20/20: EM MIXOLOGY by David Cisewski

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Slide Notes

Every good ED doc can benefit from having a few "signature cocktails" in times of need. Here is a list of a few favorites shared by several expert EM mixologists throughout NYC ED's.

20/20: EM MIXOLOGY

Published on Sep 26, 2016

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PRESENTATION OUTLINE

EM MIXOLOGY

Cocktails to swear by in the ED

Every good ED doc can benefit from having a few "signature cocktails" in times of need. Here is a list of a few favorites shared by several expert EM mixologists throughout NYC ED's.

ALLERGIC REACTION

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DR.P

Diphenhydramine - 25-50mg PO or IV
Ranitidine - 150mg PO or 50mg IV
Prednisone - 60mg (or methylprednisolone 125mg IV)
(**epinephrine if severe!!)

Expert opinion:
"Consider Epinephrine is symptoms are severe enough; As far as I know, the H2 blockers offer no benefit if you've already given enough H1 blocker; we use pepcid (famotidine) instead of zantac (ranitidine) at our ED"

AGITATED

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B-52

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B-52

Benadryl - 10mg IM
Haldol - 5mg IM
Diazepam - 2mg IM

Expert opinion:

"I don't give Benadryl routinely, but if you do, give a real dose"

Note - new research has suggested 4-6mg/kg Ketamine IM can be used as an effective 3rd-line treatment for those not responding to antipsychotics or benzo's.

Isbister, GK et al. Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department. Ann Emerg Med. 2016 May;67(5):581-587. PMID: 26899459

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INTOXICATED

RALLY PACK

Banana bag:
1 liter of normal saline (sodium chloride 0.9%) with:
Thiamine 100 mg
Folic acid 1 mg
Multivitamin for infusion (MVI), 1 ampule
Magnesium sulfate 3 g

10.

RALLY PACK

1L 0.9 NS
Thiamine 100 mg
Folic acid 1 mg
Multivitamin infusion (MVI)
MgS 3 g
**skip the D50, go for BOOST!**

Banana bag:
1 liter of normal saline (sodium chloride 0.9%) with:
Thiamine 100 mg
Folic acid 1 mg
Multivitamin for infusion (MVI), 1 ampule
Magnesium sulfate 3 g

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COMATOSE

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COMA COCKTAIL

"DON'T (panic)"

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DON'T (panic)

D50
Oxygen
Naloxone
Thiamine

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MIGRAINE

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"MTN DEW"

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MTN DEW

Metoclopramide
Triptans
NSAID (Naproxen, Ketorolac)
Dexamethasone
Ergots
Wonder Drug (CGRP-R antagonists*)

When added to standard acute migraine therapy, parenteral dexamethasone treatment with dexamethasone reduces the rate of early headache recurrence.

Colman I, Friedman BW, Brown MD, et al. Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence. BMJ 2008; 336:1359.

*though still in the approval process, modulation of calcitonin-gene related peptide (CGRP) activity offers the promise of future treatment options for acute migraine attacks.

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