The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast

In this episode of the Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Brian Gilbert, PharmD, MBA, FCCM, FNCS, FCCP, FASHP, FKCHP, Heather Blue, PharmD, BCPS, FMSHP, BCEMP, Alyssa Robertson, PharmD, BCPS, BCCCP, BCEMP, and David Zimmerman, PharmD, BCCCP, BCEMP, FASHP, FCCP, to discuss one of the most pressing operational challenges facing emergency medicine pharmacists today: ED boarding.

Drawing from their recent publication in the Journal of the American College of Clinical Pharmacy, the panel explores the growing tension between ensuring high-quality pharmacy care for boarded patients and protecting the core responsibilities of the emergency medicine pharmacist. As admitted patients remain in the emergency department for longer periods, many institutions have unintentionally shifted inpatient pharmacy responsibilities onto ED pharmacists without clearly defining ownership, creating challenges for patient safety, workflow efficiency, and pharmacist role sustainability.

The discussion examines what emergency medicine pharmacists should own, what responsibilities belong to inpatient pharmacy teams, and how health systems can build workflows that provide appropriate care for boarded patients without compromising critical ED services such as resuscitations, time-sensitive medication decision-making, protocol development, and bedside emergency care. The panel also shares practical strategies for pharmacy leaders, directors, and frontline clinicians to address role drift, improve accountability, and create sustainable staffing models that support both boarded patients and emergency department operations. Whether you practice in an academic medical center, community hospital, or resource-limited setting, this episode provides actionable insights for defining pharmacy ownership and preserving the highest-impact contributions of emergency medicine pharmacists.

In Episode 130 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Hunter Rondeau, PharmD, BCIDP, AAHIVP, antimicrobial stewardship coordinator at SSM Health, to explore the growing role of single-dose aminoglycosides for urinary tract infections with limited oral treatment options.

Hunter shares how this strategy gained traction through emergency department culture-callback programs and antimicrobial stewardship efforts, highlighting real-world scenarios where a single IV dose can prevent unnecessary admissions, PICC placement, and prolonged antibiotic exposure. The discussion dives into the evolving resistance landscape, the rise of ESBL and CRE organisms, and the clinical decision-making needed to identify the right patients for this approach.

Jimmy and Hunter also review key evidence, including systematic reviews, IDSA guidance, and emerging emergency medicine data that support the safety and effectiveness of single-dose aminoglycosides. From patient selection and workflow implementation to provider education and follow-up, this episode offers practical insights for pharmacists looking to expand their impact in the ED and beyond.

If you’re interested in antimicrobial stewardship, emergency medicine pharmacy, and innovative ways to manage resistant UTIs while keeping patients out of the hospital, this episode is packed with pearls you can apply in practice.

In Episode 129 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Oscar Santalo, PharmD, MBA, MHA, BCPS, to discuss his recently published study in the Journal of Acute Care Pharmacotherapy (JACP) examining prescription abandonment after emergency department discharge. Jimmy and Oscar walk through the motivation behind the research and explore how automated pharmacy kiosks may serve as a practical solution to improve medication access at the point of discharge. The conversation focuses on why prescription abandonment remains a persistent challenge in emergency care and how pharmacy-led innovations can help bridge gaps during transitions from the ED to home. This episode also takes a broader look at the role of clinical pharmacy in emergency medicine, highlighting how system-level approaches can support adherence, continuity of care, and better patient experiences. If you’re interested in how evidence published in JACP can inform real-world practice, this episode offers thoughtful insight from the study’s author himself.

In Episode 128 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, takes on one of the most common—and most consequential—errors in emergency care: how we give IM epinephrine for anaphylaxis. Spoiler alert: if you’re giving it in the arm, you may be giving your patient little more than saline. Using real EMS-to-ED scenarios and landmark pharmacokinetic data, Jimmy breaks down why IM epinephrine in the deltoid fails, how thigh administration delivers up to 10-fold higher plasma concentrations, and why many adults are being significantly underdosed with the standard 0.3 mg approach. This episode dives into absorption physiology, weight-based dosing, needle length, and the dangerous downstream consequences that occur when inadequate IM therapy pushes teams toward risky IV epinephrine boluses. If you manage anaphylaxis in the ED, ICU, or prehospital setting, this episode will fundamentally change how you think about epinephrine. The takeaway is simple—and non-negotiable: don’t try to outsmart physiology. Don’t ask why. Give it in the thigh.

In Episode 127 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, breaks down the long-awaited RSI Trial comparing ketamine versus etomidate for rapid sequence intubation in critically ill patients. Challenging more than two decades of dogma, Jimmy explores why ketamine was associated with more early cardiovascular collapse—including higher rates of vasopressor escalation and significant blood pressure drops—despite its reputation as the “safer” agent in shock. Using real-world scenarios from the ED and ICU, this episode unpacks the concept of the ketamine hemodynamic paradox, catecholamine depletion, dosing considerations, and how these findings should change your airway preparation strategy. If you care about making intubations as boring—and as safe—as possible, this is a must-listen.

Picking up right where Part 1 left off, this episode zeroes in on the practical, high-stakes side of inpatient heart failure management. Dr. Cait Kulig returns to unpack key adverse effects of diuresis, strategies to overcome diuretic resistance, and how to approach add-ons, IV vasoactive agents, and inotropes.

Jimmy and Cait also dive into the impact of acute decompensated heart failure on pharmacokinetics, diuretic selection, and guideline-directed therapy across HFrEF and HFpEF—including tips for transitioning to ARNIs and remembering what really matters during inpatient optimization.

Whether you're adjusting diuretics or making big-picture decisions, this episode will help you level up your heart failure confidence.

In Part 1 of this two-part masterclass on acute heart failure, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, teams up with Cait E. Kulig, PharmD, HF-Cert, clinical cardiology expert and creator of CAR Rx Explain, to unpack the fundamentals of heart failure in a way that finally clicks.

From defining heart failure and understanding ejection fraction to breaking down volume status and the Forrester plot, this episode delivers clear, memorable teaching pearls for any pharmacist working with cardiac patients. Learn when to hold GDMT, how to think through diuretic strategies, and what questions you should be asking your patients on admission. This is heart failure demystified—through the lens of real-world clinical decision-making.

💡 Up next in Part 2: We pick up with the adverse reactions of diuresis, dive into overcoming diuretic resistance, and discuss IV vasoactives, GDMT classes, and more.

In Episode 124 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, explores the ongoing debate around anticoagulation reversal in patients with minor traumatic intracranial hemorrhage (TICH). Highlighting a recent multicenter study, Jimmy breaks down the data, challenges current guideline-driven practices, and raises critical questions about risk, patient selection, and clinical judgment. Tune in for a nuanced discussion that could reshape how we approach minor TICH in the emergency department.

In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, introduces the Society of Emergency Medicine Pharmacists (SEMP), a newly established organization dedicated to advancing the practice of emergency medicine pharmacy. Jimmy discusses SEMP's mission to optimize pharmacotherapeutic care in emergency departments through practice improvement, education, advocacy, research, and international collaboration. He highlights the importance of creating a unified global community for emergency medicine pharmacists and explores how SEMP aims to provide tailored support and resources for practitioners in this dynamic field. Tune in to learn how SEMP plans to shape the future of emergency medicine pharmacy and how you can get involved.​