Sara J. Hyland PharmD

Do you have experience and/or opinions regarding sugammadex use in the ICU or Emergency department?

We'd be grateful if you took our practice survey here-
t.co/GHiaYoGzqK

#Medsky #PharmSky #EMIMCC #FOAMed

Yup lol. Also Ancef

We do a tremendous disservice to people with penicillin allergies in jumping to second- or third-line antibiotics, and this practice has demonstrated worse clinical outcomes

Don't even need to jump to carbapenem d/t PCN allergy. I would have proceeded with ceftriaxone or cefepime depending on what we're treating. Advise them to check out the AAAAI guidelines and any number of side chain charts.

education.aaaai.org/penicillin-a...

foamed.ebmedicine.net/rapid-refere...

Thank you for your time and consideration, and please share this survey link broadly!

All hospital HCWs who take care of and/or supply medications for critically ill patients are invited, including physicians, prescribers, and hospital pharmacists/pharmacy leadership.

The purpose of this IRB-exempt research study is to characterize current perceptions and practices relating to sugammadex across ED and ICU settings.

It is voluntary, anonymous, and should take about 10 minutes to complete. (sorry it is only intended for U.S. practitioners)

Do you have experience and/or opinions regarding sugammadex use in the ICU or Emergency department?

We'd be grateful if you took our practice survey here-
t.co/GHiaYoGzqK

#Medsky #PharmSky #EMIMCC #FOAMed

VTE prophylaxis in foot & ankle surgery review-
www.hmpgloballearningnetwork.com/site/podiatr...

How can we best use limited data and tailor ppx to individual patient risk/benefit in this heterogenous surgical population? 🦶🔪💉💊

What's your approach? #Medsky #FOAMed #VTE #FAS #pharmsky

Had a great time chatting with you guys about residual NMB and reversal strategies in the ICU! Thanks so much for the conversation and for highlighting this topic.

#emimcc #medsky #pharmsky

Probably Low at those doses but possible, probably risk/benefits and monitor
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...

a woman speaking into a microphone with the words " it 's up for debate " below her ALT: a woman speaking into a microphone with the words " it 's up for debate " below her

Sugammadex in the ICU: let's talk about a *real* conundrum

Everyone always talks about the use of sugammadex for failed intubations (bad idea, lets move on)

But we overlook something we *should* be talking about: when we should use sugammadex for pre-extubation paralysis reversal... #1/4 #EMIMCC

a woman in a polka dot dress is applauding in a crowd of people with snl written on the bottom ALT: a woman in a polka dot dress is applauding in a crowd of people with snl written on the bottom

I know we're like hidden unicorns sometimes😂❤️

accpjournals.onlinelibrary.wiley.com/doi/abs/10.1...

I wish I could like this 1000 times 😂 so true. This yielded many good lessons in understanding pharmacomechanisms /toxidromes that are maybe getting lost nowadays. But certainly better for the patients that we have better options now haha

Totally. As can all of us OR pharmacists working with anesthesiologists in the pre-sug era;) 🤝

Though is a topic of active research by my group and hopefully others! Interested in the discussion here /end

but if deemed only minimal NMB likely, then this need not be accomplished with sug per se.

Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/

Ideal state may have been to assess NMB and reverse at end of case. Guessing block would have been greater and sug would be helpful at that point.

At this juncture though NMB is likely shallow or minimal though unable to assess precisely. Some reversal would likely be prudent, but 2/

Definitely agree with all this

To discuss the case question presented here- I think this is a good one for which there is likely divide and also lots of "not on the radar" as stated.

Firstly - if pt was only intubated for procedure then why did we wait 3 hrs to extubate? Sig HD instability? 1/

Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: A Retrospective Analysis and Practical Guidance - PubMed Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where...

Thanks @mdaware.org here's that paper -
pubmed.ncbi.nlm.nih.gov/36407180/

💯

The degree and duration of residual NMB after a single dose of roc is highly variable and probably alarmingly long in a fair amount of patients. when you start really digging into this it's all there but doesn't seem widely understood

A Critical Analysis of the Literature on Time-to-Antibiotics in Suspected Sepsis - PubMed The Surviving Sepsis Campaign recommends immediate antibiotics for all patients with suspected sepsis and septic shock, ideally within 1 hour of recognition. Immediate antibiotic treatment is lifesavi...

This article does an excellent job dissecting this issue too. I especially value the points about inappropriate linearizing and combining disparate patient severity
pubmed.ncbi.nlm.nih.gov/32691835/

Summary of SSC guidelines on time to abx

Evolution and controversies in sepsis management

Influence of the appropriateness of abx on sepsis mortality

Challenges with interpreting influence of time-to-abx influence on mortality

Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-

@dybspharmd.bsky.social

14) our #ketamine in the ED infographic
#emimcc

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

13) STEMI pharmacotherapy reviews

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

I know, super lame ;P Send me your email

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

It looks like they just moved the links for some reason, my thanks and apologies!

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

Oh my it looks like they just moved it for some reason, my thanks and apologies!

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

#cardiosky

Thank you to this amazing team of STEMI pharmacist queens 👑💖💊
@ Danielle Blais
@ Marnie Max
@ Rachael Eaton
@stephaniewong.bsky.social
@lichenlady94.bsky.social

#medsky #pharmsky #emimcc #cardsky