30 results on '"Regan A. Baum"'
Search Results
2. Guidance for emergency medicine pharmacists to improve care for people with opioid use disorder
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Abby M. Bailey, Jordan R. Kelsch, Regan A. Baum, Elise L. Metts, and Kyle A. Weant
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Opioid epidemic ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Pharmaceutical Science ,Medicine ,Pharmacology (medical) ,Opioid use disorder ,Pharmacy ,business ,medicine.disease ,Opiate overdose - Published
- 2021
3. Evaluation of Dosing Strategies of N-acetylcysteine for Acetaminophen Toxicity in Patients Greater than 100 Kilograms: Should the Dosage Cap Be Used?
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Sanjay R. Mohan, Kyle A. Weant, Peter Akpunonu, Abby M. Bailey, Mark K. Su, Molly M Howell, Ashley N Webb, LeeAnn Geraghty, Jordan A Woolum, and Regan A. Baum
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business.industry ,Cumulative dose ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,030208 emergency & critical care medicine ,Toxicology ,Intensive care unit ,Acetaminophen ,law.invention ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,law ,Anesthesia ,medicine ,Original Article ,030212 general & internal medicine ,Antipyretic ,Dosing ,Antidote ,business ,Adverse effect ,medicine.drug - Abstract
INTRODUCTION: Acetaminophen is a commonly used analgesic and antipyretic, with the potential to cause significant injury when ingested in toxic amounts. Although the antidote n-acetylcysteine (NAC) is available, evidence supporting dose recommendations for patients weighing over 100 kg are lacking. We performed a retrospective, multi-center analysis to determine if a capped NAC dosing scheme is similar to a non-capped dosing scheme in patients weighing over 100 kg. METHODS: Between January 2009 and January 2016, we identified patients presenting to 12 different centers who were evaluated for acetaminophen poisoning treatment. Patients must have weighed greater than 100 kg and were evaluated and identified as needing treatment for acetaminophen-related poisoning with NAC. The primary outcome was occurrence of hepatic injury, defined as an AST or ALT ≥ 100 IU/L. Secondary endpoints included number of drug-related adverse events, occurrence of hepatotoxicity, cumulative NAC dose, regimen cost, length of hospital and intensive care unit stays, and in-hospital mortality. RESULTS: There were 83 patients identified as meeting the pre-specified inclusion and exclusion criteria. A capped NAC dosing scheme resulted in no difference in hepatic injury when compared to a non-capped regimen (49.4% vs 50%, p = 1.000). The capped dosage regimen was associated with a lower cumulative dose (285.2 mg/kg vs 304.6 mg/kg, p < 0.001) and cost. No other statistically significant differences were identified among the secondary endpoints. CONCLUSION: A capped NAC dosing scheme was not associated with higher rates of hepatic injury or hepatotoxicity in obese patients in the setting of acetaminophen poisoning when compared to a non-capped regimen. Further research is needed to verify these results.
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- 2021
4. Brown recluse spider envenomation with systemic loxoscelism and delayed hemolysis: A case report
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Blake DiPaola, Jason Davis, Regan A. Baum, Peter Akpunonu, and Andrew Micciche
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Toxicology - Published
- 2023
5. Intravenous phytonadione administered orally in reducing warfarin-related coagulopathy
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Abby M. Bailey, George A Davis, Peter Akpunonu, Jamie Litteral, Ashley N Webb, Jordan H Rice, Alexandra Wiegand, Regan A Baum, and Adam Dugan
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Adult ,business.industry ,Warfarin ,Anticoagulants ,General Medicine ,Vitamin K 1 ,Vitamin k ,Toxicology ,medicine.disease ,Antifibrinolytic Agents ,Anesthesia ,Phytonadione ,medicine ,Coagulopathy ,Humans ,International Normalized Ratio ,business ,medicine.drug ,Retrospective Studies - Abstract
The cost of phytonadione tablets has increased markedly and is significantly higher than the intravenous formulation. The intravenous formulation given orally is a potential alternative but has not been directly evaluated in comparison to the commercially available tablet. The objective of this study was to evaluate the efficacy of phytonadione intravenous solution given orally compared to commercially available phytonadione tablets for reversal of coagulopathy related to warfarin.We conducted a retrospective, observational study of adult patients who received phytonadione tablets and the IV formulation orally for warfarin-related coagulopathy. The international normalized ratio (INR) was measured before and after phytonadione administration. The primary outcome was INR1.5 at 24 h after phytonadione administration.From January 1, 2015 to August 1, 2018 a total of 200 patients were identified. In total, 58% (The IV phytonadione solution given by mouth and the tablet formulation performed similarly.
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- 2021
6. Sedation and Acute Encephalopathy in a Pediatric Patient Following Ingestion of Delta-8-Tetrahydrocannabinol Gummies
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Regan A. Baum, Roy Gerona, Andrew Reckers, Matthew Riley, Ross Ellison, Blake Davidson, Peter Akpunonu, and Jordan Trecki
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medicine.medical_treatment ,Sedation ,Encephalopathy ,Intensive Care Units, Pediatric ,Eating ,mental disorders ,medicine ,Cannabidiol ,Humans ,Ingestion ,Dronabinol ,Child ,Tetrahydrocannabinol ,Toxicology testing ,Brain Diseases ,Illicit Drugs ,Cannabinoids ,business.industry ,organic chemicals ,Articles ,General Medicine ,medicine.disease ,Child, Preschool ,Anesthesia ,Toxicity ,Marijuana Use ,Female ,Cannabinoid ,medicine.symptom ,business ,medicine.drug - Abstract
Patient: Female, 2-year-old Final Diagnosis: Acute encephalopathy, resolved • poisoning by delta-8-THC symptoms • altered mental status • respiratory failure Symptoms: Acute encephalopathy • altered mental status • respiratory failure Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology • Toxicology Objective: Unusual clinical course Background: Delta-8 tetrahydrocannabinol (delta-8 THC) is an isomer of delta-9-tetrahydrocannabinol (delta-9 THC), the primary psychoactive cannabinoid in the marijuana plant. Typically found at lower concentrations in marijuana, delta-8 THC exhibits psychoactive properties similar to delta-9 THC. Products containing delta-8 THC are readily available across the US and currently there is a lack of available confirmatory testing specific to delta-8 THC as there is cross-reactivity to other naturally occurring cannabinoids in standard immunoassays. Pediatric exposures to this substance are on the rise. Case Report: We present a case with laboratory confirmation of a previously healthy 2-year-old girl ingesting approximately 15 mg/kg of delta-8 THC gummies. The patient arrived minimally responsive and requiring intubation for encephalopathy. Laboratory confirmation of delta-8 THC exposure is not routinely available with common testing modalities. A urine drug screen preformed in the hospital was positive for delta-9 THC. With the collaboration of the Drug Enforcement Administration’s Toxicology Testing Program, detection and confirmation of delta-8 THC was performed in the serum and urine using liquid chromatography-quadrupole time-of-flight mass spectrometry. Conclusions: The prevalence of delta-8 THC-containing products in the illicit drug market is increasing rapidly. Delta-8 THC products are now available in gas stations and in headshops. The clinical presentation of delta-8 THC exposure is similar to known effects of delta-9 THC exposure. These similarities limit the clinicians’ abilities to determine the specific substance ingested. Symptomatic and supportive care remains an effective treatment for cannabinoid toxicity.
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- 2021
7. The Cents of the Dosage Cap in Patients Greater than 100 Kilograms Receiving N-Acetylcysteine for Acetaminophen Toxicity
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Regan A. Baum, Mark K. Su, and Kyle A. Weant
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Drug-Related Side Effects and Adverse Reactions ,Health, Toxicology and Mutagenesis ,The Poison Pen ,Humans ,Analgesics, Non-Narcotic ,Toxicology ,Acetaminophen ,Acetylcysteine - Published
- 2022
8. Use of Intranasal Ketamine in Pediatric Patients in the Emergency Department
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Anne Marie Guthrie, Adam Dugan, Landon A. Jones, Abby M. Bailey, Regan A. Baum, Trei Tackett, and Craig Carter
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Nausea ,medicine.drug_class ,medicine.medical_treatment ,Sedation ,Conscious Sedation ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Hypnotics and Sedatives ,Intranasal Ketamine ,Intubation ,Ketamine ,Prospective Studies ,Child ,Adverse effect ,Analgesics ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Anesthesia ,Sedative ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,medicine.symptom ,Emergency Service, Hospital ,business ,medicine.drug - Abstract
OBJECTIVES Ketamine is a safe and widely used sedative and analgesic in the pediatric emergency department (ED). The use of intranasal (IN) ketamine in exchange for the administration of intravenous sedatives or analgesics for procedural sedation in pediatric patients is not commonplace. The goal of this study was to evaluate provider perceptions and patient outcomes at varying doses of IN ketamine for anxiolysis, agitation, or analgesia. METHODS From January 2018 to May 2018, we performed a prospective survey and chart review of pediatric patients receiving IN ketamine. The primary outcome was to determine provider satisfaction with using IN ketamine. Secondary objectives included comparing outcomes stratified by dose, adverse events, assessing for treatment failure, and ED length of stay (LOS). As a secondary comparison, patients receiving IN ketamine whom otherwise would have required procedural sedation with intravenous sedatives or analgesics were placed into a subgroup. This subgroup of patients was compared with a cohort who received intravenous sedatives or analgesics for procedural sedation during a similar period the preceding year (January 2017 to June 2017). RESULTS Of the 196 cases, 100% of the providers were comfortable using IN ketamine. The median overall provider satisfaction was 90 out of 100, the perception of patient comfort was 75 out of 100, and perceived patient comfort was maximized when using doses between 3 and 5 mg/kg. There were 15 (7.7%) patients who experienced ketamine treatment failure. Overall, the rate of adverse events was 6%, but were considered minor [nausea (n = 3; 1.5%), dizziness (n = 2; 1%), and drowsiness (n = 2; 1%)]. No patients required respiratory support or intubation. The mean LOS was 237.9 minutes, compared with those who underwent procedural sedation with an LOS of 332.4 minutes (P < 0.001). CONCLUSIONS This study demonstrates that IN ketamine was able to provide safe and successful analgesia and anxiolysis in pediatric patients in an ED setting. In addition, providers expressed a high degree of satisfaction with using IN ketamine (90 out of 100) in addition to a high degree of patient comfort during the procedure (75 out of 100). Intranasal ketamine provides an alternative to intravenous medication normally requiring more resource-intensive monitoring. Procedural sedations are resource and time intensive activities that increase ED LOS. Intranasal ketamine used for anxiolysis and analgesia offers the benefits of freeing up resources of staff and monitoring while enhancing overall throughput through a pediatric ED.
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- 2019
9. Crotalus durissus terrificus (viperidae; crotalinae) envenomation: Respiratory failure and treatment with antivipmyn TRI® antivenom
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J. Plott, Peter Akpunonu, Abby M. Bailey, Daniel E. Keyler, Regan A. Baum, and J. Bronner
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Male ,0106 biological sciences ,medicine.medical_treatment ,Antivenom ,Snake Bites ,Venom ,Toxicology ,complex mixtures ,01 natural sciences ,03 medical and health sciences ,Viperidae ,biology.animal ,Crotalid Venoms ,Animals ,Humans ,Medicine ,South American rattlesnake ,Envenomation ,Adverse effect ,Mechanical ventilation ,0303 health sciences ,biology ,Antivenins ,business.industry ,010604 marine biology & hydrobiology ,Crotalus ,030302 biochemistry & molecular biology ,Middle Aged ,biology.organism_classification ,Occupational Injuries ,Respiration, Artificial ,Respiratory failure ,Anesthesia ,Respiratory Insufficiency ,business - Abstract
We report an envenomation to a professional herpetologist by a South American rattlesnake (Crotalus durissus terrificus) that resulted in respiratory failure, and therapeutic improvement following antivenom administration. A 56-year-old male was bitten on the left wrist by a Crotalus durissus terrificus (C. d. terrificus) while attempting to tube the snake for maintaining safe control while performing venom extraction. The patient was intubated due to rapidly ensuing respiratory failure and administration of Antivipmyn-TRI® was initiated while being transported via ambulance. The patient was admitted to the hospital unconscious and unresponsive. Mechanical ventilation was required until 5 h after completion of antivenom administration. No significant adverse effects were observed with antivenom administration. The patient was discharged approximately 55 h following envenomation. This is the first reported case in the United States of a patient following a C. d. terrificus envenomation with consequent respiratory failure, and in which Antivipmyn-TRI® was successfully administered.
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- 2019
10. Assessment of dose capping in phenytoin loading practices in the emergency department and the impact of an emergency medicine pharmacist
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Regan A. Baum, Stephanie Baker Justice, Abby M. Bailey, Martina Holder, and Kyle A. Weant
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Phenytoin ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Pharmacist ,Pharmaceutical Science ,Medicine ,Pharmacology (medical) ,Pharmacy ,Emergency department ,business ,medicine.drug - Published
- 2019
11. A Review of the Management of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis
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Regan A. Baum, Elise L. Metts, Abby M. Bailey, and Jordan A Woolum
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medicine.medical_specialty ,Skin barrier ,business.industry ,030208 emergency & critical care medicine ,Stevens johnson ,Disease ,Emergency Nursing ,medicine.disease ,Dermatology ,Toxic epidermal necrolysis ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Stevens-Johnson Syndrome ,Emergency Medicine ,Humans ,Medicine ,Infection control ,030212 general & internal medicine ,Adverse effect ,business - Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis represent a spectrum of severe cutaneous adverse reactions that carry the potential for severe, long-term adverse effects, including death. Although medications are most commonly implicated in the development of these diseases, other factors, including infection and genetics, play a role. Management is generally supportive in nature and includes maintenance of the patient's airway, breathing, and circulation. Special disease considerations include the use of skin barrier management, unique infection prevention measures, and systemic immunomodulatory therapies.
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- 2019
12. Use of lidocaine for treatment of pulseless ventricular tachycardia after massive cocaine overdose
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Jordan A. Woolum, Regan A. Baum, Peter Akpunonu, Matthew J Travis, Cicero Running Crane, and Abby M. Bailey
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Tachycardia ,Powdered cocaine ,Lidocaine ,business.industry ,Pulseless ventricular tachycardia ,Emergency department ,medicine.disease ,humanities ,Refractory ,Cocaine overdose ,Anesthesia ,Ventricular fibrillation ,cardiovascular system ,Medicine ,medicine.symptom ,business ,medicine.drug - Abstract
A 35-year-old woman presented to the emergency department in cardiac arrest after ingesting large quantities of powdered cocaine. With an initial rhythm of ventricular fibrillation, emergency medic...
- Published
- 2019
13. Modified two step N-acetylcysteine dosing regimen for the treatment of acetaminophen overdose a safe alternative
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Regan A. Baum, Abby M. Bailey, Adam Dugan, Elise L. Metts, Scott Wilkie, and Kyle A. Weant
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Acetylcysteine ,Regimen ,acetaminophen overdose ,business.industry ,Anesthesia ,digestive, oral, and skin physiology ,Two step ,Dosing regimen ,medicine ,business ,medicine.drug ,Acetaminophen - Abstract
Intravenous N-acetylcysteine (IV NAC) is currently the approved treatment for acetaminophen (APAP) overdose with a three-step regimen totaling 300 mg/kg over 21 hours. Due to the complexity of this...
- Published
- 2018
14. Antiemetic Use in the Emergency Department
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Stephanie Baker Justice, Abby M. Bailey, Chara Calhoun, Kyle A. Weant, and Regan A. Baum
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Antiemetic Agent ,medicine.medical_specialty ,Vomiting ,medicine.drug_class ,Nausea ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Antiemetic ,030212 general & internal medicine ,Intensive care medicine ,Prescribed medications ,Medication use ,business.industry ,Emergency department ,Anesthesia ,Emergency Medicine ,Etiology ,Antiemetics ,030211 gastroenterology & hepatology ,medicine.symptom ,Emergency Service, Hospital ,business - Abstract
Nausea and vomiting are 2 of the most common complaints of patients presenting to the emergency department (ED). In addition, antiemetics are the most commonly prescribed medications in the ED behind analgesics. Treating these conditions can be complex, especially as one considers that nausea and/or vomiting could be the primary presenting illness or simply a symptom of a more complex etiology. Although there is a wide variety of pharmacotherapeutic options in the armamentarium to treat these conditions, very few consensus recommendations exist to help guide the use of antiemetic agents in the ED, leading to wide variability in medication use. Contributing to these variations in practice is the extended spectrum of etiologies and potential physiological factors that contribute to the development of nausea or vomiting. A thorough understanding of the pharmacology and administration of these agents can help practitioners devise tailored antiemetic regimens based upon the underlying etiology.
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- 2017
15. Evaluation of Infection Rates with Narrow versus Broad-Spectrum Antibiotic Regimens in Civilian Gunshot Open-Fracture Injury
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Adam Dugan, Abby M. Bailey, Rahul Agrawal, Regan A. Baum, and Jordan A. Woolum
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Adult ,Male ,Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,medicine.drug_class ,Antibiotics ,Article ,law.invention ,03 medical and health sciences ,Fractures, Open ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Adverse effect ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,030208 emergency & critical care medicine ,General Medicine ,Guideline ,Bacterial Infections ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Regimen ,Emergency Medicine ,Female ,Wounds, Gunshot ,Gunshot wound ,business ,Fluoroquinolones - Abstract
Introduction Civilian gunshot open-fracture injuries portray a significant health burden to patients. Use of antibiotics is endorsed by guideline recommendations for the prevention of post-traumatic infections, however, antimicrobial selection and their associated outcomes remains unclear. Therefore, we sought to compare infectious and other clinical outcomes between three antimicrobial cohorts in patients with gunshot-related fractures requiring operative intervention. Materials and methods Patients were identified by retrospectively querying the University of Kentucky Trauma Registry for gunshot wound victims. A narrow regimen, an expanded gram-negative regimen, and a regimen containing a fluoroquinolone antimicrobial were identified for comparison. The primary outcome was a composite of infections at or before 14 days of hospitalization. Secondary endpoints included hospital length of stay, incidence of multidrug resistant bacteria and methicillin-resistant Staphylococcus aureus colonization, number of drug-related adverse events, number of Clostridium difficile infections, and 30-day mortality. Results 252 patients were selected for inclusion: 126 in the narrow regimen, 49 in the expanded gram-negative regimen, and 77 in the fluoroquinolone-based regimen. There were no statistical differences in the primary endpoint of early infectious outcomes between groups (p = 0.1797). The expanded gram-negative regimen was associated with increased hospital length of stay, and increased incidence of multi-drug resistant bacteria and methicillin-resistant Staphylococcus aureus colonization. There were no statistically significant differences in any of the remaining secondary endpoints. Conclusion In this study evaluating civilian gunshot trauma, broad spectrum antibiotic coverage was not associated with improvements in post-traumatic infections. A randomized trial is needed to confirm these results.
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- 2019
16. Compliance and Related Outcomes of Prophylactic Antibiotics in Traumatic Open Fractures
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Stephanie Baker Justice, Regan A. Baum, Hannah C. Johnson, Kyle A. Weant, and Abby M. Bailey
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Pharmacology ,medicine.medical_specialty ,Standard of care ,Prophylactic antibiotic therapy ,medicine.drug_class ,business.industry ,Antibiotics ,030208 emergency & critical care medicine ,Pharmacy ,Original Articles ,Compliance (physiology) ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,business ,Intensive care medicine - Abstract
Purpose: Prophylactic antibiotic therapy is a standard of care for patients who present with open fractures due to the risk of infectious complications. This study was conducted to characterize the use of initial prophylactic antibiotic use in open fractures, guideline compliance, and its impact on care. Methods: Retrospective chart review of adult patients presenting with an open fracture to a Level 1 Trauma Center Emergency Department over a 12-month period was conducted. Results: Of the 202 patients meeting inclusion criteria, overall compliance with guideline recommendations for antibiotic prophylaxis was found to be 33.2%. The duration of prophylactic therapy was significantly longer in the noncompliant group and among those who received a secondary antibiotic ( P < .05 for both comparisons). The duration of therapy was found to be significantly longer in those patients who developed an infection ( P < .001). Those who developed an infection had a longer hospital length of stay (LOS) ( P < .001) and intensive care unit LOS ( P = .002). In addition, those who developed an infection had significantly more surgeries ( P < .001) and received more red blood cell transfusions ( P < .001). Correlation analysis confirmed a significant association between infection and duration of antibiotic prophylaxis ( P = .02), number of surgeries ( P < .0001), and number of transfusions ( P < .0001). Conclusion: Guideline compliance was exceedingly low due to the extended duration of initial antibiotic therapy and did not appear to yield any clinical benefits. Infection was significantly associated with longer duration of initial prophylactic therapy and morbidity. Opportunities exist to elevate compliance with guidelines and to reevaluate prophylactic antimicrobial therapy in this setting.
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- 2019
17. Variability in training, practice, and prioritization of services among emergency medicine pharmacists
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Abby M. Bailey, Jaclyn M Stoffel, Adam Dugan, and Regan A. Baum
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Prioritization ,medicine.medical_specialty ,Emergency Medical Services ,Demographics ,Best practice ,education ,Pharmacist ,Pharmacy ,Pharmacists ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,health care economics and organizations ,Pharmacology ,Response rate (survey) ,business.industry ,Health Priorities ,Health Policy ,Emergency department ,Education, Pharmacy ,Emergency medicine ,Emergency Medicine ,business ,Residency training - Abstract
Purpose The purpose of this survey-based research project is to identify factors, including prior training, institution demographics, and pharmacist prioritization of services that may impact variability in practice among emergency medicine (EM) pharmacists. Methods An electronic survey was available for 6 weeks. Participants were contacted through professional membership directories. Survey questions addressed EM pharmacist training and institution demographics. Pharmacists were asked to define the frequency with which they performed ASHP-identified best practice services. Results Responses were received by 208 pharmacists (response rate = 9.4%) who were primarily from academic (48.1%) or community (47.6%) emergency departments (EDs). Pharmacists working in an academic ED were more likely to have EM postgraduate year 2 training (27.8%) compared to a community ED (11.2%) (p = 0.0182). Pharmacists practicing in an academic emergency department (ED) reported participating in traumas, care for boarded patients, and performing scholarly activities more frequently (p < 0.01) and medication reconciliations less frequently (p < 0.01) than those in a community ED. Most EM pharmacists reported postgraduate year 1 training (45.7%) as compared to postgraduate year 2 EM (18.3%) or critical care (13.7%) pharmacy residency training. Conclusion Institution and ED demographics as well as pharmacist level of training can affect the frequency of services provided in the ED setting.
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- 2019
18. Chomping at the Bit: A Descriptive Report on Pediatric Clenbuterol Ingestion
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Peter Akpunonu, Jordan A Woolum, Nicholas Mancuso, Philip W. Rutter, and Regan A. Baum
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Male ,business.industry ,Hypophosphatemia ,Pharmacology ,Adrenergic beta-Agonists ,030226 pharmacology & pharmacy ,03 medical and health sciences ,Eating ,Electrocardiography ,0302 clinical medicine ,Clenbuterol hydrochloride ,Clenbuterol ,Child, Preschool ,Medicine ,Ingestion ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Adrenergic agonist ,business ,Bit (key) ,medicine.drug - Abstract
Introduction: Clenbuterol hydrochloride is a selective beta-2 adrenergic agonist with uses in both humans and animals. Ingestions occurring within the United States are generally due to incidental ingestion of a veterinary product, use as a cutting agent for illicit substances, or illegal use for performance-enhancing purposes. Case Report: A four-and-a-half year-old male presented approximately two-and-a-half hours after an accidental ingestion of an unknown quantity of clenbuterol. Initial laboratory results and electrocardiogram were remarkable for hyperglycemia, hypokalemia, and hypophosphatemia, with an electrocardiogram demonstrating sinus tachycardia. Heart rate ranged from 126 to 147 beats per minute while other vitals remained within normal limits. The patient was observed for 24 hours and discharged with normalized vital signs, laboratory results, and electrocardiogram. Discussion: Clenbuterol hydrochloride is a beta-agonist with high potency, extended half-life, and bioavailability of 70% to 80%. Tachycardia occurs due to beta-1 receptor stimulation, as well as a homeostatic reflex to peripheral vasodilation. Hyperglycemia is not uncommon in exposures and intracellular shifting of potassium causes hypokalemia. Treatment is primarily supportive in nature, with hemodynamic management representing the primary focus of initial triage.
- Published
- 2019
19. 1878. Expanding Kentucky’s 'One and Done' Tradition: Lipoglycopeptide Administration in the Emergency Department at a Tertiary, Academic Medical Center
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Thein Myint, Sarah Cotner, Regan A. Baum, Abby M. Bailey, Donna R. Burgess, Jeffrey Reynolds, Garrett B. Hile, and Katie L Wallace
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medicine.medical_specialty ,Lipoglycopeptides ,Lipoglycopeptide ,business.industry ,Skin and skin structure infection ,Incidence (epidemiology) ,Oritavancin ,Dalbavancin ,Emergency department ,chemistry.chemical_compound ,Abstracts ,Infectious Diseases ,Oncology ,chemistry ,B. Poster Abstracts ,Emergency medicine ,medicine ,business ,Administration (government) - Abstract
Background Acute bacterial skin and skin structure infection (ABSSSI) incidence continues to rise, accounting for around 3.5 million emergency department (ED) visits per year in the United States. Dalbavancin and oritavancin are lipoglycopeptides with long half-lives allowing for single dose treatment options for eligible patients presenting with ABSSSIs in the ED, avoiding an inpatient admission. The objective of this study was to investigate the financial outcomes of utilizing these agents in the ED. Methods This was a single-center, retrospective study in adult patients with ABSSSIs that received a lipoglycopeptide in the ED at an academic medical center from April 2016 to February 2018. A multidisciplinary institutional guideline was developed and implemented in April 2016. Data were documented in the electronic medical record and/or REDCap™ database. A comparator group was identified by utilizing similar ICD-10 codes for patients that were admitted for ABSSSI. Variable direct cost-avoidance was examined to explore the financial implication of lipoglycopeptide treatment in this population. Results The average length of stay in the comparator group who were admitted for ABSSSIs during the predefined time period was 4.3 days. Because patients receiving a lipoglycopeptide did not require admission for intravenous antibiotics, 94.6 patient-days were avoided increasing the capacity by 14.1 patients. Overall, 22 patients received either dalbavancin (n = 18) or oritavancin (n = 4). The age was 40.8 ± 13.2 years for the study group with 55% male. The age of the comparator group was 40.5 ± 19.7 years. All patients were discharged home from the ED without being admitted. Two patients were readmitted for treatment failure requiring IV antibiotics. Despite 2 of 22 patients receiving a lipoglycopeptide without insurance, the variable direct cost avoidance was $4,560 per case, or $1,060 per day. Conclusion The use of lipoglycopeptides offers patient convenience and financial benefits, warranting its consideration for use in the ED at tertiary academic medical centers. Disclosures All authors: No reported disclosures.
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- 2018
20. Antibiotic Prophylaxis for Open Fractures in the Emergency Department
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Abby M. Bailey, Regan A. Baum, Stephanie Baker Justice, and Kyle A. Weant
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medicine.medical_specialty ,business.industry ,Emergency medicine ,Emergency Medicine ,Medicine ,Emergency department ,Emergency Nursing ,Antibiotic prophylaxis ,business ,Intensive care medicine - Published
- 2015
21. Suspected Synthetic Cannabinomimetic Intoxication: Case Series and Review
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Ryan Chan, Karen Blumenschein, Regan A. Baum, and Abby M. Bailey
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Emergency Medical Services ,Adolescent ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Patient age ,medicine ,Mydriasis ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Cannabinoids ,Illicit Drugs ,Emergency department ,Middle Aged ,Anesthesia ,Urine drug screen ,Consciousness Disorders ,Female ,medicine.symptom ,Complication ,business ,030217 neurology & neurosurgery ,Altered level of consciousness ,Akathisia, Drug-Induced - Abstract
Purpose:The purpose of this work was to retrospectively review patient cases presenting to the University of Kentucky Chandler Medical Center (UKCMC) emergency department (ED) with symptoms of suspected synthetic cannabinomimetic (SC) intoxication. These drugs, currently undetected by standard urine drug screen tests, comprise a structurally diverse group of compounds designed to mimic the psychoactive effects of Δ9-tetrahydrocannabinol (Δ9-THC), the primary psychoactive cannabinoid in marijuana.Summary:Fourteen cases of suspected SC intoxication were identified between July 1, 2015, through September 30, 2015. The median patient age was 25.5 years (range: 13-45 years), and most (64%) patients were males. The most common psychoactive symptom was agitation (n = 6, 42.9%), while the most common physical symptoms were altered level of consciousness (n = 9, 64.3%) and mydriasis (n = 3, 21.4%). Most cases resolved without complication in 24 hours; 2 patients required hospitalization.Conclusion:Recent legislation has failed to curb the public health concerns emanating from SC misuse. Education about the risks of SC use along with additional regulation may be required to remove the false sense of safety that some individuals, especially adolescents and young adults, may associate with these compounds, which are often misconstrued as “herbal marijuana.” Clinicians need to be prepared to identify and treat symptoms of SC intoxication as incidents of toxicity continue to rise.
- Published
- 2017
22. Chemotherapy in the Emergency Department? There Is a Role for That: Methotrexate for Ectopic Pregnancy
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Kyle A. Weant, Chara Calhoun, Stephanie Baker Justice, Regan A. Baum, and Abby M. Bailey
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Pregnancy ,Medicine ,Humans ,Vaginal bleeding ,030212 general & internal medicine ,Adverse effect ,Chemotherapy ,Abortifacient Agents, Nonsteroidal ,030219 obstetrics & reproductive medicine ,Ectopic pregnancy ,business.industry ,Emergency department ,medicine.disease ,United States ,Surgery ,Pregnancy, Ectopic ,Methotrexate ,Emergency medicine ,Emergency Medicine ,Female ,medicine.symptom ,business ,Emergency Service, Hospital ,medicine.drug - Abstract
Approximately 1.6% of all emergency department (ED) visits in the United States are for vaginal bleeding in early pregnancy, translating to around 500,000 ED visits per year. A potentially life-threatening condition, ectopic pregnancy occurs in 1.5%-2% of pregnancies. Many patients will require either surgical or pharmacological intervention following a positive diagnosis. With regard to pharmacological options, methotrexate, largely known for its use in the oncology arena, has emerged as the most effective nonsurgical option and the pharmacological agent of choice. However, this therapy is not without its own unique adverse event profile and patients should be adequately educated on the monitoring parameters of this pharmacotherapy.
- Published
- 2017
23. Characterization and Management of Patients with Heroin versus Nonheroin Opioid Overdoses: Experience at an Academic Medical Center
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Julia Martin, Kate Morizio, Abby M. Bailey, Regan A. Baum, and Adam Dugan
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Adult ,Male ,medicine.medical_specialty ,Emergency Medical Services ,Adolescent ,Poison control ,01 natural sciences ,law.invention ,Heroin ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,law ,Naloxone ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,0101 mathematics ,Aged ,Retrospective Studies ,Academic Medical Centers ,business.industry ,010102 general mathematics ,Disease Management ,Opioid overdose ,Emergency department ,Middle Aged ,medicine.disease ,Intensive care unit ,Hepatitis C ,Substance abuse ,Analgesics, Opioid ,Opioid ,Anesthesia ,Emergency medicine ,Female ,Drug Overdose ,business ,medicine.drug - Abstract
tudy Objectives To characterize the differences between patients who had heroin and nonheroin opioid overdoses and to determine whether there were any significant differences in their management with regard to the naloxone use. Design Retrospective cohort study. Setting Large academic medical center. Patients A total of 923 patients admitted to the medical center who were identified for overdose by heroin or other opiate-related narcotics between January 2010 and September 2015; 480 patients experienced a nonheroin opioid overdose event, and 443 patients experienced a heroin overdose event. Measurements and Main Results Patients presenting with heroin overdose tended to be younger and male, with higher rates of hepatitis C virus (HCV) infection compared with those presenting with nonheroin opioid overdose (p
- Published
- 2017
24. Being Prepared
- Author
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Regan A. Baum, Kyle A. Weant, Abby M. Bailey, Stephanie N. Baker, and Hannah E. Chandler
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Sarin ,Pralidoxime ,business.industry ,Antidotes ,Cyclosarin ,Disaster Planning ,Emergency Nursing ,Pharmacology ,Organophosphates ,chemistry.chemical_compound ,Atropine ,Organophosphate Poisoning ,chemistry ,Anesthesia ,Soman ,Emergency Medicine ,medicine ,Humans ,Chemical Warfare Agents ,business ,Emergency Treatment ,Acetylcholine ,medicine.drug ,Tabun ,Nerve agent - Abstract
Nerve agents are extremely toxic and are some of the most lethal substances on earth. This group of chemicals consists of sarin, cyclosarin, soman, tabun, VX, and VR. It is currently unknown how many countries possess these chemicals and in what quantities. These agents work through altering the transmission and breakdown of acetylcholine by binding to, and inactivating, acetylcholinesterase. This results in an uncontrolled and overwhelming stimulation of both muscarinic and nicotinic receptors. Receptor activation at these sites can lead to a wide variety of clinical symptoms, with death frequently resulting from pulmonary edema. Antidotal therapy in this setting largely consists of atropine, pralidoxime, and benzodiazepines, all of which must be administered emergently to limit the progression of symptoms and prevent the enzyme inactivation from becoming permanent. This article reviews the mechanism of action of the nerve agents and their effects on the human body, the currently available therapies to mitigate their impact, and important therapeutic considerations for health care practitioners in the emergency department.
- Published
- 2014
25. Treatment of Diabetic Ketoacidosis With Intravenous U-500 Insulin in a Patient With Rabson-Mendenhall Syndrome: A Case Report
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Megan M. Moore, Alexander H. Flannery, Abby M. Bailey, and Regan A. Baum
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Male ,medicine.medical_specialty ,Pediatrics ,Diabetic ketoacidosis ,medicine.medical_treatment ,030209 endocrinology & metabolism ,Diabetic Ketoacidosis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Insulin resistance ,Internal medicine ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Pharmacology (medical) ,Infusions, Intravenous ,Donohue Syndrome ,biology ,business.industry ,Genetic disorder ,medicine.disease ,Insulin receptor ,Endocrinology ,Treatment Outcome ,U 500 insulin ,biology.protein ,Regular insulin ,Rabson–Mendenhall syndrome ,business - Abstract
Rabson-Mendenhall syndrome is a rare genetic disorder resulting from mutations in the insulin receptor and is associated with high degrees of insulin resistance. These patients are prone to complications secondary to their hyperglycemia including diabetic ketoacidosis (DKA). We report the case of a 19-year-old male with Rabson-Mendenhall syndrome presenting with DKA who required doses of up to 500 U/h (10.6 U/kg/h) of insulin. The patient’s insulin infusion was originally compounded with U-100 regular insulin, although to minimize volume, the product was compounded with U-500 insulin. The DKA eventually resolved requiring infusion rates ranging from 400 to 500 U/h. Although numerous opportunities for medication errors exist with the use of U-500 insulin, this case outlines the safe use of concentrated intravenous insulin when clinically indicated for patients requiring extremely high doses of insulin to control blood glucose.
- Published
- 2016
26. Crotalus durissus terrificus (Viperidae; Crotalinae) envenomation and treatment with Antivipmyn TRI® antivenom
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J. Bronner, Peter Akpunonu, Regan A. Baum, and Daniel E. Keyler
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biology ,business.industry ,Viperidae ,biology.animal ,Antivenom ,Medicine ,Crotalinae ,Pharmacology ,Toxicology ,business ,Envenomation ,Crotalus durissus terrificus - Published
- 2018
27. High-Dose Adenosine for Treatment of Refractory Supraventricular Tachycardia in an Emergency Department of an Academic Medical Center: A Case Report and Literature Review
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Roger L. Humphries, Justin Rose, Regan A. Baum, and Abby M. Bailey
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Tachycardia ,Adult ,Male ,Adenosine ,Heart block ,medicine.medical_treatment ,Accessory pathway ,030204 cardiovascular system & hematology ,Cardioversion ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Palpitations ,Tachycardia, Supraventricular ,Humans ,business.industry ,030208 emergency & critical care medicine ,Emergency department ,medicine.disease ,Treatment Outcome ,Anesthesia ,Emergency Medicine ,Supraventricular tachycardia ,Medical emergency ,medicine.symptom ,business ,Anti-Arrhythmia Agents - Abstract
Background Symptomatic tachycardia is a common admission diagnosis in the emergency department (ED). This can be a life-threatening condition and requires immediate attention. Supraventricular tachycardia (SVT) is commonly treated with adenosine, and successful treatment is limited to atrioventricular (AV) node-dependent SVTs as adenosine causes a transient heart block. However, there are limited data available for instances when the recommended dosing regimen (6 mg, 12 mg, 12 mg) fails to terminate SVT. Case Report A 33-year old man was evaluated in the ED with an electrocardiogram revealing a regular narrow complex tachycardia with a heart rate of 180 beats/min and a rhythm consistent with SVT. He reported experiencing 3 days of fatigue, myalgias, palpitations, and dyspnea on exertion, but was otherwise hemodynamically stable. Attempts at chemical cardioversion with standard doses of adenosine (6 mg, 12 mg, and 12 mg) were given without success. After consultation with the cardiology service, additional doses of 24 mg and then 36 mg of adenosine were administered. The last dose of 36 mg produced sustained conversion and return to a normal sinus rhythm. The patient later underwent radiofrequency ablation of a left-sided orthodromic reciprocating accessory pathway. After 3 months of medical management, the patient had an implantable cardiac defibrillator placed for prevention of sudden cardiac death. Why Should an Emergency Physician Be Aware of This? Each case of SVT demands immediate attention from an emergency physician. It is imperative that providers be aware of the limitations of adenosine and when it may be appropriate to deviate from standard dosing recommendations. This is in addition to collaborating with an expert in cardiac electrophysiology when initial management tactics are not successful.
- Published
- 2015
28. Impact of an Antimicrobial Stewardship and Emergency Department Initiated Dalbavancin Guideline for Patients with Acute Bacterial Skin and Soft-Tissue Infections
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Abby M. Bailey, Thein Myint, Katie L Wallace, Donna R. Burgess, and Regan A. Baum
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medicine.medical_specialty ,Patient care team ,business.industry ,Dalbavancin ,Soft tissue ,Emergency department ,Guideline ,Poster Abstract ,Abstracts ,Infectious Diseases ,Oncology ,Hospital admission ,medicine ,Antimicrobial stewardship ,Intensive care medicine ,business - Abstract
Background Acute bacterial skin and skin structure infections (ABSSI) are one of the most common reasons for patient hospitalization. These admissions may be solely for receipt of intravenous vancomycin due to concern for resistance to alternative agents or failure of oral therapy, providing a niche for long-acting agents like dalbavancin. The objective of this study was to evaluate patient outcomes following initiation of a dalbavancin guideline for ABSSI in the emergency department (ED). Methods This was a single-center, case series study evaluating adult patients with ABSSI from April 2016 to May 2017 who were screened for receipt of dalbavancin. Candidates were identified by a dalbavancin guideline implemented in the ED in April 2016 with hours from 7 am to 7 pm. Patients were assessed for inclusion by an ED pharmacist and physician. If the patient qualified for receipt of dalbavancin, the ED pharmacist contacted the Antimicrobial Stewardship Team (AST) for final approval. The guideline was revised in January 2017 to lessen restrictions. Patients were contacted via phone by an ED pharmacist for follow-up and the interaction documented in the electronic medical record. Patient data were collected using REDCap™. Results Overall, 22 patients (15 males/7 females) were evaluated for inclusion to receive dalbavancin. The average age of the patients was 38 years old, ranging from 21 to 61 years. Of these 22 patients, 7 received a single dalbavancin dose of 1,500 mg over 30 minutes for ABSSI (cellulitis {n = 5} and shooter’s abscess {n = 2}). The reasons for exclusion were: lack of systemic signs of infection (n = 5), risk of Gram-negative infection (n = 2), outside guideline time period (n = 2), required hospital support (n = 2), immunocompromised (n = 1), severe hepatic disease (n = 1), bacteremia (n = 1), and diabetic foot infection (n = 1). All patients received a follow-up visit (n = 4) or phone call from the ED pharmacist (n = 3). Only 1 patient required a later hospital admission due to further complications. Conclusion A multidisciplinary team approach to treating ABSSI in the ED was highly successful at our academic medical center. Further expansion of guideline hours should enhance the utilization of this guideline. Disclosures All authors: No reported disclosures.
- Published
- 2017
29. 513: INCIDENCE AND CHARACTERIZATION OF HEROIN OVERDOSE AND NALOXONE DOSING AT AN ACADEMIC HEALTH CENTER
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Adam Dugan, Julia Martin, Regan A. Baum, Kyle A. Weant, Abby M. Bailey, and Kate Morizio
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business.industry ,Anesthesia ,Incidence (epidemiology) ,Naloxone ,Medicine ,Heroin overdose ,Dosing ,Critical Care and Intensive Care Medicine ,business ,medicine.drug - Published
- 2016
30. Four-factor prothrombin complex concentrate–associated hypotension
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Regan A. Baum, Abby M. Bailey, and Paul J. Wong
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Male ,medicine.medical_specialty ,Fatal outcome ,Intracranial Hemorrhages ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,Fatal Outcome ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Aged ,Coagulants ,business.industry ,Warfarin ,Anticoagulants ,General Medicine ,Blood coagulation factors ,Prothrombin complex concentrate ,Blood Coagulation Factors ,030228 respiratory system ,Emergency Medicine ,Hypotension ,business ,medicine.drug - Published
- 2016
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