What do a 45 mL infusion, L-carnitine and Androgel have in common?
Diphacinone Toxicity Daniel Hu, PharmD, BCCCP Critical Care and Emergency Medicine Pharmacist Providence St. Peter Hospital Diphacinone (2-diphenylacetyl-1,3-indanedione, CAS Number 82-66-6) is an indandione-type anticoagulant.1,2 It falls into a class of compounds known as long-acting anticoagulant rodenticides, along with brodifacoum, bromadiolone, chlorophacinone, and difenacoum, which inhibit the synthesis of clotting factors II, VII, IX, and X. These compounds were developed to replace warfarin in rodenticides and many available mouse and [...]
Thiamine IV push? @raviempharmD (Ravipal Singh, PharmD, BCCCP) dives deep to answer this question
Guest post by Evan Mulvihill, PharmD on the hot topic of Cannabinoid Hyperemesis Syndrome
A discussion of antivenom for pit viper envenomations.
Single dose aminoglycoside for urinary tract infections, a guest post on empharmd.com Looking for a single dose, no compliance issues, inexpensive, safe, and effective option to treat urinary tract infections? An older therapeutic option might be the answer. A recent systematic review by Goodlet et al. looks into the utility of single dose aminoglycoside for urinary tract infections.1 Article A Systematic Review of Single-Dose Aminoglycoside Therapy for Urinary Tract [...]
Atrial fibrillation - the old debate of rate versus rhythm rages on but there are fundamental aspects that all EM pharmacists must know. - Art credit: "Autumn Rhythm" Jackson Pollock
I Have Andexxa Issues, 2: A Formulary Toolkit, a guest post by Zahra Nasrazadani, PharmD, BCPS. Dr. Nasrazadani is an Emergency Medicine Clinical Pharmacist at Salina Regional Health Center. A few months ago, Kristina Kipp wrote her inaugural EMCrit article enumerating her (extremely justified) concerns with the data we had available at the time regarding andexanet alfa…or should I say “coagulation factor Xa (recombinant), inactivated-zhzo”(1)? Since then—and in a somewhat perverse order [...]
Why is dose banding for pediatric medications important? If you go to any medication aisle of a store, you can find a wide selection of medications for pediatric patients. Everything from analgesics, cough and cold medications, and agents for gastrointestinal relief. Being a new parent myself, in learning the many ins and outs of infanthood, I did notice something that struck me as rather interesting, perhaps because of my background [...]
Next in the High-Yield MED Reviews giveaway: The Power of Now; Practice Presence to Keep a Healthy Mindset in the ED @RyanRogoPharmD
Next in the High-Yield MED Reviews giveaway: Apixaban or Rivaroxaban: The Jury’s Still out
Next in the High-Yield MED Reviews giveaway: The 5 Types of Interviewees: Reflections of a PGY-1 Resident
Next up in the High-Yield MED Reviews giveaway, "How to Wean a Guy (after at least) 10 days"
First entry in the High-Yield MED Reviews BCCCP give away - Antidote For Isoniazid-Induced Seizures.
EM PharmD Core management of DKA and HHS. Focusing on the fundamentals and pharmacology
The coagulation cascade, at least the way I learned it in pharmacy school, needs to be burned. The next time you’re looking at an adaptation of this pathway, point out the platelet. If you can’t, don’t continue to read that source. So let's expand our discussion to examine DVT / PE management further. 66-year-old male being discharged from the ED with a diagnosis of DVT. Will be started on oral [...]
EM PharmD Core - Acute Severe Asthma
Reflections on 10 years as a pharmacist.
Warm and wet just sounds weird to me. Not only does it allow the mind to drift to undesirable places, it also isn’t reflective of real practice. Whenever I open a pharmacy-based text or review article regarding acute decompensated heart failure (ADHF), the first section invariably begins to discuss the Forrester Classification. While it’s a useful visual learning tool, the routine dropping of Swan-Ganz catheters is no more. And who [...]
Acute Coronary Syndromes Sir William Osler said it best, that learning medicine without books is like going to sea without a map, but learning medicine without patients is like not going to sea at all. Learning any aspect of medicine without the proper context of a real patient is just learning facts then having to figure out how they fit together later. Similarly, without proper framing of what your role [...]
Nebulized Tranexamic Acid for Hemoptysis, a guest post by Raniah Aljadeed, PharmD An 80-year-old male arrived at the Emergency Department (ED) in a serious condition: he was coughing up blood. Although he coughed up about three tablespoons (50cc/hr), he was hemodynamically stable. A physician approached me with an unfamiliar question: “Could we give him nebulized TXA?” I looked at him for a moment, nonplussed. “What?!” I exclaimed, “Hold on—let me [...]
Nausea and Vomiting in the ED: There’s Something Fishy Going On, guest post by Ruben Santiago, PharmD, BCPS, BCCCP Nausea and vomiting is a common chief complaint in the ED, one I never really paid much attention to unless prompted (appropriate agent to use in pregnancy, which medication to use for a patient with a prolonged QTc, etc.) - at least, that was my practice before I began practicing in [...]
Fosfomycin: The Forgotten Treasure, a guest post by Tony Mixon, PharmD, BCPS We have all been there, a patient with so many complicating factors that it’s difficult to choose the least bad option to treat a urinary tract infection. For example, a patient with a CrCl ~22 ml/min, a prolonged QTc, sulfa allergy (described as immediate death), and amoxicillin allergy (also somehow described as immediate death) who absolutely refuses to [...]
BCPS Recertification Re-up It's about time to report back on my BCPS recertification follow up. In two previous posts, I outlined my impressions of High-Yield Med Reviews and BCPS recertification based on my experience going through the modules and webinar. While I still stand behind my evaluation of HYMR, my assessment was somewhat limited because it was all before the exam. Now that I have my scores, I feel I [...]