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|

Drug interactions with warfarin: Don’t bleed me out!

Warfarin is one of those drugs that always sends off little red warning lights when I see it on a patient’s medication list. Am I going to do something that will make this patient bleed out? Which drugs interact with warfarin?

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By Delphine Huang, MD|2016-12-19T13:00:15-08:00Mar 5, 2015|Expert Peer Reviewed (Clinical), Social Media & Tech, Tox & Medications|

Malignancy-Associated Hypercalcemia: Which Bisphosphonate is Best?

Malignancy-associated hypercalcemia (MAH) is the most common metabolic derangement encountered in the oncologic population in the ED. It can occur in up to 30% of cancer patients at some point during the disease.^1–3 Clinical manifestations include mental status changes (which may progress to coma) and renal impairment.³ These patients may be classified based on both type and severity. Therapies for managing MAH emergently should focus on correcting the underlying mechanism, as outlined below with their respective causes:³

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By Meghan Groth, PharmD, BCPS|2016-12-19T12:59:11-08:00Feb 19, 2015|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Tox & Medications|

Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?

The 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (SSTI) recommend sulfamethoxazole-trimethoprim (SMX-TMP) for purulent infections where methicillin-resistant S. aureus (MRSA) is a likely pathogen. ¹ But, what dose of SMX-TMP should we be prescribing? Both the SSTI and MRSA guidelines say 1-2 double strength tablets twice a day. ^1,2 So, which is it, 1 tablet or 2?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:36:10-08:00Feb 16, 2015|Infectious Disease, Tox & Medications|