Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration

Blood SampleThere is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol concentration (BAC) to evaluate a patient’s level of intoxication.  There is very little data to suggest that either approach is superior; however, both practice patterns have significant limitations and carry a certain degree of medicolegal risk. 

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By |2016-11-11T19:19:30-08:00Mar 6, 2014|Medicolegal, Tox & Medications|

Did you know that there are new Tox/Meds PV Cards?

tox AgileMDDon’t know when to use ketofol for procedure sedation or if you can rapidly load phenytoin? See the new PV-Plus Cards on AgileMD for free on any smartphone/tablet/desktop. Other topics include:

  • Thrombolytics for submassive PE
  • Vasopressor agents for the hypotensive patients
  • Tramadol
  • t-PA for codes
  • Searchable Emergency Drug Card with dosages for Adults and Pediatrics

UPDATE Jan 1, 2018: The PV Cards are no longer on AgileMD.

By |2018-01-30T02:31:50-08:00Mar 5, 2014|ALiEM Cards, Tox & Medications|

Amylase Level for Pancreatitis: Stop doing it

BloodTestTubeA patient actively vomiting is wheeled into your ED. Within minutes IV access is obtained, and your nurse asks what tests and medicines are wanted. A liter of normal saline, ondansetron, and an H2 blocker are easy, but what labs to order? I think we can all agree on a metabolic profile to look at electrolytes and liver function tests, and a lipase level to assess for pancreatitis. But what about an amylase level?

Originally from Clinical Monster blog

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By |2026-06-16T16:05:01-07:00Feb 24, 2014|Gastrointestinal|

Blood Cultures in Pneumonia

PneumoniaRULA 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Unfortunately, the admitting service points out that no blood cultures were drawn! What is the evidence for this?

Originally from Clinical Monster blog

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By |2026-06-16T16:04:59-07:00Feb 17, 2014|Infectious Disease, Pulmonary|

Cyclobenzaprine vs TCA Toxicity

CyclobenzaprineShould we treat a cyclobenzaprine (Flexeril) overdose similar to a tricyclic antidepressant (TCA) overdose? With the only difference between the commonly prescribed muscle relaxant, cyclobenzaprine, and the TCA amitriptyline consisting of a single double bond, should the emergency provider be concerned for life threatening arrhythmias in cyclobenzaprine overdose?

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By |2016-11-20T07:20:37-08:00Feb 13, 2014|Tox & Medications|
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