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What is YOUR ED "out" of ?

Discussion in 'Emergency Medicine' started by RustedFox, 02.17.12.

  1. Greenbbs

    Greenbbs

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    We just got word today we have enough etomidate to last *maybe* until friday. Short on iv zofran. Have lido from what seems to be 5 different manufacturers. We are even saving the 5ml lido ampules from the line kits if we put in a line on a sedated, intubated patient.
  2. Daiphon

    Daiphon Semper Ubi Sub Ubi SDN Advisor

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    As long as the vial was clearly marked, young padawan... there was a resident several years ago that was dismissed from the institution for carrying unmarked syringes with unknown dosages of epi, etomidate, vec, sux, and some other stuff, like fentanyl, versed...

    That didn't go over so well with the people in Room 19. Not. At. All.

    Cheers!

    ps - at least being out of MTX means no inadvertent intrathecal MTX overdoses... those are baaaaaaad. d=)
  3. Daiphon

    Daiphon Semper Ubi Sub Ubi SDN Advisor

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    We luckily aren't *out* of much, but that's because my purchaser in hospital pharmacy services is a demi-goddess. Most of what we're out of are chemo agents; but that's not an isolated issue.

    We are down to <4 days of ketorolac... which is a problem, as we see a huge sickle cell population and the guidelines at my shop aren't written as "NSAID" but as "ketorolac" before opioids unless documented allergy.

    Unfortunately, we are out of acetone reagent... and I don't care for dipsticks for DKA; plus, kinda need the acetone in some other issues (AKA, IsoOH, etc) that can be very helpful.

    Cheers!
    -d
  4. njac

    njac Senior Member

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    don't worry - was walking those halls carrying a kit given out by the basement pharmacy with a vial of 1mg/mL epi and a bag of ns to QS to 10mL with. I wrote up anesthesia last year for busting out unmarked "phenylephrine" in a code in CT.
  5. zinjanthropus

    zinjanthropus

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    IV ativan
    IV zofran
    PO Zofran ODT
    IV reglan
    IV compazine
    Fentanyl
    Toradol
  6. tkim

    tkim D-d-d-dilaudid

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    mannitol, fer f_ck sakes
  7. EM2BE

    EM2BE Elf

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    Just got toradol and zofran back!
  8. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    What, this seems legit.
    [​IMG]

    Attached Files:

  9. 8654Marine

    8654Marine

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    don't know if this counts, we just ran out of trauma surgeons.
  10. xaelia

    xaelia neenlet

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    Yesterday we were out of residents.

    They wouldn't let me declare internal disaster and place us on divert, either.

    Hopefully our residents are back today.
  11. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    If you think not having residents is a disaster, then you definitely MUST stay in academics.

    What was that line from "The House of God"? Rule #11, paraphrased - "Show me a med student that only triples my work and I will kiss his feet". Transpose "resident" on "med student".
  12. xaelia

    xaelia neenlet

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    Heheh.

    'tis a joke.

    Everything ran much faster without the middleman in there....except the documentation.
  13. la gringa

    la gringa Senior Member

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    the only thing i CAN'T get is compazine (which sucks b/c it's my favorite migraine drug)... i am mindful of my use of other shortage drugs, and am using a lot more zofran ODT w/o much change in results, which surprised me. i save IV zofran for the actively puking.
  14. Jarabacoa

    Jarabacoa non carborundum ilegitemi

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    You see, you are doing it wrong. You don't actually talk to residents and try to teach. You block them out and perform other tasks such as discharging patients and prescription writing at the same time they are talking. They interfere in my life as much as the teacher on Peanuts interfered in Charlie Brown's..." MRHHR MRAM MROMH RHOMRHOM RHOM!" But the history and physical actually reads like they examined the patient and listened to them for 30 minutes whine. Their histories appear complete and include long lists of allergies and medications, rather than "medications and allergies reviewed on nurses notes" like mine all do.
  15. xaelia

    xaelia neenlet

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    An attending I worked with had been there nine years and did not know how to discharge a patient.
  16. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    The only way I could ever get away with given Compazine for migraine is if they release a racemic preparation that I can refer to as D-Compazine. Only drugs that start with D work for migraines in Vegas.
  17. EM_Rebuilder

    EM_Rebuilder Member

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    Yeah, I LOVE compazine for HAs. The place I am at had it when I started back in August.. ran out a few months later. Nobody else had heard of using it. Now the joke is that 'I used it all up'...
  18. SoCuteMD

    SoCuteMD

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    I think my ED is out of both IV valium and ativan. So that is AWESOME.
  19. DrMom

    DrMom Official Mom of SDN Moderator Emeritus

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    droperidol, right? ;)
  20. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    DrMom answered it for me. Droperidol is your friend.
  21. DrMom

    DrMom Official Mom of SDN Moderator Emeritus

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    I've grown to appreciate the compazine shortages. Gives me a good excuse to use droperidol. Most of my patients haven't heard of it so take it willingly and I've had great results with it.

    We haven't had compazine or reglan for weeks. Very low on morphine, fentanyl, various benzos, magnesium, zofran IV, and who knows what else.
  22. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    I love the stuff but there's some "policy" that it can't be given without an EKG on the chart. You know the kind of policy I mean, the kind that isn't on paper anywhere but exits in nurse's minds. It's similar to the policy that says a patient with an equivocal troponin has to go to the floor one day and the unit the next. "It's policy." "Well it wasn't policy yesterday. You sure this doesn't have more to do with staffing? Huh?"

    So I'd like to use it. The problem is it's just too dangerous. It causes V fib in nurses 100% of the time when it's ordered.
  23. jjesusfreak01

    jjesusfreak01

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    Ha, Droperidol is being added to the medic scope in my county EMS system. The ER nurses are going to love that.
  24. dchristismi

    dchristismi Gin and Tonic

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    Apparently we're out of ketamine now. But we have valium back. But are completely out of ketorolac. Ug.
  25. tkim

    tkim D-d-d-dilaudid

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    gave droperidol to migraineur today. even though i gave benadryl prior to droperidol, they still got the jitters and wanted to leave after the bolus.

    the nurse was appalled but i think it's a great side effect for a migraine med.
  26. RustedFox

    RustedFox LOL in NAD S/P FDGB.

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    Love the term "migraneur".

    Anybody else beginning to think that "migraines" may not really exist ?
  27. name?

    name?

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    Toradol, compazine, reglan, zofran, and urine HCG. That's right kids, we have to get blood to check if you're pregnant. Awesome.
  28. dchristismi

    dchristismi Gin and Tonic

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    I get migraines, and that is one weird neurologic phenomena. The only time I ever contemplated going to the ED for one was the first time I saw an aura and it scared the bejezus out of me. Granted, I was on my 3rd year neuro rotation and when the scotoma first showed up, I just KNEW it was optic neuritis. The ziggly, scintillating lines came next, and then my arm fell asleep. About a half hour later, I got the weirdest headache ever - the first unilateral headache I'd ever had. Then I put it together. The headache wasn't even that bad.

    Oh, wait. You meant Migraineur, as in NurseKs "Migraineur." In that case, you may very well be right. ;)
  29. RustedFox

    RustedFox LOL in NAD S/P FDGB.

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    HaHa.... I'm not even sure who NurseK is, but I stumbled into a bonus joke, apparently.

    It may sound strange, but I've never met a person who does suffer from migraine headaches and has described it as a UNILATERAL headache with visual field disturbances, aura, etc. Thus, I began to ask myself - "waaait a minute... fibromyalgia, irritable bowel, mitral valve.... /.... migraines?"

    - on an unrelated note: awhile ago, you and I talked about some gigs in Florida. I found one on the gulf coast that I dig. See you soon, D.
  30. la gringa

    la gringa Senior Member

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    i get migraines too, and if you read my history w/o meeting me, you'd never pick me out of a crowd.

    migraines, atypical asthma, s/p back surgery and now out of pain, allergic to a few things, hate narcs, work full time, love to exercise, can't handle more than about 50mg of caffeine at a time but can drink your butt under the table... yeah, i'm weird. people like me do exist, but i've learned that i'm not just a unicorn... i'm a multicolored fluorescent unicorn!
  31. dchristismi

    dchristismi Gin and Tonic

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    Fox,
    PM me where you're going! ('Cause we keep stealing docs from some of the coastal groups) :)

    Oh, and NurseK writes a hilarious blog at http://crasspollination.blogspot.com/
    It's not just a bonus joke, it's a bonus time-killer!
  32. pagemmapants

    pagemmapants Unknown Member

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    Put someone into Torsades with Zofran once. Never done it with d-d-d-droperidol.

    Next think you know, the pharm boards will be taking away our ondansetron and we'll be left handing out ginger ale and mints.



    http://www.ncbi.nlm.nih.gov/pubmed/15915019
  33. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    We're now out of bicarb. We're being told to use sodium acetate instead but we don't have much of that either.
  34. la gringa

    la gringa Senior Member

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    i heard from my last P&T meeting that compazine may be gone forever. i almost cried.

    am becoming a droperidol lover more and more every time i use it. it's PHENOMENAL for opiate withdrawal violent puking, and other types of violent puking/acting out.
  35. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    I love Inapsine too. Nectar of the gods. Unfortunately it kills 99% of patients who get it. Makes their hearts explode or something according to the FDA. It's no where near as safe as the tried and true FDA approved stuff like tPA for stroke.:annoyed:
  36. la gringa

    la gringa Senior Member

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    i personally saved the sanity of 2 nurses recently by giving it to patient who didn't respond or were "allergic" to zofran/phenergan. they were skeptical but are now believers.

    it was given routinely by anesthesia when i was in training... and SO much cheaper than zofran... and not on any drug shortage list!!!

    the list of "black box" drugs is getting to be so long it's mind-numbing. the FDA is so on my personal sh!t list, as i had to go overseas for a spine implant b/c of their draconian rules. i have yet to see a lumbar spine post-op patient doing as well as i am.... but anyway, off my soap box.

    i hear you on tPA... hate the stuff. most patients cringe when you give them the study #'s.
  37. xaelia

    xaelia neenlet

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    No more succinylcholine, nitroglycerin for infusion or transdermal patch, also short on bicarbonate.

    Pretty fun!
  38. RustedFox

    RustedFox LOL in NAD S/P FDGB.

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    Fun. Thread resurrection.

    These days, its hard to find Etomidate.

    I was also told that we're down to a handful of nitropaste doses.
  39. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    I got a message from my (oncology) pharmacist the other night that there's a national shortage on droperidol now and our hospital has a stash that they're holding in reserve strictly for BMT patients with intractable N/V after everything else is given. Which sucks because I totally agree on it's effectiveness...the fact that it helps chill them the hell out doesn't hurt either.
  40. xaelia

    xaelia neenlet

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    Haloperidol, also a butyrophenone, works basically just as well as droperidol....

    Dosing range between 0.5mg - 2mg IV.

    I have no problem using an antiemetic with supratentorial effects; its anxiolytic/sedating/mood-stabilizing features are part of its efficacy....
  41. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    That's my backup. But our nurses like inapsine better and I don't have a good reason to argue.
  42. goodoldalky

    goodoldalky Member

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  43. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    It's taken almost a year to convince my nurses to give it. I was the only person ordering it when I first moved here, now I've succeeded in getting it in the pyxis.

    And yet the new nurses still google it about half the time I give it.





    These days I'm out of trauma surgeons with sense.
  44. docB

    docB Chronically painful Administrator SDN Senior Moderator Lifetime Donor

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    Unfortunately we can't give haldol ic any more because its only approved for IM.

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