We often have less than optimal IV access to administer fluids, blood products, and medications in sick ED patients. If more than one medication needs to be infused in the same line, how do we know if they are compatible? The gold standard for checking IV compatibility is Trissel’s Stability of Compounded Formulations. 1 But a textbook doesn’t help us in critical situations. Is there a better way?
You are working a shift in the emergency department, and you hear the ambulance sirens. EMS is bringing you two patients, friends from a nearby shelter. Per report, the two men were “smoking drugs” together outside of the shelter. Bystanders noted that the 29-year-old man became increasingly agitated, shouting, banging on the door, and threatening his other shelter mates, while the other, a 50-year-old man, laid down on the sidewalk. EMS also reports picking up these patients in an area known for high “K2” use.
Simulation equipment can be rather expensive and wanting to practice fluid and drug administration does not always warrant the purchase of specialized equipment. Luckily, a simple administration trainer can be made in less than 10 minutes and only costs a few dollars (or even nothing). This is an ideal option for resuscitation training if you are already using a manikin without IV arms or an IO option. Learners can practice preparing infusions and administering fluid or preparing an injection and administering it via the syringe port. This trainer can have multiple IV cannulas in one lid and can even include an intraosseous cannula, such as an EZ-IO.
We are proud to present CAPSULES module 6: Pharmacology of Acute Coronary Syndromes, now published on the Academic Life in EM University (ALiEMU) website. Here is a summary of the key points from this outstanding module by Drs. Paul Takamoto and Glen Oettinger.
A 52-year old man presents via EMS with a chief complaint of “racing heartbeat” for one hour. He is placed on a cardiac monitor which shows a heart rate of 185, an ECG reveals supraventricular tachycardia (SVT), and his blood pressure is 143/95 mmHg. As you ask the nurse to procure 6 mg of adenosine, the patient’s eyes grow wide.
“Please doc…” he pleads, “anything but that! Last time they gave that to me I thought I was gonna die!”
You recently read about using calcium channel blockers (CCBs) for paroxysmal SVT (PSVT), but can’t recall the last time you actually considered using them. After all, it’s been over 20 years since we switched to using adenosine first-line.
Drug poisoning is now the leading cause of injury death in the United States,1 with opioids accounting for up to 40% of these deaths. In the U.S., prescription opioid death rates have more than quadrupled since 1999, and death rates exceed those due to motor vehicle crashes.2 Similar trends in opioid exposure and death rates in Canada suggest that it is not far behind. Prescriptions for opioid analgesics paralleled a rise in opioid abuse and fatalities between 2002 and 2010, leveling off between 2011 and 2013,3 only to rise again in 2014.4 Among the more frequently misused opioids nationwide are oxycodone and hydrocodone (the most widely prescribed drug in the U.S.) in their various formulations, and methadone, but a “rising star” in the epidemic in many regions is fentanyl.
We are proud to present CAPSULES module 5: Procedural Sedation & Analgesia in the ED, now published on the Academic Life in EM University (ALiEMU) website. Here is a summary of the key points from this outstanding module by Dr. Zlatan Coralic and Dr. Nadia Awad.