Archive for category: Pharmacology

More Dogma: Epinephrine in Digital Nerve Blocks

03 Sep
September 3, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketYou are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about […]

Post Intubation Sedation for Pregnant Patients

10 Aug
August 10, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit Pocket You have just intubated a seizing eclamptic woman who is 34 weeks pregnant. As she is being prepped for transfer to the OB unit for an emergent C-section your nurse asks you what medications you would like for post intubation analgesia and sedation. You have limited recollection of […]

Beyond ACLS: CPR, Defibrillation, and Epinephrine

23 Jul
July 23, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketAdvanced Cardiac Life Support (ACLS) provides a well structured framework for those who resuscitate infrequently. There is room to move beyond the algorithm to potentially provide better care for our patients for those who resuscitate frequently. I will describe some tweaks to the way CPR, defibrillation, and medications are […]

Journal Update – Beta Blocker vs. Calcium Channel Blocker for Rate Control in Atrial Fibrillation

09 Jul
July 9, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Atrial fibrillation (AF) is a commonly encountered dysrhythmia in the Emergency Department (ED). Atrial flutter is less common but its management is very similar to that of AF. In patients with chronic AF or unknown time of onset and a rapid ventricular response (RVR), rate control and consideration […]

Morphine Kills in Acute Decompensated Heart Failure

08 Jun
June 8, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Intravenous morphine use has been reported in nearly one of seven patients hospitalized with acute decompensated heart failure (ADHF). I have anecdotally, even seen physicians giving morphine as a “first-line” agent: Nitroglycerine, Non-Invasive Positive Pressure Ventilation (NIPPV), and Morphine. There is surprisingly little evidence supporting routine use of […]

Skin Anesthesia: Lidocaine vs Bupivacaine +/- Epinephrine

23 Apr
April 23, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit Pocket  When selecting a local anesthetic agent for skin wounds I have historically been taught to use lidocaine to provide a faster onset, and to use bupivacaine for a longer duration of action. It can be time consuming to find 0.5% Bupivacaine with epinephrine and 2% Lidocaine with Epinephrine […]

Lidocaine + Bupivacaine vs Bupivacaine Alone for Digital Nerve Blocks

09 Apr
April 9, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketWhen I first learned digital nerve blocks in the late 1990’s I was taught to mix Lidocaine and Bupivacaine 50/50 to provide faster onset (Lidocaine) and a longer duration of action (Bupivacaine). My use of two agents for digital nerve blocks was recently questioned by one of my colleagues. […]

January 2015 REBELCast

10 Jan
January 10, 2015

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketWelcome to the January 2015 REBELCast, where Swami and I are going to tackle a very important scenario that comes up in the daily practice of not only Emergency Medicine, but also in Medicine.  Today we are going to specifically tackle one topic: Topic: Is the use of cephalosporin antibiotics […]

Colchicine for Treatment of Pericarditis

11 Aug
August 11, 2014

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketAcute and recurrent pericarditis are frequently diagnosed in the emergency department.  Traditionally, treatment has consisted of anti-inflammatory medications (eg. ASA or NSAIDs) or corticosteroids.  Colchicine is an underutilized therapy for pericarditis and provides significant benefit when combined with NSAIDs/ASA. Addition of colchicine to standard therapy results in earlier reduction […]

Topical Tranexamic Acid for Epistaxis or Oral Bleeds

14 Jul
July 14, 2014

Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketRecently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use […]

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