Understanding Phenytoin Equivalents

Sometimes, in an effort to make things simpler, we actually make them more confusing. Such is the case with phenytoin equivalents.

Fosphenytoin is a water-soluble prodrug of phenytoin. After IV administration, much of the fosphenytoin is metabolized to phenytoin within 15 minutes. Advantages over phenytoin include the option for IM administration and less cardiotoxicity allowing for faster infusion rates. Even the potential for hyperphosphatemia from the release of phosphate is generally inconsequential.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:19:39-08:00Apr 15, 2014|Tox & Medications|

Neuraminidase Inhibitors for Influenza – The Truth, The Whole Truth, and Nothing But the Truth Finally

Over the last 5 years, the use of neuraminidase inhibitors for the treatment of influenza has skyrocketed. Emergency physicians have been pushed to prescribe these medications under the belief that they reduced symptoms, the risk of complications, hospitalizations, and transmission. However, the recommendation for the use of these drugs has never sat on firm evidence-based ground. So what did we know then, and what do we know now?

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By Anand Swaminathan, MD MPH|2019-01-28T23:34:05-08:00Apr 14, 2014|Infectious Disease, Tox & Medications|

PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

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By Salim Rezaie, MD|2019-09-10T13:34:00-07:00Apr 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

Top 10 reasons NOT to order a CT scan for suspected renal colic

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLarger It appears that the excitement and utilization of computed tomography (CT) imaging in the emergency department (ED) has far outpaced our concern for the short- and long-term consequences of increased reliance on this technology. CT has greatly supplemented, or even replaced, our clinical decision making for many chief complaints. Many articles document the dramatic increased CT use in contemporary practice, including a 330% increase in the rate of CT imaging from 1996 to 2007. The likelihood of a CT order being part of any ED encounter now approaches 15%, with no signs of decline.¹

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By Daniel Firestone, MD RDMS|2016-11-11T19:20:03-08:00Apr 10, 2014|Expert Peer Reviewed (Clinical), Genitourinary, Radiology|

Article: Hypotonic maintenance IV fluids in pediatrics

A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it?

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By William Paolo, MD|2016-11-11T19:19:57-08:00Apr 9, 2014|Endocrine-Metabolic, Pediatrics|

Beware of fluoroquinolones: You, your patient, and the FDA

Fluoroquinolones are a widely used class of antibiotic that are effective in treating a wide variety of infections. Despite their popularity there is increasing concern regarding to the potential complications associated with these agents. In 2008, the U.S. Food and Drug Administration (FDA) issued a black box warning involving fluoroquinolone use and an increased risk of tendon rupture. More recently in 2013 the FDA released another warning regarding the risk of peripheral neuropathy and required additional warnings to be added to the drug labels [1].

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By Matthew DeLaney, MD|2026-06-16T16:05:14-07:00Apr 7, 2014|Medicolegal, Tox & Medications|

High Sensitivity Troponin T and Acute Myocardial Infarction: One and Done?

There has been a lot of publicity about evaluation of chest pain patients in the emergency department (ED) with high sensitivity troponin testing. In the past with older troponin assays, clinicians would evaluate patients, get an ECG, and an initial set of cardiac biomarkers. The subsequent set of biomarkers would be performed at 6-8 hours later before determination of disposition. In the past few years, several studies have been published evaluating point of care troponins, sensitive troponins, and high sensitivity troponins which have changed our practice and evaluation of these patients. An early version of a study was recently released in the Journal of the American College of Cardiology (JACC) stating that for ED chest pain patients, we may be able to discharge patients from the ED with an initial normal ECG and single high sensitivity troponin T (hs-cTnT). So is it true… one and done?

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By Salim Rezaie, MD|2019-09-10T13:34:11-07:00Apr 3, 2014|Cardiovascular, Expert Peer Reviewed (Clinical)|