The Training of an EM Pharmacist

At the 2014 American College of Emergency Physicians Scientific Assembly, ACEP passed Resolution 44, officially recognizing Emergency Medicine Pharmacists as valuable members of the EM team. Nadia Awad (@Nadia_EMPharmD) summarized the importance of the resolution’s passage on the EMPharmD blog. The role of an EM Pharmacist has been outlined by the American Society of Health-System Pharmacists (ASHP). In addition, Zlatan Coralic (@ZEDPharm), one of ALiEM’s regular contributors, framed the EM Pharmacist as the ‘ultimate consult service.’ The intent behind this post is not to discuss the role of the EM Pharmacist, but to highlight the rigorous training process through which most EM Pharmacists have traversed to work in this amazing specialty.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2020-09-05T07:43:30-07:00Dec 9, 2014|Academic, Tox & Medications|

ALiEM-Annals of EM Journal Club: Satisfaction Scores and ED Analgesic Medications

ALiEM-AnnalsEM-Square This ALiEM-Annals of EM Global Journal Club features the Annals of EM journal club by Schwartz et al. entitled “Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications.” We hope you will participate in an online discussion based on the clinical vignette and questions below from now until Dec 5 2014. Please respond by commenting below or tweeting using the hashtag #ALiEMJC. In a few months, a summary of this journal club will be published in Annals of EM.

On Dec 4, 2014 at 1300 PST (1600 EST), we will host a live Google Hangout with the authors Drs. Tayler Schwartz and Kavita Babu.

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By Justin Hensley, MD|2017-07-15T12:31:51-07:00Dec 1, 2014|Journal Club, Tox & Medications|

Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient.^1–4

This situation raises several questions:

Should we write on IV bags in permanent marker?
Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
If so, is there potential harm to the patient?

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By Jeremy Bair, PharmD, BCPS|2019-02-19T18:22:53-08:00Nov 24, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|

Trick of the Trade: Naloxone Dilution for Opioid Overdose

Traditional teaching recommends naloxone doses of at least 0.4 mg IV to reverse opioid toxicity. Drs. Lewis Nelson (@LNelsonMD) and Mary Ann Howland (@Howland_Ann) co-authored the opioid antagonist chapter in Goldfrank’s Toxicologic Emergencies.¹ They write:

“However, this dose [0.4 mg] in an opioid-dependent patient usually produces withdrawal, which should be avoided if possible. The goal is to produce a spontaneously and adequately ventilating patient without precipitating significant or abrupt opioid withdrawal. Therefore, 0.04 mg is a practical starting dose in most patients, increasing to 0.4 mg, 2 mg, and finally 10 mg.”

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:44:53-08:00Nov 17, 2014|Tox & Medications|

Trick of the Trade: Mix Ceftriaxone IM with Lidocaine for Less Pain

Ceftriaxone is a broad-spectrum antibiotic that is frequently administered intramuscularly (IM) in emergency medicine. However, these injections hurt — A LOT! Can we do anything to minimize the pain?

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By Zlatan Coralic, PharmD|2021-02-01T09:28:54-08:00Nov 6, 2014|Tox & Medications|

Mythbusting the Banana Bag

We’re all pretty familiar with the banana bag: intravenous (IV) fluids with the addition of thiamine, folic acid, multivitamins, and sometimes magnesium. Banana bags are commonly utilized in patients at risk for alcohol withdrawal symptoms or those who present to the emergency department (ED) acutely intoxicated.

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By Meghan Groth, PharmD, BCPS|2019-04-05T17:18:28-07:00Nov 5, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|

Antibiotics, Myasthenia Gravis, and Risk of Weakness

A 71 year old female presents to the ED with lethargy, fever (39.5 C), and tachypnea (RR 28 rpm). She has a long-standing history of myasthenia gravis (MG) for which she receives periodic IVIG infusions. She is accompanied by her son, who informs you that she had a recent 10-day hospital stay for weakness. A CXR reveals an infiltrate in the left lower lobe.

The decision is made to initiate antimicrobial therapy for presumed healthcare-associated pneumonia. But, which antibiotics are safe to use in a patient with severe MG?

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:22:53-08:00Oct 20, 2014|Rheumatology, Tox & Medications|

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