Sara J. Hyland PharmD
@sarajpharmd.bsky.social
Periop and Emergency Medicine PharmD
| Homesteader, cook, yogi, mama
| Peaceful free-thinker trying to do some good✌
#FOAMed #MedSky #PharmSky
https://scholar.google.com/citations?user=NDd3R3QAAAAJ&hl=en
| Homesteader, cook, yogi, mama
| Peaceful free-thinker trying to do some good✌
#FOAMed #MedSky #PharmSky
https://scholar.google.com/citations?user=NDd3R3QAAAAJ&hl=en
Yup lol. Also Ancef
November 6, 2025 at 8:50 PM
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
November 6, 2025 at 8:06 PM
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...
education.aaaai.org/penicillin-a...
foamed.ebmedicine.net/rapid-refere...
Penicillin Allergy Center | AAAAI Education Center
education.aaaai.org
November 6, 2025 at 8:06 PM
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...
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.
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.
October 28, 2025 at 9:19 PM
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.
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)
It is voluntary, anonymous, and should take about 10 minutes to complete. (sorry it is only intended for U.S. practitioners)
October 28, 2025 at 9:19 PM
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)
It is voluntary, anonymous, and should take about 10 minutes to complete. (sorry it is only intended for U.S. practitioners)
Probably Low at those doses but possible, probably risk/benefits and monitor
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
July 2, 2025 at 1:16 PM
Probably Low at those doses but possible, probably risk/benefits and monitor
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...
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
June 17, 2025 at 8:19 PM
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;) 🤝
June 17, 2025 at 7:58 PM
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
June 17, 2025 at 6:30 PM
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/
Guidance from current ASA guidelines is challenging to apply here and evidence very limited in ICU settings 3/
June 17, 2025 at 6:30 PM
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/
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/
At this juncture though NMB is likely shallow or minimal though unable to assess precisely. Some reversal would likely be prudent, but 2/
June 17, 2025 at 6:30 PM
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/
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/
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/
June 17, 2025 at 6:30 PM
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/
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/
💯
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
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
June 17, 2025 at 5:18 PM
💯
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
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
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/
pubmed.ncbi.nlm.nih.gov/32691835/
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...
pubmed.ncbi.nlm.nih.gov
June 10, 2025 at 4:45 PM
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/
pubmed.ncbi.nlm.nih.gov/32691835/
Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-
June 10, 2025 at 4:38 PM
Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-
June 8, 2025 at 9:43 PM
June 8, 2025 at 9:38 PM
I know, super lame ;P Send me your email
May 19, 2025 at 8:53 PM
I know, super lame ;P Send me your email