About Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules series, ALiEMU
Attending Pharmacist, EM and Toxicology, MGH
Assistant Professor of EM, Harvard Medical School

Trick of the Trade: Naloxone Dilution for Opioid Overdose

NaloxoneTraditional teaching recommends naloxone doses of at least 0.4 mg IV to reverse opioid toxicity. Drs. Lewis Nelson (@LNelsonMD) and Mary Ann Howland (@Howland_Ann) co-authored the opioid antagonist chapter in Goldfrank’s Toxicologic Emergencies.1 They write:

“However, this dose [0.4 mg] in an opioid-dependent patient usually produces withdrawal, which should be avoided if possible. The goal is to produce a spontaneously and adequately ventilating patient without precipitating significant or abrupt opioid withdrawal. Therefore, 0.04 mg is a practical starting dose in most patients, increasing to 0.4 mg, 2 mg, and finally 10 mg.”

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Antibiotics, Myasthenia Gravis, and Risk of Weakness

antibioticsA 71 year old female presents to the ED with lethargy, fever (39.5 C), and tachypnea (RR 28 rpm). She has a long-standing history of myasthenia gravis (MG) for which she receives periodic IVIG infusions. She is accompanied by her son, who informs you that she had a recent 10-day hospital stay for weakness. A CXR reveals an infiltrate in the left lower lobe.

The decision is made to initiate antimicrobial therapy for presumed healthcare-associated pneumonia. But, which antibiotics are safe to use in a patient with severe MG?

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Antidiabetic Medications: Hypoglycemic Potential in Overdose

antidiabetic medicationsWith several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. 1

Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration.

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Most Followed #FOAMed Women on Twitter

twitter_2012In 2014 we published a list of the Most Followed #FOAMed Twitter Users (FOAM = Free Open Access Meducation). One observation, keenly pointed out by Dr. Nikita Joshi (@njoshi8), was the lack of female representation on the list. Separately, Dr. Esther Choo (@choo_ek) published a blog post entitled Women in Emergency Medicine Who Give Great Talks. As a follow up to our original post, here are the most ‘followed’ women on Twitter in the FOAM world.

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Essential Non-Blog FOAM Resources for the ED Practitioner

Keyboard FOAM resourceIn my 10+ years working in the ED, I’ve come across a few online FOAM resources (Free Open Access Meducation) that are essential to my practice. Inspired by ALiEM’s new How I Work Smarter series, I wanted to share these free tools in the hope that they may help you work smarter too, regardless of what your role is in the emergency management of patients.

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Social Media in the EM Curriculum: Annals of EM Resident Perspective article

Hand holding a Social Media 3d SphereThis month marks our second ALiEM-Annals Resident’s Perspective discussion. Similar to the ALiEM-Annals Global EM Journal Club series and the first Resident’s Perspective piece on Multiple Mini Interviews, we will be discussing the most recent Annals of Emergency Medicine Resident’s Perspective piece on the Integration of Social Media in Emergency Medicine Residency Curriculum. We hope you will participate in an online discussion based on the paper summary and questions below from now through August 1, 2014. Respond by commenting below or tweeting using the hashtag #ALiEMRP.

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Most Followed #FOAMed Twitter Users

Twitter-HashtagsAs the Free Open Access Meducation (FOAM; #FOAMed) movement has continued to flourish over the past few years, Twitter has become a vital method for disseminating/discussing educational and clinical content. We thought it would be interesting to see who is being ‘followed’ on Twitter in the FOAM world. Certainly, the metric of Twitter followers does not necessarily correlate with quality. And, it misses newcomers to the FOAM scene and those with a more focused area of expertise/interest. We are more interested in understanding the landscape such as who is involved, geographic locations, areas of expertise, and association with blogs/podcasts.

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