Updates in Pharmacology: Interactions and Adverse Effects of Psychiatric Medications

Authors: Erica Bates, MD; Philip Magidson, MD MPH; Robert Brown, MD; Megan Donohue, MD; Akilesh Honosage, MD
Editors: Michael C Bond, MD FAAEM; Kelly Maurelus, MD FAAEM
Originally Published: Common Sense March/April 2017

Introduction
Over the past decade, the number of psychiatric medications dispensed has increased dramatically and now annually numbers in the tens of millions. As Emergency Physicians now frequently encounter patients on psychiatric medications, understanding potential complications and potentially life threatening reactions is necessary. This journal review covers common potential side effects, adverse reactions, and drug-drug interactions of various psychiatric medications commonly found in the ED.

Advancing the Need to Reduce Unnecessary Antibiotic Treatment by Using the Biomarker Procalcitonin

Authors: Raymond Beyda, MD; Jackie Shibata, MD; Lee Grodin, MD; and Theodore Segarra, MD
Editors: Kelly Maurelus, MD FAAEM and Michael C. Bond, MD FAAEM
Originally Published: Common Sense January/February 2017

ED physicians frequently treat and admit patients for infectious diseases. Judicious use of antimicrobial therapy is important in order to avoiding the development of antimicrobial resistance and adverse drug effects. Procalcitonin (PCT) is one of several bbiomarkers which may be useful in decreasing unnecessary antibiotic therapy. Specifically, PCT levels should be low for viral, as opposed to bacterial, infections. Procalcitonin has been studied as both a diagnostic and prognostic marker in various types of systemic and organ-specific infections. The potential for PCT to reduce unnecessary antimicrobial therapy has been shown in several observational and randomized controlled trials performed in outpatient, inpatient, and ICU environments. The most robust evidence is in sepsis and pulmonary infections. Here we review some of the evidence behind the use of PCT in acute infectious disease management.

Acute Heart Failure

This post was peer reviewed.
Click to learn more.

Image Credit: Pixabay

Author: Daniel F. Leiva, DO, MS
Baystate Medical Center

Acute heart failure is a common and potentially life-threatening disorder the emergentologist should know well. In 2006 there were 5.1 million people living with heart failure in the United States and an estimated 23 million people worldwide.[1,2] Patients can present to the emergency department as a new, acute failure or an acute-on-chronic exacerbation. They typically complain of dyspnea, fatigue, paroxysmal nocturnal dyspnea, or orthopnea, the latter two of which are highly sensitive and specific.[3] Additional symptoms may include cough, chest pain, palpitations, tachypnea, peripheral edema, weight gain, or decreased exercise tolerance, depending especially on the presence of a precipitant. These can include volume excess, especially in renal or liver failure patients, sudden hypertensive states, acute myocardial infarction, myocarditis, pulmonary embolus, excessive exertion in a deconditioned state, changes to drug therapies, including the addition or removal of drugs or changes in dosages, and substance abuse.[3] The most important piece of history to establish in a patient is a previous diagnosis of heart failure. Consideration should be given to systolic dysfunction/heart failure with reduced ejection fraction (HFrEF) versus diastolic dysfunction/heart failure with preserved ejection fraction (HFpEF); left-sided versus right-sided heart failure; and high-output versus low-output failure, which can change the acute management of the patient.[4] Previous echocardiogram records may be beneficial in making this determination if available.

Spinal Epidural Abscess vs. Cauda Equina Syndrome

This post was peer reviewed.
Click to learn more.

Image Credit: Wikipedia

Author: Patrick Wallace, OMS-IV
Rocky Vista University College of Osteopathic Medicine
AAEM/RSA Education Committee

Spinal Epidural Abscess
Spinal epidural abscess (SEA) is a potentially debilitating and life-threatening cause of low back pain. It occurs in 0.2 to 2 cases per 10,000 hospital admissions.[1-3] However, recent articles note the incidence is increasing as much as five-fold.[4,5] SEA most commonly occurs in the thoracic and lumbar regions.[4,6] The difficulty in diagnosing an SEA is due to the nonspecific symptoms that often mimic the more common benign low back pain complaints seen in the emergency department. Making the diagnosis prior to the development of neurological symptoms is rare, so this cause should always be considered in the differential.

The Challenge of Identifying a Septic Joint

Authors: Raymond Beyda, MD; Lee Grodin, MD; Jackie Shibata, MD; Ted Segarra MD
Editors: Kelly Maurelus, MD FAAEM and Michael Bond, MD FAAEM 
Originally Published: Common Sense May/June 2017

The ED evaluation of patients with acute monoarthritis is often challenging given the broad differential diagnosis and significant morbidity which can result from missed septic arthritis (SA). The following articles aim to simplify the work-up of the undifferentiated hot and swollen joint.