Bupropion Overdose: Factors Associated with Seizures

By |Categories: EM Pharmacy Pearls, Neurology, Tox & Medications|

Background Bupropion ingestions are one of the scarier poisonings due to a relatively narrow therapeutic index and the numerous adverse effects that may occur. Medical toxicologist Dr. Dan Rusyniak details his hatred of this drug in overdose in a Tox & Hound blog post aptly-titled Illbutrin. When bupropion was first approved in the 1980s, the max dose was 600 mg/day [1]. However, reports of seizures, particularly in patients with bulimia, caused its temporary removal from the market [2]. It was reintroduced a few years later with a max dose of 450 mg/day [3]. Common signs and symptoms noted in overdose [+]

ALiEM AIR Series | HEENT 2021 Module

By |Categories: Approved Instructional Resources (AIR series), HEENT|

Welcome to the AIR HEENT Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to head, eyes, ears, nose, and throat emergencies in the Emergency Department. 6 blog posts within the past 12 months (as of March 2021) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 4 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III [+]

  • Ankle x-ray film

SplintER Series: What is Wrong With My Daughter?

By |Categories: Expert Peer Reviewed (Clinical), Orthopedic, SplintER|Tags: |

  A 16 year-old competitive gymnast presents to the emergency department with left ankle pain for several weeks and missed periods. The mother provides consent to treat the patient and informs you she is concerned that with the patient’s missed periods, she may be pregnant. You obtain x-rays of her ankle (Figure 1). Figure 1. Case courtesy of Dr Hani Makky ALSALAM, Radiopaedia.org, rID: 8720   Stress fracture at the distal tibial metaphysis - note the faint sclerotic line at the tibial metaphysis (Figure 2). Figure 2. Arrows identifying the stress fracture. Case courtesy of [+]

One-Time Vancomycin Doses in the Emergency Department

By |Categories: EM Pharmacy Pearls, Infectious Disease, Tox & Medications, Uncategorized|

Background A previous ALiEM post from 2013 by an EM pharmacist colleague argued the case against one-time vancomycin doses in the ED prior to discharge. The take-home points from this post were: No evidence that a one-time vancomycin has any benefit This practice is not recommended by the Infectious Diseases Society of America (IDSA) May extend the patient’s ED stay by at least an hour for the IV infusion, depending on the dose Increases the cost of the ED visit (e.g., IV line, medication, RN time) Pharmacokinetically 1 dose of vancomycin doesn't make sense Vancomycin 1 gm IV x1 provides [+]

Reading from the Silver Linings Playbook: The ALiEM Connect Project

By |Categories: Academic, Beyond the Abstract, Education Articles, Medical Education, Professional Development, Social Media & Tech|

It feels like yesterday that we were sheltered-in-place, staring at our computers, wondering, “So now what?”  As COVID-19 paused all in-person educational sessions, the early morning residency conference we used to begrudgingly join quickly became something that we profoundly missed. While we can now be “present” while wearing sweatpants and a button-down shirt, we miss the human connection. Many of us would gladly even suffer through traffic just to be a part of this morning conference tradition. As educators and innovators, we know what a disruptive force the COVID-19 pandemic has been to the medical community. It has strained our [+]

Safety and Efficacy of Clevidipine for Acute Blood Pressure Control

By |Categories: Cardiovascular, EM Pharmacy Pearls, Neurology, Tox & Medications|

Background Rapid and precise control of blood pressure is vital for patients with a hypertensive emergency or an acute stroke. Commonly, nicardipine is utilized in these situations, with nitroprusside being a less appealing alternative. The most recent AHA/ASA Acute Ischemic Stroke Guidelines, updated in 2019, also recommend clevidipine as a first-line antihypertensive option [1]. Clevidipine is a dihydropyridine calcium channel blockers, similar in mechanism to nicardipine and amlodipine. The main advantage of clevidipine over nicardipine is related to its pharmacokinetics (Table 1). Given its shorter half-life of elimination, clevidipine can be titrated every 1-2 minutes. Additionally, if hypotension does occur, [+]

Droperidol for Agitation in Older Adults in the Emergency Department

By |Categories: EM Pharmacy Pearls, Geriatrics, Tox & Medications|

Droperidol is safe and effective for the treatment of severely agitated patients in the ED [1-3]. But what about its use for agitation in elderly patients specifically? Droperidol Efficacy Two Australian studies evaluated droperidol in more than 200 older adults (≥ 65 years old) in the prehospital and ED settings [4,5]. Both studies found droperidol to be effective in elderly patients with acute behavioral disturbances. The median time to sedation was ~20-30 minutes with doses ranging from 2.5-10 mg (Table 1).  Characteristic Page, et al (n=162) Calver, et al (n=47) Median Age 78 years 81 years Initial Droperidol IM Dose [+]

Is Lactated Ringer’s Solution Safe for Hyperkalemia Patients?

By |Categories: EM Pharmacy Pearls, Tox & Medications|

Background There are three primary fluids used for resuscitation, each contains varying amounts of potassium per liter (Table 1): 0.9% Sodium Chloride (normal saline) Lactated Ringer’s solution Plasma-Lyte A Additionally, these fluids contain markedly different amounts of other electrolytes, some of which directly influence their pH (Table 1). Solution Na* Cl* K* Ca* Lactate* Acetate* Osmolarity^ pH Sodium Chloride 0.9% (normal saline) 154 154 - - - - 308 5.5 Lactated Ringer’s 130 109 4 2.7 28 - 273 6.5 Plasma-Lyte A 140 98 5 - 27 294 7.4 Blood 135-145 96-106 3.5-5 8.5-10.5 0-1 NA 275-295 7.35-7.45 Table 1: [+]

ALiEM AIR Series | Environmental 2021 Module

By |Categories: Approved Instructional Resources (AIR series)|Tags: , , |

Welcome to the AIR Environmental Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to environmental emergencies in the Emergency Department. 6 blog posts within the past 12 months (as of January 2021) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 3 AIR and 3 Honorable Mentions. We recommend programs give 3 hours (about 30 minutes per article) of III credit for this module. AIR [+]