The Ultimate Consult Service: Emergency Pharmacists

Imagine a consult service located IN the ED. The consultants are some of the friendliest people you’ve met and are there to help you. They tirelessly go out of their way to guide you through hospital protocols, help you with treatments, keep a close eye on your work, and ensure that you and your patients stay out of trouble. Not only are these consultants helpful to you, but also your residents, mid-levels, nurses, and the admitting teams. Everything they know, they teach you – and some are very active in FOAMed and emergency medicine research.

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By Zlatan Coralic, PharmD|2018-03-12T19:56:03-07:00Oct 3, 2013|Tox & Medications|

Patwari Academy videos: LVADs

Complications from left ventricular assist devices (LVAD) increasingly account for Emergency Department visits. What are LVADs? They are a short-term, artificial, circulatory device which performs the function of a very poorly functioning heart. It is important to understand the myriad of complications that can arise and the general approach to patients with an LVAD. These two short videos by Dr. Rahul Patwari summarize these in a nutshell.

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By Michelle Lin, MD|2019-01-28T21:55:07-08:00Sep 22, 2013|Cardiovascular, Patwari Videos|

Quick clinical tip: Rotational angulation of metacarpal fracture

Metacarpal fractures are commonly present to the Emergency Department for care. The plain film shown here shows metacarpal neck fractures of the middle and ring finger shown. There are specific criteria requiring closed reduction in the ED (PV Card). Generally ANY rotational angulation requires reduction. Detection of such angulation depends on the clinical exam rather than the plain film. How does one diagnose it?

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By Michelle Lin, MD|2016-11-11T19:03:49-08:00Sep 19, 2013|Orthopedic|

Deciphering Acid-Base Disorders

Derangements in acid-base status are commonly discovered on routine emergency department evaluation and often suggest the presence of severe underlying disease. Many acute conditions can disrupt homeostatic mechanisms used to buffer and excrete acid, and these changes may necessitate immediate intervention. When you discover a patient with an abnormal pH, what is your approach to the diagnosis?

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By Todd A. Seigel, MD|2016-12-14T05:13:55-08:00Sep 16, 2013|Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

Door to Balloon Time: Are We Measuring the Right Thing?

Door-to Balloon (D2B) time is a time measurement that starts with patient arrival to the emergency department (door) and ends when a catheter crosses a culprit lesion in the cardiac cath lab (balloon). The benefit of prompt primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial infarction is very well established. Because of this “time is muscle” strategy, the American College of Cardiology (ACC) launched a national Door to Balloon (D2B) initiative in November 2006. The purpose of this was to recommend a D2B time of no more than 90 minutes. Currently, there is quite a bit of effort put into this guideline by cardiology and emergency medicine, but are we measuring the right thing?

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By Salim Rezaie, MD|2019-09-10T13:35:47-07:00Sep 12, 2013|Cardiovascular|

PV Card: Emergency Drug Cards for Adults and Children

Rob Bryant, MD (@RobJBryant13), Amie Hatch, PharmD, BCPS (@Amie_EMPharmD), and Jeremy Bair, PharmD (@bairpharm) from Intermountain Healthcare in Utah have created and adopted a fantastic medication reference card which is used by physicians and nurses in the Emergency Department. The medications were chosen because they are often prone to dosing errors and require time-sensitive ordering. They generously offered to share this incredibly compact resource for free to the Emergency Medicine community as a PV card. If you see them, give them a high-five.

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By Michelle Lin, MD|2021-10-06T19:44:45-07:00Sep 11, 2013|ALiEM Cards, Expert Peer Reviewed (Clinical), Tox & Medications|

High Sensitivity Troponin Testing

Troponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote:

When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.

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By Salim Rezaie, MD|2019-09-10T13:35:54-07:00Sep 5, 2013|Cardiovascular|

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