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|

Trick of the Trade: IV-Push Antibiotics in the ED

Limited intravenous access is a common conundrum in the Emergency Department, with heavy implications for medication administration. Of particular concern, are the profoundly septic patients that necessitate multiple timely therapies, which require tying up a line – fluids, pressors, several antibiotics, etc. The shift away from less central line (i.e. triple lumen) placement for initial resuscitation, may serve to further exacerbate this issue.

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By Adam Spaulding, PharmD BCPS|2019-04-06T00:40:49-07:00May 11, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

Vancomycin Loading Doses in Pediatric Patients: A Missed Opportunity?

In January 2014, ALiEM featured a must-read post by Bryan Hayes regarding proper dosing of vancomycin in the emergency department, including a special note related to the recommendations regarding consideration of loading doses of vancomycin ranging from 25 to 30 mg/kg in adult patients who are critically ill with a high suspicion for MRSA infection.

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By Nadia Awad, PharmD, BCPS|2016-12-19T15:22:24-08:00May 4, 2015|Expert Peer Reviewed (Clinical), Pediatrics, Tox & Medications|

Four reasons not to order a Rapid Flu test

Every year emergency departments are inundated with cases of influenza-like illness. Rapid flu testing (RFT) offers the promise of a quick and relatively noninvasive rapid diagnostic test. However, the use of this test has significant limitations that can lead to increased risk for both the patient and the provider.

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By Matthew DeLaney, MD|2018-01-30T02:48:07-08:00Apr 27, 2015|Expert Peer Reviewed (Clinical), Infectious Disease|

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)|

A cost-effective, two-layer wound closure task trainer

Performing a two layer wound closure can be a challenging procedure in the Emergency Department for clinicians with limited wound care experience. Challenges include suture choice, suture placement, and the technique of burying the knot in the deep layer of the wound, and the availability of ready ‘volunteers’ with complex wounds willing to let novices practice on them. Commercially available suture models are expensive, and can be cumbersome to store, and difficult to obtain in a timely manner to provide the learner with opportunities to practice prior to wound repair on a patient in the department.

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By Rob Bryant MD|2016-12-19T11:02:01-08:00Apr 15, 2015|Expert Peer Reviewed (Clinical), Medical Education, Simulation, Trauma|

4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy

One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider.

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By Brian Bauerband, MD|2026-06-16T16:06:58-07:00Apr 13, 2015|Expert Peer Reviewed (Clinical), Ob/Gyn, Ultrasound|