Pharmacist involvement on the cardiopulmonary resuscitation (CPR) team is associated with lower mortality rates. Despite this finding, pharmacists respond to cardiopulmonary emergencies in only 32% of institutions. The objective of this study was to determine the responsibilities and training of pharmacists as CPR team members and to assess their attitudes toward this role. A total of 1290 adult, acute-care hospitals were randomly surveyed nationwide. A total of 1108 questionnaires were received from 40% (517/1290) of institutions surveyed. Thirty-seven percent (189/517) of the institutions indicated that pharmacists participate on their CPR teams. Pharmacists' responsibilities at cardiopulmonary emergencies included recording medications administered (73.7%), medication preparation (96.6%), providing drug information (97.7%), and calculating doses (98.2%). The most common training methods were BLS certification (79%), the buddy system (59.4%), and continuing education programs (53.6%). Training methods that positively affected perceived qualification in the primary responsibilities were BLS/ACLS certification (P < 0.001) and training programs provided by the institution (P < 0.05). Positive attitudes toward participation on the CPR team were associated with the following factors: years of experience, BLS/ACLS certification, and the pharmacist's perception that he or she was adequately trained (P < 0.001). The results indicate that CPR team pharmacists should be proficient in providing drug information, preparing medications, recording medications administered, and calculating doses. Furthermore, because adequate training positively influenced pharmacists' attitudes toward participation and their perceived qualifications, we recommend that all pharmacists on CPR teams be required to obtain BLS/ACLS certification and participate in educational programs provided by their institution.
The pH value was a reliable predictor of nasoduodenal tube placement. However, radiographic confirmation of location could not be excluded because of the low sensitivity using pH measurements alone. An increase of > or = 1.0 in gastric vs intestinal pH specimens could be useful to determine use of radiography confirmation of tube placement.
A drug use evaluation was conducted to determine if reteplase was administered expeditiously, appropriately, and safely to patients arriving in the emergency department (ED) with acute myocardial infaction (AMI). A retrospective review of the medical records of 28 patients receiving reteplase in the ED during a 6-month period was conducted. The median door-to-drug time for administration of reteplase was 33 minutes. Major and minor bleeding events occurred in 3.6% and 42.8% of patients, respectively. In general, reteplase was administered correctly and in a timely manner to appropriately screened patients.
We report a case of a 25-year-old, female Jehovah'S Witness (JW) with severe anemia secondary to emergent salpingectomy who was treated with high dose human recombinant erythropoietin (rHu-EPO). Post-operative laboratory values were significant for a Hgb of 3.4 g/dl and a Hct 9.6%. The patient received rHu-EPO 150 u/kg IV q 12 hrs x 10 days, iron dextran, folic acid, cyanocobalamin, and fluid replacement. The patients Hgb and Hct were 6.0 g/dl and 18.9% upon discharge, increased from a nadir of 2.4 g/dl and 6.7%, respectively. The immediate administration of high dose rHu-EPO to severely anemic JW patients may decrease the period of severe anemia by accelerating erythropoiesis.
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