What do I love about my job as an emergency medicine pharmacist? 🥰 I’ll give you a top 5, no particular order:

🏷 @CLKo_PharmD @GinaM8585 @SilaSmallPharmD @baIDpharm @annaIDpharmD

https://twitter.com/JasonMordino/status/1305317359243210752

1. You never know what’s going to come through our doors, anything imaginable: attacked with 🌵, ingested fireworks 🧨, surprise 👶 delivery, exercise induced anaphylaxis, cardiac arrest...what can I say, I 💜 to help & easily bored, couldn’t dream up a better career for myself.

More support for our friend succinylcholine. In our ED, sugammadex (also has its own ADRs) is not readily available, no EEG monitoring & HR/BP are nonspecific & unreliable markers of adequate analgosedation— sux should be used for RSI as often as possible!
jamanetwork.com/journals/jama/… ⏰ Here’s a little timeline to keep in mind for RSI...

https://twitter.com/ChillaPharmD/status/1105383084428451840

🚨Emergency Medicine Pearls 2019
@ASHP_EMPharm

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#twitterx #emergency #clinicalpearls #EMpearls #ASHP19 Naloxone for Clonidine Toxicity: Dosing & Administration Options (Katherine Ciampa)

🚨Emergency Medicine Pearls 2019
@ASHP_EMPharm

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#twitterx #emergency #clinicalpearls #EMpearls #ASHP19 RSI Induction Agents in the Setting of Shock: resuscitate before you intubate, optimize BP pre-intubation to buffer against further drops during & after RSI
@KayleighRx

🚨 Couldn’t make it to @ASHPOfficial @ASHP_EMPharm Emergency Medicine Pearls 2019 session this morning? Don’t worry, I‘ll share my notes — it’s always my favorite session ☺️

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#twitterx #emergency #clinicalpearls #EMpearls #ASHP19 IN lidocaine for migraines:
Many different doses of lidocaine have been found to be effective in the treatment of migraine

@hina_patel

#ClinicalPearl: Unsure if your upper GI bleed is variceal or non-variceal? If there is a chance it’s variceal, octreotide + ceftriaxone should be sufficient- no need for PPI, octreotide inhibits gastric acid secretion just as well 😄 #iamenough #twitterx #medtwitter #emergency Update with full rationale (thread):
(1/11)

🚨PSA: #iPhone users! Please set up #MedicalID on your phone-we can see your medical info even with your screen locked. This is SO HELPFUL when you come in and are unable to communicate with us after a terrible accident. 🚑😵 It can help save your life! (1/7) You can put allergies on Medical ID, emergency contacts, medical conditions, medications you take, blood type, any random medical notes, even organ donation status (and if you aren’t registered, you can register super easily through the app! 🙌🏼) (2/7)

Part 5 #Tramadont #tweetorial
(in which #Tramadont remains a hilariously accurate descriptor of tramadol!)
@NarouzeMD @EMARIANOMD @toby_ashken @DavidJuurlink

CYP2D6 & tramadol is not overrated at all.
Here is a picture of the tramadol metabolism pathway (PMID 11454734) (1/7)

https://twitter.com/narouzemd/status/1144830303489449984

We can agree that M1 is the metabolite which provides opioid analgesic effects. (PMID 10961373) (2/7)

“#Tramadont”, a #tweetorial

In response to the last #pharmacyeducationboard about tramadol- some are still doubting whether it has earned the moniker “Tramadont”. Points have been made that as tramadol is metabolized by CYP2D6 in the liver, so are other drugs. Should we (1/11) just not prescribe anyone anything metabolized in the liver? Touché. The problem with CYP2D6 specifically is that it happens to have the most polymorphisms of all the CYPs enzymes. What does this mean? It means it has the greatest potential variability in activity (2/11)

#Tramadol, a game of analgesic roulette, will it work or won’t it? Will your patient obtain analgesic effects or will they have a seizure, respiratory depression, or various other side effects...🤷🏼‍♀️that’s why it’s been nicknamed #Tramadont! Its variable effects are (1/3) attributable to hepatic enzyme CYP2D6;unless you know your pt’s CYP2D6 genetic polymorphism (which I haven’t come across anyone who does)AND a comprehensive list of all of their home meds, don’t prescribe it!🙅🏼‍♀️
#pharmacyeducationboard #twitterx #medtwitter #pharmacogenomics (2/3)