydrocortisone in sepsis? Welcome to the EM PharmD podcast! In this episode, I'll breakdown the recent VITAMINS trial published in JAMA. The question has been on everyone's mind - should septic patients get Vitamin C? Have questions or comments? Email me at craig@empharmd.com Don't forget to check www.empharmd.com for new updates and the latest information about everything emergency medicine. Follow me on Twitter [...]

Tyler Perry's Colchicine Part 2 In a previous post, I discussed the use of colchicine following acute MI in the COLCOT study. Leading up to the discussion, I briefly touched on the pharmacology of colchicine. But since this drug is so unique and fascinating, particularly with regards to its toxicology, I wanted to have a separate post to discuss just that. It often seems as though the interest in a given xenobiotic is proportional to [...]

COLCOT- Colchicine for acute myocardial infarction If you started to practice after 2011, you likely have no experience with colchicine. Before the FDA began its unapproved drug initiative in 2006 which sought formal regulatory review of medications that previously fell under “grandfather” laws. Since colchicine was available prior to the 1938 Food, Drug, and Cosmetic Act, it was never required to establish safety and efficacy for FDA approved indications.[1,2] The goal of this FDA program [...]

Is metformin the fountain of youth? Growing up, I was an avid listener of Paul Harvey. My parents would turn on the radio every morning so I could listen to “the rest of the story.” I would eat my breakfast on the floor, sitting in front of the radio- as if by sitting closer would bring me closer to the story. Each time I click onto the Apple Podcast app and open my preferred non-medical [...]

How to evaluate references of residency candidates: the meta reference. A practice that I have been developing over the past few months has been to wait 24 hours before responding to certain emails, questions, or inquiries. By doing so, it has been intended to help be become less reactive and more thoughtful when encountering these events. While it is a bit of an exercise itself to learn what can wait for 24 hours, you’d be [...]

Capsaicin for cannabinoid hyperemesis syndrome - It’s is one hot therapy. As a result of cannabis liberalization policies in many states, interest in methods to manage cyclic vomiting syndromes are heating up. By now, many ED providers are aware of the common complaint of patients with excessive vomiting with reported histories of marijuana consumption.[1,2] These cases, patients describe vomiting that was once resolved by hot showers, is no longer controlled. For a more in-depth review, [...]

How PGY2 interviews differ from PGY1 You’re in it for another year. Congratulations. The time spent now will pay dividends in the future. Since you’re in the market for a PGY2, it likely means you’ve also been successful in landing a PGY1. From your experience in the interview process, you can take much of what made you an attractive candidate the first time around and apply it again this time. But there are some key [...]