For acute pain in the ED, parenteral ketorolac is generally administered as 30 mg IV or 60 mg IM. Dr. Chris Bond (@socbmobem) has written about the ‘ceiling effect’ of NSAIDS. The question is: are we using too much ketorolac without getting additional pain benefit?
Hot-off-the-press is a new randomized, double-blind trial from Dr. Sergey Motov’s group (@painfreeED) that addresses this exact question.
Continue reading “The Ceiling Effect of IV Ketorolac”
The FDA-approved dosing for IV acetylcysteine (NAC) for acetaminophen overdose is complicated: a 1-hour loading dose, followed by a 4-hour maintenance infusion at a different rate, followed by a second maintenance infusion for 16 hours at yet a different rate. Back during my clinical toxicology fellowship, we published a study that found there was an interruption in antidotal therapy > 1 hour in 18.6% of cases (and medication errors in 33% of cases overall). 
Continue reading “Preventing Interruptions During IV NAC Therapy”
Up until two years ago, beta blocker use for refractory ventricular fibrillation (VFib) had only been studied in animal models with sporadic human case reports. Two studies in humans have now been published and may provide some guidance in managing this difficult-to-treat condition.
Continue reading “Esmolol for Refractory VFib”
Does intensive blood pressure control improve outcomes and reduce hematoma expansion in acute intracerebral hemorrhage (ICH)? The INTERACT-2 trial previously compared intensive vs. conservative blood pressure control in ICH patients and found no difference in death or disability between the two groups. Enter the ATACH-2 trial, published in the New England Journal of Medicine September 15, 2016. Dr. Ryan Radecki provides his review of the article on his EM Lit of Note site.
The purpose of this post is to evaluate the antihypertensive regimens used. Were they appropriate and are they applicable to practice everywhere?
Continue reading “Blood Pressure Management in ICH: ATACH-2 Trial with a Focus on the Meds”
Although the true incidence of bleeding is unknown, there is likely an increased risk of spinal hematoma when performing a lumbar puncture (LP) in patients on vitamin K antagonists (eg, warfarin). A new study set out to determine the safety of prothrombin complex concentrate (PCC) when administered prior to emergent LP.
Continue reading “PCC Before Emergent LP”