EM PHARMACY PEARLS ENDOCRINE-METABOLIC
EM Pharm Pearls: Aumento estimado de la concentración de glucosa en sangre con la administración de dextrosa

Una pregunta común es cuánto debemos esperar que aumente la concentración de glucosa en sangre después de la administración de dextrosa al 50% (D50). Afortunadamente, hay una respuesta de 3 estudios. Balentine JR, Gaeta TJ, Kessler D, Bagiella E, Lee T. Efecto de la admini...

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EM PHARMACY PEARLS TOX & MEDICATIONS
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 of these tests given their limitations. The American College of Medical Toxicology published a position statement on the interp...

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EM PHARMACY PEARLS PSYCHIATRY TOX & MEDICATIONS
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 for patients and healthcare workers. A commonly employed treatment regimen is the combination of haloperidol 5 mg + lorazepam 2 ...

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EM PHARMACY PEARLS HEME-ONCOLOGY NEUROLOGY TOX & MEDICATIONS UNCATEGORIZED
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 indications and considered first-line therapy for prevention of acute ischemic stroke in patients with nonvalvular atrial fibrillatio...

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CARDIOVASCULAR EM PHARMACY PEARLS
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’s heart rate and blood pressure. The 2010 guidelines for management of patients with thoracic aortic disease suggest a heart ra...

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EM PHARMACY PEARLS TOX & MEDICATIONS
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 treatments (ECTRs) may be considered. The most commonly used ECTRs are intermittent hemodialysis (iHD) and continuous renal replacement ...

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EM PHARMACY PEARLS INFECTIOUS DISEASE TOX & MEDICATIONS
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 progression to severe infection, molnupiravir and nirmatrelvir/ritonavir (Paxlovid) [1,2]. Prior to this authorization, most evidence-bas...

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EM PHARMACY PEARLS ENDOCRINE-METABOLIC TOX & MEDICATIONS
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 choice, though alternative fluids may be a better option [1-4]. Randomized trials, in adult and pediatric patients, demonstrate fas...

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EM PHARMACY PEARLS INFECTIOUS DISEASE
¿El orden de las dosis importa? ¿Qué antibiótico administrar primero en caso de una infección del torrente sanguíneo?

Antecedentes Se recomiendan antibióticos tempranos para el tratamiento de muchas infecciones, incluidos pacientes con sepsis o shock séptico [1]. A los pacientes críticamente enfermos y a aquellos con sospecha de infección y riesgo de enfermedad grave generalmente se les a...

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EM PHARMACY PEARLS TOX & MEDICATIONS
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 patients. The dosing of DigiFab can vary depending on the amount ingested, serum concentration, and/or suspected chronicity of toxic...

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