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

Leadership Team, ALiEM
Creator and Lead Editor, Capsules and EM Pharm Pearls Series
Attending Pharmacist, EM and Toxicology, MGH
Associate Professor of EM, Division of Medical Toxicology, Harvard Medical School

ALiEMU CAPSULES Module 3: Pharmacology of Emergency Airway Management – Part 1

We are thrilled to announce the next installment of ALiEM CAPSULES: P harmacology of Emergency Airway Management (part 1), which was just published to the ALiEMU site. This is the first part of a 2-part course focusing on the pharmacology of the emergency airway. For this CAPSULES module we are introducing a multimedia-enhanced learning experience. You will find HD videos throughout the module providing further educational content. Some of the quizzes are also accompanied by video cases followed by a question based on the case you just watched. If you cannot use audio on your device, no problem, all videos are closed captioned (just hit the CC button in the YouTube window). We hope these videos further enrich your ALiEMU CAPSULES educational experience and we welcome any suggestions or comments!

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-01T20:25:55-07:00Sep 28, 2015|Capsules, Tox & Medications|

Utility of Pre-4-Hour Acetaminophen Levels in Acute Overdose

Case Presentation: A 37 y/o woman presents to the ED with altered mental status. The vital signs are within normal limits. The history is provided by a friend who states that the patient was normal 2 hours ago when they were together. When she returned home, she found the patient in this state next to an empty bottle of acetaminophen (APAP) and 5 empty beer cans. A recent loss in the family has led to some depression in the last few weeks. A battery of labs are sent off including a ‘tox panel’ consisting of serum EtOH, salicylate, and APAP levels. The presumed time of ingestion is 2 hours prior to presentation.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2018-04-10T18:20:20-07:00Aug 5, 2015|Tox & Medications|

Ketamine for Excited Delirium Syndrome

Excited delirium syndrome is defined as “a syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction”.¹ You may have encountered a patient like this in the ED or prehospital setting. Although the etiology is impossible to determine in many cases, stimulant abuse and other drugs are involved in a majority of cases. An 8% mortality has been ascribed to Excited Delirium Syndrome, resulting from hyperthermia, severe metabolic acidosis, and cardiovascular collapse.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-25T08:21:33-07:00May 18, 2015|Expert Peer Reviewed (Clinical), Neurology, Tox & Medications|

Hyperkalemia Management: Preventing Hypoglycemia From Insulin

Insulin remains one of the cornerstones of early severe hyperkalemia management. Insulin works via a complex process to temporarily shift potassium intracellularly. Though insulin certainly lowers plasma potassium concentrations, we often underestimate the hypoglycemic potential of a 10 unit IV insulin dose in this setting. The purpose of this post is to highlight the need for proper supplemental glucose and blood glucose monitoring when treating hyperkalemia with insulin.

This is such an important medication safety issue, the Institute for Safe Medication Practices (ISMP) highlighted it in a February 2018 Safety Alert.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-07-08T03:22:24-07:00Apr 22, 2015|Endocrine-Metabolic, Expert Peer Reviewed (Clinical)|

The Art of Syringe Labeling in the ED

The ‘look-alike, sound-alike’ nature of many drug appearances and names is problematic. In high-stress environments such as the Emergency Department (ED), potential disasters can arise if “drug swap” or other medication errors occur. Drug swap is the accidental injection of the wrong drug.¹ The anesthesiology literature contains several published reports presenting various ideas on how to properly label syringes used in the operating room to reduce medication errors. Techniques include color-coding the labels,² labeling of the plunger,³ double-labeling,^4,5 and specific placement of the labels on the syringe.⁶

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:49:33-08:00Mar 16, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?

The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. ¹ But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. ^1,2 So, which is it, 1 tablet or 2?