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Prochlorperazine, Metoclopramide, and Diphenhydramine for Acute Migraine Headache

The 2016 American Headache Society (AHS) released recommendations on managing adults with acute migraine headaches.1 In the November 2017 EM:RAP LIN Sessions podcast episode that I recorded, I realized that I overgeneralized several statements about anti-dopaminergic agents and the use of concurrent diphenhydramine for akathisia risk reduction. So I wanted to clarify things and share a deeper-dive on the topic, thanks to the constructive feedback and help of headache guru Dr. David Vinson and EM pharmacists Dr. Curtis Geier, Dr. Bryan Hayes, and Dr. Zlatan Coralic. Below summarizes the nuanced thought processes in the anti-dopaminergic treatment of migraines.

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By |2019-05-02T14:33:39-07:00Jan 10, 2018|Expert Peer Reviewed (Clinical), Tox & Medications|
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Strategies for Surviving the IV Fluid Shortage: Antibiotic IV to PO Conversions & First Dose via IV Push

iv and oral antibioticsHurricane Maria ravaged Puerto Rico almost 3 months ago, destroying factories that manufacture and distribute medications and related supplies. Healthcare facilities across the nation are now experiencing a critical shortage of small-volume intravenous (IV) fluids, which impacts the supply of IV antimicrobials. With no end in sight, ED providers can protect the quality of patient care by considering 2 strategies: IV to PO conversion and first-dose antimicrobials via IV push.
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By |2026-02-02T20:21:18-08:00Dec 13, 2017|Tox & Medications|
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Trick of the Trade: Topical Treatment of Cannabinoid Hyperemesis Syndrome

cannabinoid hyperemesis syndrome

A 23-year-old female with no past medical history presents to the ED for the 4th time this month complaining of severe “10-out-of-10” abdominal pain, nausea, and intractable vomiting. She denies alcohol use, but reports she has smoked at least 1 marijuana “bud” daily for the last 3 years. In an attempt to relieve her symptoms, she has increased her marijuana use, however she has found that her pain is actually increasing, and the only thing that appears to help is taking a hot shower or bath. With this statement, the provider immediately considers cannabinoid hyperemesis syndrome (CHS).

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By |2021-09-29T09:36:22-07:00Nov 15, 2017|Tox & Medications, Tricks of the Trade|
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ALiEMU Capsules Module 9: Hospital Acquired Pneumonia

We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Jamie Rosini and Matt Stanton. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.
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By |2018-01-17T14:15:43-08:00Oct 2, 2017|Capsules, Infectious Disease, Pulmonary|
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Update on the ED Management of Intracranial Hemorrhage: Not All Head Bleeds Are the Same

management of intracranial hemorrhageRobust and comprehensive studies now support specific management guidelines for patients presenting with different intracranial hemorrhages (ICH). From the Emergency Department perspective, the primary dilemmas involve specific blood pressure goals and whether seizure prophylaxis with phenytoin is necessary. The Brain Trauma Foundation provides an excellent summary of the current guidelines.1

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By |2017-09-05T14:53:30-07:00Sep 4, 2017|Neurology, Tox & Medications, Trauma|
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