Emergency Medicine: Week 1



1. Pharmacokinetic interpretation and documentation of phenytoin levels for at least 1 patient
2. Pharmacokinetic interpretation and documentation of vancomycin and aminoglycosides of at least 2 patients
3. Read and discuss topics with my preceptor on: electrolyte imbalances, seizures, stroke
4. Apply concepts of electrolyte imbalance treatment and work up at least one patient

This week I did not get to spend much time on the ward due to job fair and exam.
Monday: Orientation, Patient Triage introduction, worked up one patient with hypernatremia
Thursday: Worked up one patient, attended a presentation at a local high school by my preceptor exposing high school students to role of a hospital pharmacist as part of the Pharmacist Awareness Week
Topic discussed: Diabetic Ketoacidosis in Adults
Friday: Triage, Followed up one patient from Thursday, worked up a new patient

Concepts/terms I looked up so far:

1. Double disk diffusion test: Performed for the detection of inducible clindamycin resistance. Some isolates of Staphylococcus aureus have in vitro resistance to erythromycin and susceptible to clindamycin.
The disk diffusion (D-test) method can detect S. aureus isolates with inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance.

2. Plt clumps/EDTA:EDTA-induced platelet clumping is possibly the most common cause of pseudothrombocytopenia. EDTA (ethylenediaminetetraacetic acid) is the most commonly used anticoagulant in evacuated tubes. EDTA reduces platelet activation by protecting the platelets during contact with the glass tube that may initiate platelet activation. Activation causes platelets to clump in the presence of calcium and platelets adhere to the glass surface at a rapid rate. Chelation of calcium using EDTA results in decreased platelet adhesion or retention to glass.

3. GJ feeding tube: gastro-jejunal feeding tube.
Medication administration through enteral feeding tubes: http://www.medscape.com/viewarticle/585397

4. IVC filter: http://www.guidelines.gov/content.aspx?id=15730

Cannulation is the process whereby a cannula (a small hollow plastic tube) is inserted into and kept inside the vein for a period of time.

5. Evidence behind use of CCBs in heart failure:

6. Troponin I timeline: http://www.ecmaj.ca/content/173/10/1191.full

7. Uncapping dalteparin: LMWH in Renal impairment and Obesity

8. Prolia (Denosumab): Can cause hypocalcemia (symptoms: Spasms, twitches, or cramps in muscles, numbness or tingling in fingers, toes, or around mouth)

Click to access UCM214385.pdf

9. ESBL treatment: Carbapenems are the most reliable and most effective. Among the available carbepenems, meropenem is the most active against ESBL-producing organisms in vitro, with MICs generally lower than those of imipenem (0.03-0.12 µg/ml vs 0.06-0.5 µg/ml).

10. Aspiration pneumonia antibiotics (Source: Bugs and Drugs)
Community-acquired or nursing home acquired pathogens: S. pneumoniae, H. influenzae, S. aureus, Enterobacteriaceae (Alcoholism and enteral feeding may be risk factors for colonization with these organisms)
Antibiotics recommended: Cefuroxime IV/PO 2. Gatifloxacin or Levofloxacin or Moxifloxacin for 7-10 days

Community-acquired or nursing home acquired with poor oral hygiene, severe periodontal disease, putrid sputum: S pneumoniae, H. influenzae, S. aureus, Enterobacteriaceae, Oral anaerobes, Streptococcus spp, Eikenella corrodens
Amoxicillin-clavulanate or Cefuroxime IV/PO + Metronidazole Iv/PO
Gatifloxacin or levofloxacin or moxifloxacin + metronidazole IV/PO
Treat for 7-14 days

11. BOOP (Bronchiolitis obliterans with organizing pneumonia): A rare lung condition in which bronchioles and alveoli become inflamed and plugged with connective tissue. The disorder is also known as cryptogenic organizing pneumonia (COP). Associated with other health conditions:
Infections. BOOP sometimes occurs after people have had certain infections, including chlamydia, influenza or malaria. (2) Inflammatory disorders: Risk appears to be heightened for people who have disorders such as lupus, rheumatoid arthritis or scleroderma. (3) Chemotherapy or radiation can put you at risk of developing BOOP. (4) Transplanted tissue. Bone marrow, lung, kidney and stem cell transplants sometimes trigger bronchiolitis obliterans with organizing pneumonia. (5)Drug exposure (include cocaine, gold salts and some antibiotics and anti-seizure medications).

Most people recover after weeks or months of treatment prednison but in some it can progress in spite of treatment. Source: MayoClinic

12. Glicliazide and renal insufficiency: Avoid renal function of 10-50 ml/min and <10 ml/min
Source: Dosing guidelines for Adults:
13. Phenytoin:
Dose related side effects: drowsiness, confusion, nystagmus, ataxia, slurred speech, nausea, unusual behavior, mental changes, coma
Non-dose related side effects: hirsutism, acne, gingival hyperplasia, folate deficiency, osteomalacia, hyper-sensitivity reactions, steven-johnson syndrome

About rajwantminhas

I just finished my pharmacy degree at UBC. I am excited to be part of Lower Mainland Pharmacy Services. My goal is to get exposed to different kinds of disease states, medications and become better at applying my knowledge. Patient interaction is another aspect that I am going to strive to get better at. I am looking forward to this intense year and learning tonnes!

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