Ketamine for Excited Delirium Syndrome

Excited delirium syndrome is defined as “a syndrome of uncertain etiology characterized by delirium, agitation, and hyperadrenergic autonomic dysfunction”.¹ You may have encountered a patient like this in the ED or prehospital setting. Although the etiology is impossible to determine in many cases, stimulant abuse and other drugs are involved in a majority of cases. An 8% mortality has been ascribed to Excited Delirium Syndrome, resulting from hyperthermia, severe metabolic acidosis, and cardiovascular collapse.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-25T08:21:33-07:00May 18, 2015|Expert Peer Reviewed (Clinical), Neurology, Tox & Medications|

Trick of the Trade: IV-Push Antibiotics in the ED

Limited intravenous access is a common conundrum in the Emergency Department, with heavy implications for medication administration. Of particular concern, are the profoundly septic patients that necessitate multiple timely therapies, which require tying up a line – fluids, pressors, several antibiotics, etc. The shift away from less central line (i.e. triple lumen) placement for initial resuscitation, may serve to further exacerbate this issue.

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By Adam Spaulding, PharmD BCPS|2019-04-06T00:40:49-07:00May 11, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

Vancomycin Loading Doses in Pediatric Patients: A Missed Opportunity?

In January 2014, ALiEM featured a must-read post by Bryan Hayes regarding proper dosing of vancomycin in the emergency department, including a special note related to the recommendations regarding consideration of loading doses of vancomycin ranging from 25 to 30 mg/kg in adult patients who are critically ill with a high suspicion for MRSA infection.

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By Nadia Awad, PharmD, BCPS|2016-12-19T15:22:24-08:00May 4, 2015|Expert Peer Reviewed (Clinical), Pediatrics, Tox & Medications|

PV Card: Acute Salicylate Toxicity

Patients with acute salicylate toxicity can rapidly decompensate and require clinicians to understand the pathophysiology of what is going on. First a respiratory alkalosis occurs with non-specific symptoms of vomiting and dizziness. Then an anion-gap metabolic acidosis also occurs with headache, tinnitus, and confusion. Below lists the core set of labs to obtain and treatment strategies by our stellar ALiEM-CORD Social Media and Digital Scholarship Fellow, Dr. Sam Shaikh.

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By Sam Shaikh, DO|2021-10-05T12:52:52-07:00Apr 8, 2015|Tox & Medications|

Lipid Rescue: Why Aren’t We Using It?

Though lipid rescue sounds like something from a junk food detox regimen, it’s one of the most exciting developments in emergency management of drug overdose in the last 20 years. Unlike charcoal which can lead to aspiration and has relatively little data showing improved outcomes, or dialysis which relies on convincing your nephrologist to come in at 3 am, lipid rescue is a readily available, cheap, safe therapeutic that we’ve been using in TPN for adults and children for decades. And it seems to work, but why aren’t we using it?

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By Matthew Zuckerman, MD|2016-11-14T08:09:23-08:00Apr 1, 2015|Tox & Medications|

Adenosine in reactive airway disease

Adenosine

A 44-year old woman presents via EMS with a chief complaint of a racing heartbeat. She is placed on a cardiac monitor, which displays a heart rate of 192, and a subsequent EKG reveals she is in SVT. She also complains of chest discomfort and shortness of breath. Her blood pressure is stable, and you decide to treat her with adenosine. As you take a more thorough past medical history, you learn your patient has a history of asthma. One of the EM residents mentions that he thought adenosine should not be given to patients with reactive airway disease.

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By Marian Gaviola, PharmD|2018-11-02T10:41:55-07:00Mar 30, 2015|Expert Peer Reviewed (Clinical), Pulmonary, Tox & Medications|

The Art of Syringe Labeling in the ED

The ‘look-alike, sound-alike’ nature of many drug appearances and names is problematic. In high-stress environments such as the Emergency Department (ED), potential disasters can arise if “drug swap” or other medication errors occur. Drug swap is the accidental injection of the wrong drug.¹ The anesthesiology literature contains several published reports presenting various ideas on how to properly label syringes used in the operating room to reduce medication errors. Techniques include color-coding the labels,² labeling of the plunger,³ double-labeling,^4,5 and specific placement of the labels on the syringe.⁶

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:49:33-08:00Mar 16, 2015|Expert Peer Reviewed (Clinical), Tox & Medications|

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