Beware of fluoroquinolones: You, your patient, and the FDA

Fluoroquinolones are a widely used class of antibiotic that are effective in treating a wide variety of infections. Despite their popularity there is increasing concern regarding to the potential complications associated with these agents. In 2008, the U.S. Food and Drug Administration (FDA) issued a black box warning involving fluoroquinolone use and an increased risk of tendon rupture. More recently in 2013 the FDA released another warning regarding the risk of peripheral neuropathy and required additional warnings to be added to the drug labels [1].

(more…)

By Matthew DeLaney, MD|2017-03-05T14:18:39-08:00Apr 7, 2014|Medicolegal, Tox & Medications|

Is the Patient Sober? Clinical Sobriety versus Blood Alcohol Concentration

There is significant practice variability when providers are asked to determine if a patient is intoxicated. Some providers will evaluate a patient to determine if a patient is “clinically sober”, while other providers will rely on a patient’s blood alcohol concentration (BAC) to evaluate a patient’s level of intoxication. There is very little data to suggest that either approach is superior; however, both practice patterns have significant limitations and carry a certain degree of medicolegal risk.

(more…)

By Matthew DeLaney, MD|2016-11-11T19:19:30-08:00Mar 6, 2014|Medicolegal, Tox & Medications|

Did you know that there are new Tox/Meds PV Cards?

Don’t know when to use ketofol for procedure sedation or if you can rapidly load phenytoin? See the new PV-Plus Cards on AgileMD for free on any smartphone/tablet/desktop. Other topics include:

Thrombolytics for submassive PE
Vasopressor agents for the hypotensive patients
Tramadol
t-PA for codes
Searchable Emergency Drug Card with dosages for Adults and Pediatrics

UPDATE Jan 1, 2018: The PV Cards are no longer on AgileMD.

By Delphine Huang, MD|2018-01-30T02:31:50-08:00Mar 5, 2014|ALiEM Cards, Tox & Medications|

Cyclobenzaprine vs TCA Toxicity

Should we treat a cyclobenzaprine (Flexeril) overdose similar to a tricyclic antidepressant (TCA) overdose? With the only difference between the commonly prescribed muscle relaxant, cyclobenzaprine, and the TCA amitriptyline consisting of a single double bond, should the emergency provider be concerned for life threatening arrhythmias in cyclobenzaprine overdose?

(more…)

By Jill Logan, PharmD BCPS|2016-11-20T07:20:37-08:00Feb 13, 2014|Tox & Medications|

BISAP, EHMRG, ORT: 3 New Medical Scores You’ve Never Heard Of

Let’s face it. You’ve heard about the A-a gradient. And free water deficit. And even the APACHE-II score. But how useful are these in your daily practice? You don’t care that much if a patient has shunt physiology in the first case, nor exactly how much free water they’re lacking in the second. And in the third case, your clinical acumen is probably pretty good at predicting a sick patient’s mortality already. But what about the new medical scores of BISAP, EHMRG, and ORT?

(more…)

By Graham Walker, MD|2017-03-05T14:18:46-08:00Feb 6, 2014|Cardiovascular, Gastrointestinal, Tox & Medications|

Buprenorphine and Acute Pain Management: The ED Perspective

Acute pain management in the ED is challenging. For patients on buprenorphine, it can be even more difficult. What if a patient on buprenorphine presents to the ED with a painful condition that requires a short course of opioid therapy?

(more…)

By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:17:37-08:00Feb 4, 2014|Tox & Medications|

Serotonin Syndrome: Consider in the Older Patient with Altered Mental Status

What’s the first thing that pops into your head when you see an older woman presenting to the ED from a nursing facility with atraumatic altered mental status? If you’re like me, ‘UTI’ comes quickly to mind. I then banish the thought of a UTI and force myself to go through a worst-first differential diagnosis to exclude, either through the history and clinical assessment or through testing, more dangerous causes. This is a case of a 67-year-old woman with an unusual cause of altered mental status… and a UTI.

(more…)

By Christina Shenvi, MD, PhD, MBA|2016-11-11T19:18:16-08:00Feb 3, 2014|Expert Peer Reviewed (Clinical), Geriatrics, Tox & Medications|

Previous 1···29 30 31 32 33 343536 37 38 39 40 41···45 Next