Ketamine for Refractory Status Epilepticus

Introduction Status epilepticus (SE)* is characterized by: ≥5 minutes of continuous clinical and/or electrographic seizure, OR Recurrent seizure activity without recovery to baseline between seizures. Thirty-day mortality in convulsive SE is 19 to 27%, while non-convulsive SE rates reach 65%. In one study, patients with treated and resolved SE within 10 hours had 10% mortality […]

Single-Dose Aminoglycosides for UTIs

Download PDF Introduction UTIs are most commonly caused by Enterobacteriaceae (E. coli, Proteus spp., Klebsiella spp., etc.) and other Gram-negative organisms. UTIs are classified based on risk factors (uncomplicated vs. complicated) and the area of the urinary tract affected (cystitis vs. pyelonephritis). Treatment of asymptomatic bacteriuria is often not beneficial and only supported by guidelines in pregnant women and before […]

The Use of Thrombolytics for ACS

Introduction Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy during a cardiac arrest; thrombolytic therapy is an option without PCI capability, followed by transfer to a PCI capable center.  Thrombolytic therapy is most effective when administered within 30 minutes of first medical contact, however, may be considered within 12 – 24 hours of symptom […]

Management of Hypertensive Emergency

Introduction Hypertensive emergency is characterized by systolic blood pressure (SBP) > 180 mmHg or diastolic blood pressure (DBP) > 120 mmHg with evidence of target organ damage.  Rapid blood pressure lowering with intravenous antihypertensives is warranted to prevent further organ damage.  Patients presenting with intracranial hemorrhage, aortic dissection, preeclampsia, or pheochromocytoma crisis should achieve target […]

Hypercalcemia of Malignancy

Introduction Hypercalcemia of Malignancy (HCM) is an oncologic emergency typically seen in patients with advanced stage cancers HCM is more common in patients with tumors that are associated with bone metastases (breast, lung, multiple myeloma, renal cell carcinoma and colorectal cancer) Hypercalcemia is defined as a corrected calcium level > 10.5 mg/dL Symptoms occur slowly […]

Epinephrine, anaphylaxis, and biphasic reactions

Introduction Anaphylaxis is a life-threatening, IgE-mediated allergic reaction most commonly triggered by medications, foods, and stinging insects. Symptoms occur rapidly, within minutes up to as late as 1 hour, and can involve urticaria, angioedema, dyspnea, hypotension, nausea/vomiting, and abdominal pain among many other reactions. Some patients experience biphasic anaphylaxis, which is recurrent anaphylaxis that occurs […]

The Role of Epinephrine in Cardiac Arrest

Introduction There are greater than 350,000 out-of-hospital cardiac arrests annually, and nearly 90% of them are fatal. The effects of epinephrine on animal hemodynamics have been studied since the late 1800s. While the first advanced cardiac life support (ACLS) guidelines were first published in 1974, the role of epinephrine remains controversial.   Epinephrine [Adrenalin®] Dose […]

Procainamide for Wide Complex Tachycardia

Introduction Ventricular tachycardia (VT) is an uncommon but dangerous medical condition, with an extremely variable clinical presentation. Intravenous procainamide is guideline recommended and is the drug of choice for the treatment of hemodynamically stable VT with a class IIa recommendation. Procainamide is an old drug with new evidence that supports it’s use but dosing strategies […]

Hypocalcemia in Trauma Resuscitation

Introduction Trauma is a leading cause of death in the US, and uncontrolled hemorrhage is often the primary cause of mortality. The lethal triad of trauma includes coagulopathy, hypothermia, and acidosis with calcium being heavily involved in the coagulation cascade. Calcium plays a vital role in coagulation and platelet, being required by clotting factors II, […]

Cystitis Treatment with Nitrofurantoin

Introduction Urinary tract infections (UTI) affect 150 million each year, with 50-60% of women developing at least one UTI in their lifetime. Costs of these infections, ranging from societal to health care costs, are approximately $3.5 billion per year in the US alone. Most commonly caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis. […]