Contributor: Nick Tsipis, MD Educational Pearls: PO medications are less frequently used in the ED due to their longer onset of action The position the patient is in when given PO medications may affect how quickly the medication is absorbed The quicker the medication passes through the stomach into the small intestine, the quicker it…
Read MoreContributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation A recent study in Iran compared subdissociative Ketamine given with 2.5 mg Haldol to 1 mg/kg Fentanyl for pain control in the ED Ketamine with Haldol…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Awareness with recall of paralysis can occur in intubated and ventilated patients receiving paralytic medications Patients who suffer from this effect are at high risk of developing severe PTSD, depression, and suicidal ideations Occurs in approximately 0.1-0.2% of patients undergoing general anesthesia in an OR setting 2021 study showed…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Intranasal medication administration is a convenient, quick, and relatively painless option for pediatric patients Often used as an initial medication to help control pain in children prior to establishing an IV Using an atomizer is preferred when administering intranasal medications The syringe should be angled towards the ipsilateral eye…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: There are two common options for push-dose vasopressor: phenylephrine and epinephrine. Both have been studied in the setting of the OR, but are lacking data in emergency room utilization. A recent retrospective study at one hospital compared the two options for effectiveness and safety. The data showed phenylephrine raised…
Read MoreContributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: NSAIDs are a potential alternative to opioids for pain management and are associated with decreased rates of adverse effects A recent study evaluated the effectiveness of ibuprofen and oxycodone for pain management in pediatric patients with isolated, acute-limb fractures Participants were discharged home with either ibuprofen or oxycodone and…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Direct Oral Anticoagulants (DOACs) have surpassed Warfarin and Lovenox® for anticoagulation as they do not require injection and allow for easier discharge. In the ED, they are commonly prescribed after PE or DVT diagnosis. Common DOACs are Apixaban (Eliquis®) and Rivaroxaban (Xarelto®). There has not been a direct head…
Read MoreContributor: Chris Holmes, MD Educational Pearls: Foxglove plant contains the cardiac glycoside digoxin Foxglove leaf potions were once used to treat Dropsy; a historic term for symptoms of heart failure Digoxin, previously used for treating heart failure, works by increases heart contraction strength and slows heart rate Of note, the EKG of patient on digitalis…
Read MoreContributor: Don Stader, MD Educational Pearls: Xylazine, referred to as tranq dope colloquially, is an FDA approved animal tranquilizer that is circulating in the illicit drug markets of the northeastern United states It is a powerful alpha-2 agonist, similar to clonidine, and patients with xylazine overdose may present similarly to opioid overdose Naloxone will not…
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