The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode90. In this episode I ll discuss 6 tips for pharmacists responding to inpatient medical emergencies.

Show notes at pharmacyjoe.com/episode90

In this episode I’ll discuss 6 tips for pharmacists responding to medical emergencies.

After years of working in the central pharmacy, an opportunity arose to go to the floors for code blue and rapid response calls. At the time, I was very nervous! Nothing in my pharmacy training or career prepared me for responding to medical emergencies. I was concerned that I wouldn’t have a role on the response team - they had gotten by for a long time without a pharmacist, what could they possibly need one for? I was wondering what heroic or fantastic thing I would have to do to fit in or prove my worth to the team.

It turns out - it wasn't nearly as challenging as I thought it would be! Now after years of responding to medical emergencies I can share these 6 tips:

Show notes at pharmacyjoe.com/episode89. In this episode I’ll: 1. Discuss an article about bloodless treatment of anemia. 2. Answer the drug information question “Which antibiotics should be given to a patient with necrotizing pancreatitis?” 3. Share a resource I use to teach pathophysiology.

Show notes at pharmacyjoe.com/episode89

In this episode I'll:

1. Discuss an article about bloodless treatment of anemia.

2. Answer the drug information question "Which antibiotics should be given to a patient with necrotizing pancreatitis?"

3. Share a resource I use to teach pathophysiology.

Article

Outcomes of Protocol-Driven Care of Critically Ill Severely Anemic Patients for Whom Blood Transfusion Is Not an Option

Lead author: Aryeh Shander

Published in Critical Care Medicine June 2016

Background

Englewood Hospital and Medical Center has managed patients for whom blood transfusion is not an option using a bloodless protocol, which has been in place since 1994.

Purpose

The purpose of the study was to

Show notes at pharmacyjoe.com/episode88. In this episode, I ll discuss the treatment of loperamide toxicity.

Show notes at pharmacyjoe.com/episode88

In this episode, I’ll discuss the treatment of loperamide toxicity.

Loperamide is often referred to as “the poor man’s methadone”. It has been used as both a drug of abuse and as a way of self-treating opioid withdrawal.

The dose used in loperamide abuse far exceeds the labelled 16 mg/day maximum, with some patients taking hundreds of milligrams per day.

The most serious sign of loperamide toxicity is ventricular arrhythmias, including torsades. I’ve taken care of one loperamide toxicity patient who had a QTc that exceeded 700 milliseconds!

This episode will focus on actual and theoretical treatments for cardiac toxicity of loperamide overdose.

Very little data seems to be published on the treatment of loperamide toxicity, so therapies are largely empiric.

As for the treatment of any drug toxicity, I consider 4 possible methods of treatment:

Show notes at pharmacyjoe.com/episode87. In this episode I’ll: 1. Discuss an article about using platelet infusions to treat intracerebral hemorrhage (ICH) from antiplatelet medications. 2. Answer the drug information question “Why were the contraindications to alteplase for acute ischemic stroke changed?” 3. Share a resource I used to learn how to recognize ECG rhythms.

Show notes at pharmacyjoe.com/episode87

In this episode I'll:

1. Discuss an article about using platelet infusions to treat intracerebral hemorrhage (ICH) from antiplatelet medications.

2. Answer the drug information question "Why were the contraindications to alteplase for acute ischemic stroke changed?"

3. Share a resource I used to learn how to recognize ECG rhythms.

Article

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial

Lead author: M Irem Baharoglu

Published in the journal Lancet May 2016 via online first access

Background

A 2013 article concluded that

Show notes at pharmacyjoe.com/episode86. In this episode I ll discuss updated toxicology guidelines when using intravenous lipid emulsion (ILE) for drug toxicity.

Show notes at pharmacyjoe.com/episode86

In this episode I’ll discuss updated toxicology guidelines when using intravenous lipid emulsion (ILE) for drug toxicity.

In episode 30 I discussed the use of ILE for drug toxicity. In April the American College of Medical Toxicology published guidance for using ILE.

The most significant change to the ILE recommendations is a 10-fold reduction in the maintenance infusion of ILE after the first few minutes of treatment.

Here are the new guidelines: