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Tactical Medicine News

EM Pharm Pearls: Estimated rise in blood glucose concentration with dextrose administration

by Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Jul 18, 2022
A common question is how much should we expect the blood glucose concentration to increase after dextrose 50% (D50) administration. Fortunately, th...
Tactical Medicine News

Interpretation and Limitations of Opiate Urine Drug Tests

Background Urine drug tests are commonly sent for patients in the emergency department, however care should be taken when interpreting the results ...
Tactical Medicine News

Should Diphenhydramine be included in an Acute Agitation Regimen?

Background Acute agitation in the emergency department is a common issue that frequently requires the use of chemical sedation to preserve safety f...
Tactical Medicine News

Are Thrombolytics Safe for Acute Ischemic Strokes in Patients on DOACs?

Background Direct-acting oral anticoagulants (DOACs), including apixaban, rivaroxaban, edoxaban, and dabigatran, are widely used for various indica...
Tactical Medicine News

Blood Pressure Differences in Patients with Acute Aortic Dissections

Background An acute aortic dissection (AAD) can be a life-threatening emergency which frequently requires rapid and precise control of the patient’...
Tactical Medicine News

Extracorporeal Treatment Options in Poisoned Patients

Background Caring for a patient that is critically-ill secondary to a toxic ingestion is complicated and, in severe cases, extracorporeal treatment...
Tactical Medicine News

Oral Antivirals for Treatment of Mild-Moderate COVID-19 Infection

Background Two new oral agents were given Emergency Use Authorization to be used in patients with mild-moderate COVID-19 at high risk of progressio...
Tactical Medicine News

Balanced Fluids in Diabetic Ketoacidosis

Background Many guidelines and treatment algorithms for diabetic ketoacidosis (DKA) recommend sodium chloride 0.9% as the replacement fluid of choi...
Tactical Medicine News

Dose Order Matter? Which Antibiotic to Give First for a Bloodstream Infection

Background Early antibiotics are recommended for treatment of many infections, including patients with sepsis or septic shock [1]. Critically-ill p...
Tactical Medicine News

Simplified Dosing Scheme for DigiFab® in Acute Digoxin Poisoning

Background Treatment of digoxin toxicity can be quite complex and generally involves the use of digoxin immune Fab (DigiFab®) for symptomatic patie...
Tactical Medicine News

Pre-Arrest Acidemia and the Effect of Sodium Bicarbonate on ROSC

Background Sodium bicarbonate during a cardiac arrest is widely debated and used in many cases. In a 2018 PULMCrit post, Dr. Josh Farkas reviews mu...
Tactical Medicine News

INR reduction with FFP – How low can you go?

Background Bleeding patients or those undergoing procedures that are at high risk of bleeding may require correction of their INR. Multiple product...
Tactical Medicine News

Succinylcholine and the Risk of Hyperkalemia

Background Succinylcholine is frequently used in the ED to facilitate intubation, but it may be avoided in some cases due to the risk of hyperkalem...
Tactical Medicine News

High-Dose Nitroglycerin for Sympathetic Crashing Acute Pulmonary Edema

Background Nitroglycerin (NTG) is an important intervention to consider for patients with Sympathetic Crashing Acute Pulmonary Edema (SCAPE) as it ...
Tactical Medicine News

Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias

Background There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventr...
Tactical Medicine News

Utility of Nebulized Naloxone

Background Naloxone can be administered via multiple routes, with nebulization gaining popularity in the past decade. A previous ALiEM Trick of the...
Tactical Medicine News

Bupropion Overdose: Factors Associated with Seizures

Background Bupropion ingestions are one of the scarier poisonings due to a relatively narrow therapeutic index and the numerous adverse effects tha...
Tactical Medicine News

One-Time Vancomycin Doses in the Emergency Department

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 disch...
Tactical Medicine News

Safety and Efficacy of Clevidipine for Acute Blood Pressure Control

Background Rapid and precise control of blood pressure is vital for patients with a hypertensive emergency or an acute stroke. Commonly, nicardipin...
Tactical Medicine News

Droperidol for Agitation in Older Adults in the Emergency Department

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 p...
Tactical Medicine News

Is Lactated Ringer’s Solution Safe for Hyperkalemia Patients?

Background There are three primary fluids used for resuscitation, each contains varying amounts of potassium per liter (Table 1): 0.9% Sodium Chlor...
Tactical Medicine News

Does the Combination of Parenteral Olanzapine with Benzodiazepines for Agitation in the ED Increase the Risk of Adverse Events?

A previous EM Pharm Pearl focused on the adverse events associated with the use of IV olanzapine for agitation. This pearl addresses concerns aroun...
Tactical Medicine News

Adverse Events from IV Olanzapine for Agitation in the ED

The ability to safely and effectively sedate agitated patients in the emergency department (ED) is paramount to provide prompt medical care and pro...
Tactical Medicine News

Colchicine Toxicity: A New Threat from COVID-19 Treatments

In the continued fight against COVID-19, a January 22, 2021 press release from the Montreal Heart Institute touted the potential of colchicine, cit...
Tactical Medicine News

2020 ACLS Guidelines on Medications for Toxicology-Related Conditions

The 2020 ACLS guidelines provide recommendations on the medication-specific management recommendations for toxicology [1]. Although the name of the...
Tactical Medicine News

2020 ACLS Guidelines on Medications for Management of Specific Arrhythmias

The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular ...
Tactical Medicine News

2020 ACLS Guidelines on Vasopressors and Non-Vasopressors During Cardiac Arrest

The 2020 ACLS Guidelines were published in October 2020 [1]. This first of 3 blog posts will focus on vasopressor and non-vasopressor medications d...
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