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Podcast 539: Coricidin Abuse
Contributor: Rachel Beham, PharmD Educational Pearls: Coricidin HBP Cough & Cold (dextromethorphan and chlorpheniramine) is one of the more commonly abused over-the-counter medications Dextromethorphan, binds to multiple receptors, particularly...
Podcast 538: Low Maintenance Boxer’s Fracture
Contributor: Jared Scott, MD Educational Pearls: A distal 5th metacarpal neck fracture is often referred to as a “boxer’s fracture” and a common fracture encountered in the emergency department...
Podcast 537: Thoughts on Cardiac Arrest
Contributor: Don Stader, MD Educational Pearls: High-quality compressions are an essential, and probably one of the most important, part of cardiac arrest Actual evidence for drugs in cardiac arrest...
UnfilterED #4: Dr. Vivek Tayal
Dr. Vivek Tayal of Carolinas Medical Center, a pioneer of using ultrasound in the emergency department, reflects on his role in establishing ultrasound use in emergency medicine and much...
Podcast 536: Epistaxis 101
Contributor: Dylan Luyten, MD Educational Pearls: Clear the nasal passages – have the patient, if stable, blow their nose to dislodge any clot that might be in the way...
Podcast 535: A Prescription for Falls
Contributor: Aaron Lessen, MD Educational Pearls: Emergency department evaluation of falls, particularly in the elderly, should include an assessment of risk factors Common causes of falls in the...
Mental Health Monthly #1: Decision Making Capacity
In the first episode of this new series, the complexities of decision making capacity are discussed. References and Further Reading: [1] Appelbaum, P. S. (2007). Assessment of patients’ competence...
Podcast 532: SVC Syndrome
Contributor: Jared Scott, MD Educational Pearls: Superior vena cava (SVC) syndrome is caused by physical compression of the SVC and can present with facial swelling, upper extremity swelling, flushing,...
Podcast 529: Hemophilia
Contributor: Aaron Lessen, MD Educational Pearls: Hemophilia is characterized by bleeding (A /B) A is is 8, B (chrstmas, 9) Hemophilia refers to a group of bleeding disorders caused...
Podcast 528: Decompensated Liver Failure
Contributor: Michael Hunt, MD Educational Pearls: Cirrhosis is the end stage of chronic structural damage to the liver. This is most commonly due to alcohol but other causes viral...
Podcast 527: Knee Dislocations
Contributor: Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial...
Podcast 526: Desmopressin for Intracranial Hemorrhage
Contributor: Charleen Melton, PharmD Educational Pearls: Desmopressin (DDAVP) is an analogue of anti-diuretic hormone (ADH) that has been used for the treatment of intracranial hemorrhage. It works by increasing...
Podcast 525: Enjoyable Epistaxis?
Contributor: Jared Scott, MD Educational Pearls: The ED is full of painful procedures. One of the most commonly dreaded procedures is nasal packing for epistaxis, as it is quite...
Podcast 523: A Dizzying Diagnosis
Contributor: Don Stader, MD Educational Pearls: It can be difficult to distinguish between central and peripheral causes of vertigo. Cerebellar stroke should be considered with any dizzy patient. Signs...
UnfilterED #3: Dr. Katie Bakes & Dr. Pete Bakes
Husband and wife Pete and Katie Bakes, both emergency physicians in the Denver-Metro area, reflect on their upbringings, the many lessons learned over their twenty year careers, and how...
Podcast 522: e-Cigarette and Vaping Related Lung Injury
Contributor: John Winkler, MD Educational Pearls: Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO It is thought to...
Podcast 521: Traumatic Hyphema
Author: Jared Scott, MD Educational Pearls: A hyphema is blood in the anterior chamber of the eye, typically caused by trauma While there is a spectrum of disease, blurred...
Podcast 520: Approach to the arresting patient
Contributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical The differential for near cardiac...
Podcast 519: Malaria Drug Resistance
Contributor: John Winkler Educational Pearls: There is increasing resistance to antimalarial drugs, especially in P. falciparum. This trend started with chloroquine, but is now spreading to the other first-line...
Podcast 518: Professional Complications
Contributor: Jared Scott, MD Educational Pearls In a 4 yr period at 2 hospital systems, unprofessional behavior of surgeons was monitored via a complaint system. Number of complaints was...
Podcast 517: It’s all about the PEEP
Contributor: Dylan Luyten, MD Educational Pearls: Bag-valve masks (BVM) typically have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered...
UnfilterED #2: Lisa Raville & Dr. Josh Blum
Lisa Raville and Dr. Josh Blum, two pioneers of harm reduction in Denver, discuss the addiction crisis, the current state of harm reduction and how it will evolve in...
Podcast 516: Narcan and Pulmonary Edema
Contributor: Erik Verzemnieks, MD Educational Pearls: Important to realize complications can occur in the post-opioid overdose patient regardless of cause Narcan administration has been associated with non-cardiogenic pulmonary edema,...
Podcast 515: Non-Accidental Trauma
Contributor: Jared Scott, MD Educational Pearls: Non-accidental trauma (NAT) to children is commonly missed by medical providers Try to remember TEN-4-FACES as a useful aide for concerning patterns that...
Podcast 514: Pain Control While on Naltrexone
Author: Don Stader, MD Educational Pearls: Suboxone, methadone, and naltrexone are commonly used as treatments for opiate use disorder. Naltrexone is a full mu-opiate receptor antagonist, making acute pain...
Podcast 513: Plague
Author: John Winkler, MD Educational Pearls: The plague (black death) is caused by the Yersinia Pestis bacteria. This bacteria is spread by fleas and carried by rats. It is...
Podcast 512: Abstinence is Bad, mmmkay?
Author: Don Stader, MD Educational Pearls: Abstinence from substances such as tobacco or alcohol are effective strategies to achieve long term sobriety However, abstinence is not an effective strategy...
Podcast 511: Ebola Treatment
Author: Rachel Beham, PharmD Educational Pearls: There are currently many Ebola vaccines that are being studied, and one (recombinant VZV-Ebola vaccine) is currently being used in Africa. This vaccine...
Podcast # 510: Ebola
Author: John Winkler, MD Educational Pearls: There is a new outbreak of Ebola in The Congo. This is likely due to civil war and rebel attacks on healthcare workers...
Podcast 509: Circadian Rhythm and Shift Work, From Z to Z
Contributor: Jared Scott, MD Educational Pearls: Sleep deprivation and disturbed sleep cycles increases the risk of many acute and chronic medical issues such as motor vehicle accidents, diabetes, cardiovascular...
Podcast 508: Are you with child?
Contributor: Chris Holmes, MD Educational Pearls: In ancient Egypt, pregnant women would urinate over barley and wheat seeds to help determine the sex of thier fetus, as well as...
Podcast 507: Who gonna crump?
Contributor: Nick Tsipis, MD Educational Pearls: Communication proves time and time again to be most helpful in preventing surprises after patient admission Frequent re-evaluations and repeat vital signs can...
UnfilterED #1: Dr. Michael Hunt
On the first installment of this new series, Dr. Michael Hunt shares stories, lessons and advice as he reflects on his 35 year career as an emergency physician. ...
Podcast 506: Seymour Fracture
Contributor: Don Stader, MD Educational Pearls: Seymour fracture is an eponym for a Salter-Harris I/II fracture of the distal phalanx of the finger or toe in children, associated with...
Podcast 505: Sleep on Strep Throat
Contributor: Don Stader, MD Educational Pearls: Only 10% of patients receiving antibiotics for strep throat actually have the diesease Treatment of strep with antibiotics only slightly reduces the duration...
Podcast 504: Ocular Compartment Syndrome
Contributor: Don Stader, MD Educational Pearls: The eye is surrounded by relatively inflexible tissues such as the bone of the orbit and the fibrous tissue of the eye. This...
Podcast 502: EMS Psych Clearance
Contributor: Aaron Lessen, MD Educational Pearls: Patients with psychiatric complaints are often complicated to disposition from the main ED, and many will require inpatient psychiatric stays Some health systems...
Podcast # 501: Take Down Potions
Author: Jared Scott, MD Educational Pearls: Study from Hennepin County EM studied the efficacy of different drugs for agitation, which included 737 patients Most patients in this study were...
Colorado MAT Part 4: Buprenorphine in the Emergency Department
Treatment with buprenorphine is easier, less time consuming and far more effective for management of opioid withdrawal and OUD than standard care with clonidine, IVF, haldol and other symptomatic...
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Colorado MAT Part 3: Medications for MAT in the ED
There are three MAT drugs available to treat addiction: naltrexone (brand name Vivitrol), methadone (brand names Dolophine or Methadose) & buprenorphine (brand name Suboxone, Subutex, and Sublicade). The only...
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Colorado MAT Part 2: Medication Assisted Treatment
Medication Assisted Treatment or (Medication for Addiction Treatment) is an important frontier in ED care of patients with Opioid Use Disorder. Naltrexone, methadone and buprenorphine are the medications approved...
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Colorado MAT Part 1: Understanding Addiction & Opioid Use Disorder
Addiction is widely misunderstood by the public and by many healthcare providers. It is not taught in most medical schools. Combating the opioid epidemic will require providers to understand...
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Podcast #500: 2018-19 Rapid Fire EM Literature Review
Author: Dave Saintsing Educational Pearls: Poor sleep is an independent risk factor for development of health problems such as type 2 diabetes. A 2019 study, randomized participants to 3...
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Podcast #499: Posterior Circulation Ischemia
Podcast # 499: Posterior Circulation Strokes Contributor: Neal O’Connor, MD Educational Pearls: Dizziness is a very common complaint in the emergency department, but how can we find patients with...
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Podcast # 498: Ortho Tips
Author: Susan Ryan, DO Educational Pearls: General orthopedic principles: Examine above and below the injury Document neurovascular status X-ray imaging typically requires three different views Fracture description should include...
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Podcast #497: Does my patient with CP have ACS?
Author: Dylan Luyten, MD Educational Pearls: While certain aspects of the history, exam, and EKG may increase likelihood of ACS, there is no one element that performs well on...
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Podcast # 496: Hallucinogens
Author: David Holland, MD Educational Pearls: Hallucinogenics have been used for a variety of cultural and religious reasons for thousands of years In the 1960’s a Harvard professor began...
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Podcast # 495: Trauma in the Elderly
Author: Rachel Brady, MD Educational Pearls: Elderly patients (>65 years old) have a higher trauma mortality compared to younger patients, even though they have lower mechanisms of injury Elder...
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Podcast #494: A Standard Toxicology Approach
Contributor: JP Brewer, MD Educational Pearls: Obtaining collateral is often vital to determine the potential drugs accessible to the patient – this may include medications found in their medicine...
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Podcast # 493: One Pill for the Kill
Contributor: JP Brewer, MD Educational Pearls: Because of their smaller size, there are a variety of adult-dose pills that are potentially toxic to children. The most common categories of...
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Podcast # 492: Pain While on Buprenorphine
Contributor: Don Stader, MD Educational Pearls: Buprenorphine is a partial Mu-agonist and binds with higher affinity than most opioids Pain management with opioids therefore can be difficult in patients...
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Podcast # 491: Buprenorphine for Withdrawal
Educational Pearls: Buprenorphine is a semi-synthetic derivative of the opium poppy FDA approved for the treatment of opiate use disorder and chronic pain Benefit in emergency department use is...
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Podcast # 490: Canadian Syncope Rule
Contributor: Don Stader, MD Educational Pearls: Syncope is usually benign but can be caused by serious etiologies which include: PE, certain cardiac arrhythmias, AAA, intracranial bleed/stroke The Canadian Syncope...
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Podcast # 489: Bats & Rabies
Contributor: Jared Scott, MD Educational Pearls: The CDC recommends rabies prophylaxis if there was a direct encounter with a possibly rabid animal except… Bats are treated differently since their...
Podcast # 488: Dalbavancin
Contributor: Nick Hatch, MD Educational Pearls: Dalbavancin (Dalvance®) is an antibiotic that can be used for skin and soft tissue infections, providing MRSA coverage It cannot be used in...
Podcast # 487: Hunting for Epiglottitis
Contributor: Michael Hunt, MD Educational Pearls: Due to the efficacy of vaccination, epiglottitis is now more common in adults than children Risk factors include smoking and other immunocompromising co-morbidities,...
Podcast # 486: Morel Mushrooms
Contributor: Nick Hatch, MD Educational Pearls: True morel mushrooms are commonly foraged The false morel mushroom (Gyromitra esculenta) looks similar to the true morel, but is toxic False morel...
Podcast # 485: Cerebellar Stroke
Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentation...
Podcast # 484: Elevated ICP
Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma. While definite treatment is to remove the offending cause, there are...
Podcast # 483: Dual Antiplatelet Therapy in TIA
Contributor: Don Stader, MD Educational Pearls: Antiplatelets include Aspirin and Clopidogrel, and are generally used for arterial clotting (MI, stroke) Anticoagulants such as Coumadin, Xarelto, Eliquis are generally used...
Podcast # 482: Tetracyclines and Hyperpigmentation
Contributor: Michael Hunt, MD Educational Pearls: Tetracycline antibiotics such as minocycline can cause greyish hyperpigmentation This hyperpigmentation can sometimes be reversible but not always Minocycline has been used for...
Podcast # 481: Medical Errors and Cognitive Bias
Contributor: Peter Bakes, MD Educational Pearls: While there are many different types of medical error, one of the most common errors in emergency medicine is failure to diagnose Systematic...
Podcast # 480: Inhalant Abuse
Author: Sam Killian, MD Educational Pearls: Abuse occurs by breathing in volatile substances such as solvents, glues, paints, butane, and propane Inhalants are generally depressants Estimated that 100-125 people...
Podcast # 479: Clots and Pregnancy
Author: Nick Hatch, MD Educational Pearls: Pregnancy is a hypercoagulable state, which predisposes women to venous thromboembolism, but also elevates levels of circulating d-dimer A recent study evaluated the...
Podcast # 478: Psychedelics and Depression
Author: Chris Holmes, MD Educational Pearls: Hallucinogenic drugs have been in use since ancient times for both medical and recreational purposes Ayahausca is an ancient psychedelic with origins in...
Podcast # 477: Postpolypectomy Electrocoagulation Syndrome
Author: Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopy Occurs when cautery causes transmural thickening from a contact...
Podcast # 476: Evidence for Patient Satisfaction
Author: Dylan Luyten, MD Educational Pearls: Actual wait times are weakly correlated to patient satisfaction but the difference between perceived/expected wait times and actual wait times is strongly correlated...
Podcast # 475: Orthostatic Vital Signs and Syncope
Author: Michael Hunt, MD Educational Pearls: A recent study evaluated the relationship between abnormal orthostatic vital signs and serious outcomes within 30 days in patients over 60 presenting to...
Podcast # 474: Obesity Hypoventilation Syndrome
Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and common...
Podcast # 473: Direct to Consumer Antibiotics
Author: Sam Killian, MD Educational Pearls: A recent study in Pediatrics compared the rates of antibiotic prescriptions for acute respiratory infections (ARIs) between direct to consumer (DTC) telemedicine, urgent...
Podcast # 472: SMART Crystalloids
Author: Gretchen Hinson, MD Educational Pearls: In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks Compared to normal saline, a...
Podcast # 471: Cyclic Vomiting
Author: Don Stader, MD Educational Pearls: Cyclic vomiting syndrome (CVS) is different than cannabis hyperemesis syndrome (CHS). It is important to differentiate the two. CHS is thought to be...
Podcast # 470: Zofran and Pregnancy
Author: Jared Scott, MD Educational Pearls: Ondansetron (Zofran) is one of the latest drugs that has had concerns raised about side effects, particularly in pregnancy 2018 study probed two...
Podcast # 468: Typhlitis
Educational Pearls: Typhlitis refers to the presence of enterocolitis in the setting of neutropenia – also known as neutropenic enterocolitis Commonly a result of chemotherapy for hematologic malignancies. The...
Podcast # 467: Cauda Equina Syndrome
Author: Erik Verzemnieks, MD Educational Pearls: Cauda equina syndrome is caused by the compression of the nerve roots that extend beyond the termination of the spinal cord Trauma, infection,...
Podcast # 466: Subacute Sclerosing Panencephalitis
Author: Nicholas Hatch, MD Educational Pearls: Measles has a period of infectivity starts before the appearance of the characteristic rash, up to 4-5 days A devastating consequence of measles...
Podcast # 464: Narcan’t?
Author: Aaron Lessen, MD Educational Pearls: A problem of take-home-naloxone is the administration of it by an able-bodied bystander Australian study looked at consecutive opioid overdose deaths in a...
Podcast # 463: Buproprion Overdose
Author: Erik Verzemnieks, MD Educational Pearls: Buproprion is used as an antidepressant and for smoking cessation Severe buproprion overdoses can cause seizures and lead to cardiac dysrhythmias Benzodiazepines are...
Podcast # 462: Death after OD
Author: Don Stader, MD Educational Pearls: 10% of patients seen in the emergency department for opioid overdose patients will die within a year Half of these overdoses will occur...
Podcast # 461: Breath Stacking
Author: Gretchen Hinson, MD Educational Pearls: Breath stacking occurs when a patient is unable to expire fully before another inspiration In intubated/ventilated patients, this is because adequate time has...
Podcast # 460: Hunting for PE in Syncope
Author: Michael Hunt, MD Educational Pearls: Most causes of syncope are benign Pulmonary embolism can result in syncope and is life threatening A recent study of Canadian and...
Podcast # 459 Clonidine Ingestion
Author: Julian Orenstein, MD Educational Pearls: Severe clonidine ingestion can present as a fluctuating mental status between typically accompanied by changes in vital signs (hypotension/bradycardia) Respiratory depression requiring...
Podcast # 458: A Tylenol a Day Keeps the Delirium Away?
Author: Nick Hatch, MD Educational Pearls: A recent study investigated the effect of scheduled IV acetaminophen on the incidence of delirium in post-CABG patients in the ICU The...
Podcast # 457: Stroke Scores
Author: Jared Scott, MD Educational Pearls: Modified Rankin Score: measure of disability often used to qualify outcomes following stroke = no disability, 6=dead, 0-1 indicate good outcome) 0-6...
Podcast # 455: Hunting for PeeCP
Author: Michael Hunt, MD Educational Pearls: Like all tests, urine toxicology (utox) screens can have false positives Prescription medications such as demerol, antipsychotics, ketamine, and tramadol can all...
Podcast # 454: Tylenol Overdose
Educational Pearls: Acetaminophen overdose can also present in patients taking too much over the course of days to weeks – not just intentional ingestions If acute overdose is...
Podcast # 453: Headache Triggers
Author: Sam Killian, MD Educational Pearls: Headache is a common complaint in the ED. It’s plausible that headaches could be correlated with environmental factors A 2015 study ED...
Podcast # 452: CADASIL
Author: Sam Killian, MD Educational Pearls: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) occurs in 1:100000 individuals The disease is caused by a defect in the...
Podcast # 451: NSAIDs
Author: Don Stader, MD Educational Pearls: Non-steroidal anti-inflammatory drugs (NSAIDs) are effective pain relievers but come with important side effects NSAIDs inhibit COX-1 and/or COX-2, which decreases the production...
Podcast # 450: Probiotics in Gastroenteritis
Author: Sam Killian, MD Educational Pearls: Viral gastroenteritis alters the gut microbiome and it is theorized that probiotics may help reduce the duration and severity of the disease. Double-blind...
Podcast #449: Banana Bags
Author: Dylan Luyten, MD Educational Pearls: A “banana bag” is a bag of IV fluid that contains various vitamins and minerals including folate and thiamine IV fluids do not...
Podcast #448: Chronic Salicylate Toxicity
Author: Ryan Circh, MD Educational Pearls: Chronic salicylate (ASA) toxicity can present in elderly patients as altered mental status Consider chronic toxicity in patients with an unexplained anion gap...
Podcast #447: IV Tylenol
Author: Dylan Luyten, MD Educational Pearls: Recent randomized controlled trial compared intravenous to oral acetaminophen in emergency department patients There was no difference in pain relief between the groups...
Podcast #446: Retinal Detachment
Author: Dylan Luyten, MD Educational Pearls: 1:500 patients will experience a retinal detachment Consider stroke on your differential (central retinal arterial occlusion) Flashes and floaters are a common complaint...
Podcast #445: Hunting for the endotracheal tube
Author: Michael Hunt, MD Educational Pearls: Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive...
Podcast #444: Dyspnea in the intubated patient
Author: Aaron Lessen, MD Educational Pearls: Dyspnea can occur in up to 50% of intubated patients Dyspnea is associated with prolonged mechanical intubation Often goes undiagnosed as these patients...
Podcast #443: Measles – a timely revisit
Author: Sue Chilton, MD Educational Pearls: Measles is highly contagious Typically patients just look sick Remember 4 & 4, 14, and 4-C’s: Contagious 4 days before and after onset...
Podcast #442: When a severe man cold isn’t
Author: Jared Scott, MD Educational Pearls: CXR is 40-90% sensitive for detecting pneumonia when compared to CT Patients with a high degree of suspicion for pneumonia may still...
Podcast #441: Is Heparin Worthless for ACS?
Author: Don Stader, MD Educational Pearls: Recent study demonstrated patients with non-STEMI treated with heparin had no difference in survival, but had an increased risk of major bleeding...
Podcast # 440 : Carbon Monoxide Poisoning
Author: Katie Sprinkle, MD Educational Pearl: Carbon monoxide (CO) is the leading cause of death from poison world-wide CO forms from the combustion of any carbon based product...
Podcast # 439 : Oops I did it again
Author: Aaron Lessen, MD Educational Pearl: A double ingestion of a single pill is typically a benign event but several drug classes may cause problems A published review of...
Podcast # 438 : tPA for Frostbite
Author: Aaron Lessen, MD Educational Pearls: Several studies have shown administration of tPA can improve outcomes and reduce need for amputation tPA is considered in grade III and...
Podcast # 437 : Myasthenia Gravis
Podcast # 437 : Myasthenia Gravis Author: Gretchen Hinson, MD Educational Pearls: Myasthenia gravis (MG) is an antibody mediated autoimmune disorder against the acetylcholine receptors at the neuromuscular...
Podcast # 436 : Epinephrine Autoinjectors
Author: Charleen Gnisci, PharmD Educational Pearls: Between 2011 to 2016, Mylan increased EpiPen prices by 400% ($700 for 2 packs) AUVI-Q was recalled in 2012, which left the...
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