Common medications in EM

[MSUSpartan642]

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I was wondering if people could comment on some of the most common medications commonly used by Emergency physicians? I know we should know the ACLS, RSI, etc. But what other ones medications (Dosing and length of treatment) would it be useful for a medical student and hopefully incoming PGY-1 to begin to commit to memory?

 

[Xerxes1729]

The really common stuff (ibuprofen, morphine, ceftriaxone, vancomycin, etc.) you will learn quickly without trying. If the place you're at has CPOE, it will generally give you the standard dose.

What you need to learn are the things that are used regularly but not daily, like vasoactive and sedating drips, that you'll often order verbally without the benefit of a computer to tell you what the right dose is.

 

[RustedFox]

The really common stuff (ibuprofen, morphine, ceftriaxone, vancomycin, etc.) you will learn quickly without trying. If the place you're at has CPOE, it will generally give you the standard dose.

What you need to learn are the things that are used regularly but not daily, like vasoactive and sedating drips, that you'll often order verbally without the benefit of a computer to tell you what the right dose is.

This is good advice. The 'drips' especially. Do what I did: print out a short list of the most common ones (all your pressors/sedatives) and tape it to the back/front of your Tarascon/antibiotic quick reference books/whatever you carry with you. You'll "not" be able to "not see" them whenever you open the book. I call it "learning thru sheer petulence."

 

[WilcoWorld]

If you're a med student, my primary request is that you know every medication that your patient is taking, what it does and what it's side effects are.

If I order a drip of anything other than my top 3-5 gtt's, I'm going to look up the dose.

 

[Perrin]

Know the dose and concentration of epi for anaphylaxis, I've seen residents order the wrong concentration a few times. This is an error that usually only the more experienced nurses pick up on. The wrong dose turns the patient's bad day into your very bad day.

Learn the drugs and dosages in the 'cocktails' and the respiratory combos. We had an attending who, whenever he saw an intern order a 'GI cocktail' or "Duo-neb', would scratch it out and make them write out the medication, dose, and route. He did this because years ago, before CPOE and it's drug allergy checking, a resident gave a GI cocktail to someone who had a real barbiturate allergy that was clearly documented in the chart. The patient had to be intubated and spent some time in the unit.

 

[WilcoWorld]

Know the dose and concentration of epi for anaphylaxis, I've seen residents order the wrong concentration a few times. This is an error that usually only the more experienced nurses pick up on. The wrong dose turns the patient's bad day into your very bad day.

Learn the drugs and dosages in the 'cocktails' and the respiratory combos. We had an attending who, whenever he saw an intern order a 'GI cocktail' or "Duo-neb', would scratch it out and make them write out the medication, dose, and route. He did this because years ago, before CPOE and it's drug allergy checking, a resident gave a GI cocktail to someone who had a real barbiturate allergy that was clearly documented in the chart. The patient had to be intubated and spent some time in the unit.

There are barbiturates in GI cocktails? That's news to me.

edit: Just looked up Donnatal on a hunch- that must be what you're referring to. I don't use Donnotal in my GIC's, but that's good to know nonetheless. Thanks.

 

[Perrin]

There are barbiturates in GI cocktails? That's news to me.

edit: Just looked up Donnatal on a hunch- that must be what you're referring to. I don't use Donnotal in my GIC's, but that's good to know nonetheless. Thanks.

There's some differences between institutions, but in our instance if precluded complacency.

 

[NERDY]

However, if you don't know a dose look it up OR ask the pharmacist. If you go to med school at MSU, chances are you are rotating at big hospitals that have 24/7 pharmacy. You don't want to be playing with medication doses.

 

[Hamhock]

The really common stuff (ibuprofen, morphine, ceftriaxone, vancomycin, etc.) you will learn quickly without trying. If the place you're at has CPOE, it will generally give you the standard dose.

What you need to learn are the things that are used regularly but not daily, like vasoactive and sedating drips, that you'll often order verbally without the benefit of a computer to tell you what the right dose is.

Yes, good advice about common emergent drips. However, before you memorize a bunch of drips, find out what the common 'units' are for each drip in your ED.

For example, if your ED uses epi drips in mcg/kg/min and you ask the nurse to start the epi drip "at five" (as you memorized typical ranges in mcg/min, like my first ED), you will likely get some odd looks, loose some respect, or have more ICH and MI patients than the other interns.

HH

 

[Tiger26]

Yes, good advice about common emergent drips. However, before you memorize a bunch of drips, find out what the common 'units' are for each drip in your ED.

For example, if your ED uses epi drips in mcg/kg/min and you ask the nurse to start the epi drip "at five" (as you memorized typical ranges in mcg/min, like my first ED), you will likely get some odd looks, loose some respect, or have more ICH and MI patients than the other interns.

HH

Agree with Hamhock and others.

Know the most common ones and the "oh s**t, badness is imminent" medications.

I listened to a Mel Herbert lecture, where he called this "brainstem information" because it's stuff you don't have time to look up at 2am with someone brings in a kid turning blue

RSI meds, sedation, asthma interventions, vent settings, ACLS/PALS drugs, pressors, IVF/Blood/FFP dosing, dextrose, narcan, hyperkalemic meds, nitro drips, ETT sizes and depths for kids

 

[J ROD]

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[Angry Birds]

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