Author: JP Brewer, M.D. Educational Pearls After the first hour, every 1 hour delay in antibiotics in a patient with septic shock patient is associated with a 4% increase in mortality. In patients with high suspicion for septic shock (fever and hypotension), antibiotics should be initiated ASAP. Rocephin (ceftriaxone) should be used for those with community-acquired…
Read MoreAuthor: Aaron Lessen, M.D. Educational Pearls Icatibant was introduced to treat ACE-inhibitor induced angioendema. This type of angioedema is refractory to epinephrine and antihistamines, and is likely mediated by elevated bradykinin.(which is inactivated by ATII and ACE). Icatibant initially was shown to reduce facial swelling and airway obstruction in the setting of ACE-I angioedema, but…
Read MoreAuthors: Don Stader, M.D & Rachael Duncan, PharmD BCPS BCCCP Educational Pearls Fentanyl patches may be abused in many ways, including changing the patches more frequently, chewing them, extracting the fentanyl in a tea, and administering them rectally. Fentanyl is very lipophilic and has a fast onset, but it has a very low bioavailability when given…
Read MoreAuthor: Heidi Wald, MD, MSPH Associate Professor of Medicine – University of Colorado School of Medicine, Physician Advisor – Colorado Hospital Association Dr. Heidi Wald explains common misconceptions of UTI’s in elderly patients and provides tips on how to properly identify them. References: Trestioreanu , Adi Lador , May-Tal Sauerbrun-Cutler and Leonard Leibovici Antibiotics for asymptomatic bacteriuria Cochrane…
Read MoreAuthor: Rachael Duncan, PharmD BCPS BCCCP Educational Pearls Desmopressin is an ADH mimetic and helps retain water, release von Willibrand Factor (in high doses), and treat diabetes insipidus (in low doses). It can also be used in renal colic, because it may reduce muscle spasm in the ureters. The dosing for renal colic is very small…
Read MoreAuthor: Rachel Duncan, PharmD BCPS Educational Pearls: Toradol (Ketorolac) is an NSAID used for its anti-inflammatory properties In practice, the common dosages are 30mg IV or 60mg IM Clinical concerns arise in patients with renal insufficiency or bleeding, but the risks are small (<1%) Studies have found that doses over 7.5mg have the same efficacy…
Read MoreAuthor: Donald Stader M.D. Educational Pearls: Coffee originates from Ethiopia. Its “active ingredient” is caffeine Caffeine is a xanthine alkaloid used in medicine to control headache and as a neonatal stimulant Studies have shown that coffee may increase lifespan Overdose can be encountered in those using diet pills or concentrated caffeine pills and is treated…
Read MoreRun Time: 2 minutes Author: Aaron Lessen M.D. Educational Pearls: There are patients that present to the ER with ugly wide complex tachycardias, but are stable and talking – It is possible to try and use medications before immediately running to shock the patient back into a normal sinus rhythm. Possible medications for cardioversion of…
Read MoreRun Time: 4 minutes Author: Rachael Duncan, PharmD BCPS Educational Pearls: Propranolol overdose presents with bradycardia, hypotension, decreased activity, and decreased body temperature. Propranolol is a lipophilic beta-blocker. Appropriate reversal agents for overdose on propranolol are epinephrine, dopamine, glucagon, calcium, levophed, and an IV lipid sink to sequester the propranolol. In cardiogenic shock, the heart begins…
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