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:
UPDATE Jan 1, 2018: The PV Cards are no longer on AgileMD.
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?
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?
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?
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.
Tramadol is a popular agent for the treatment of pain and offers an alternative to opioid therapy. Tramadol exerts its analgesic effects through weak stimulation of the mu opioid receptor as well as inhibiting the reuptake of serotonin and norepinephrine similar to some antidepressant medications. While tramadol may be an effective option for mild to moderate pain in otherwise healthy individuals, the following patients may benefit from an alternative analgesic selection. 1–4
Vancomycin remains one of our workhorse antimicrobials for treating infections caused by methicillin-resistant S. aureus
(MRSA). As the incidence of MRSA infections continues to rise AND we are starting to see increasing minimum inhibitory concentrations (MIC) with vancomycin, it is paramount that we optimize its use, starting in the Emergency Department (ED).