Cardiac Glycosides
Diverse plants are sources of sugarcontaining compounds (glycosides) that also contain a steroid ring and augment the contractile force of heart muscle : cardiotonic glycosides / cardiosteroids, or “digitalis”. If…
Hyponatremia and Hypernatremia in the Emergency Department
Diagnosis and Management of Hyponatremia
Excess free H2O relative to Na → serum Na < 135 mEq/L. Neurologic spectrum 2/2 water shift in cells: Fatigue → lethargy → AMS (altered mental status) (usually starting <120 mEq/L) → seizure → coma
Know the Thresholds for Red Blood Cell (RBC) Transfusion in the Critically Ill
While it is not the only state that defines a critically ill patient, shock is considered by many to be the prototypical derangement of the critically ill. With our bedside…
Drugs Acting on Smooth Muscle
Bronchodilators Narrowing of bronchioles raises airway resistance, e.g., in bronchial or bronchitic asthma. Several substances that are employed as bronchodilators are: β2-sympathomimetics (given by pulmonary, parenteral, or oral route)methylxanthine theophylline…
Acute Pelvic Pain in the Emergency Department
The approach to the woman with pelvic pain is to start with the initial resuscitation and β-HCG. Then the focus should be on emergent gynecologic disease, such as ovarian torsion and PID / TOA (Tuboovarian Abscess)
Threatening Hemorrhage in the Patient Taking an Oral Anticoagulant Medication
Guidelines for the Management of Supratherapeutic INR
Oral anticoagulant medications are commonly prescribed. Whether it is a traditional vitamin K antagonist (VKA) or a novel oral anticoagulant (NOAC) medication, all carry the risk of serious hemorrhage. Traditional…
Inhibitors of the Renin Angiotensin Aldosteron System
ACE inhibitors, such as captopril and enalaprilat, the active metabolite of enalapril, occupy the enzyme as false substrates. Affinity significantly influences efficacy and rate of elimination. Enalaprilat has a stronger and longerlasting effect than does captopril.
Lower Abdominal Pain in the Emergency Department
Work-up for lower abdominal pain begins with resuscitation and exclusion of critical diagnoses: AAA (Abdominal Aortic Aneurysm); Mesenteric Ischemia; Perforation; SBO (small bowel obstruction); ectopic pregnancy
Know When to Administer Sodium Bicarbonate in the Critically ill Poisoned Patient
Potential Indications for Bicarbonate Therapy in Metabolic Acidosis
Sodium bicarbonate is an important antidote in the treatment of the critically ill poisoned patient. This contrasts with the general approach to acidosis due to other conditions, where sodium bicarbonate…
Calcium Antagonists (Ca-channel blockers)
The term Calcium (Ca2+) antagonist is applied to drugs that inhibit the influx of Ca2+ ions without affecting inward Na+ or outward K+ currents to a significant degree. Other labels are Ca-entry blocker or Ca-channel blocker.
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