Ethanol withdrawal is a complex disease state. Two of the main players are GABA (an inhibitory neurotransmitter) and glutamate (an excitatory transmitter that can act on NMDA receptors). Simplistically, chronic ethanol use leads to a down-regulation of GABA receptors and an up-regulation in glutaminergic receptors, such as NMDA. When ethanol is abruptly discontinued, we are left with a largely excitatory state with less ability for GABA-mediated inhibition and more capacity for NMDA/glutamate-mediated excitation. While much of the treatment of severe ethanol withdrawal is focused on GABA, there are agents, such as phenobarbital and propofol, that can suppress the glutaminergic response. Ketamine seems like it should confer benefit, as well, due to its NMDA antagonist properties. Until recently there was only one clinical study using ketamine for severe ethanol withdrawal.1 Now there are three.2,3
We are proud to present Capsules Module 10: Concepts in Infectious Disease, now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Meghan Groth and Paul Takamoto. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
Welcome to the 4th annual installment of our must-know Emergency Medicine pharmacotherapy articles post, this time for 2017. We summarize some important EM pharmacotherapy articles from the last 12 months. We have tried to focus on articles that you may have missed, but are potentially high-impact for improving clinical practice in the ED. Without further ado, we present the 12 must-know EM pharmacotherapy articles of 2017.
The 2016 American Headache Society (AHS) released recommendations on managing adults with acute migraine headaches.1 In the November 2017 EM:RAP LIN Sessions podcast episode that I recorded, I realized that I overgeneralized several statements about anti-dopaminergic agents and the use of concurrent diphenhydramine for akathisia risk reduction. So I wanted to clarify things and share a deeper-dive on the topic, thanks to the constructive feedback and help of headache guru Dr. David Vinson and EM pharmacists Dr. Curtis Geier, Dr. Bryan Hayes, and Dr. Zlatan Coralic. Below summarizes the nuanced thought processes in the anti-dopaminergic treatment of migraines.
Seasons greetings from the ALiEM team. We have published so many posts this year that you may have missed a few. Did you at least catch the top 10 ALiEM clinical posts in 2017? These are the most-viewed posts in the past calendar year. From nerve blocks, to managing epistaxis, head bleeds, and providing post-ROSC care – check these out as you ring in the New Year!
We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Jamie Rosini and Matt Stanton. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
Several years ago I created a resource for my ED rotation that I share with pharmacy students, pharmacy residents, and EM physician residents. It contains most of the guidelines and position statements on EM drug therapy that I utilize most often and is updated as new iterations are published. We’d like to share this tool with you to be used/modified to meet your rotation needs.
Last updated: February 22, 2018