To improve patient safety, radiologists involved in percutaneous procedures should have knowledge of the antithrombotics that will be encountered routinely in clinical practice.

Liposomal bupivacaine did not improve pain control in patients undergoing TKA when compared with historical management strategies; however, differences may have been obscured by increased utilization of adjunctive analgesics among patients in the control group.

There was not a statistically significant difference in postoperative opioid consumption between patients receiving and not receiving IV acetaminophen intraoperatively.

Background: Pulmonary embolism (PE) is the associated cause of unexplained cardiac arrest in 5% to 13% of patients. Although thrombolytic agents have been studied, patient outcomes during cardiac arrest are lacking. Objective: The purpose of this study was to describe outcomes of patients who received thrombolytic therapy during cardiac arrest for suspected or confirmed PE. Methods: This retrospective review included adults who received alteplase or tenecteplase during cardiac arrest for suspected or confirmed PE. The primary end point was incidence of survival to hospital discharge, whereas secondary end points included a description of dosing strategies of thrombolytic therapy, the incidence of return of spontaneous circulation (ROSC), the occurrence of minor or major bleeding, and intensive care unit and hospital lengths of stay. Results: Of the 22 patients included in the study, 3 patients (13.6%) survived to hospital discharge, and ROSC was obtained in 11 patients (50%). Three patients had confirmed PE prior to cardiac arrest, with the remaining 19 patients having a documented suspicion for PE. The most frequent dosing strategy was alteplase 100 mg given via intravenous push (13 of 22 patients; 59%). One minor and no major bleeding events occurred. Conclusion and Relevance: Medical advances in PE management continue to evolve; yet the role of thrombolytic therapy in PE-related cardiac arrest remains unclear, with low overall rates of survival. These findings add to the relatively small body of evidence and highlight that optimal dosing remains unknown in this setting.

Purpose: The purpose of this study was to evaluate the impact of the implementation of pharmacist-guided, unit-specific dornase alfa utilization guidelines for patients without cystic fibrosis in an academic medical institution. The study reviewed the prescribing patterns in the institution’s pediatric intensive care unit (PICU) and pediatric cardiac intensive care unit (PCICU) before and after the implementation of these guidelines. The primary objective of this study was to determine the effects of the guidelines on the number of dornase alfa doses prescribed in critically ill pediatric patients without cystic fibrosis. We also evaluated the pharmacoeconomic effect of the guidelines and the impact on clinical outcomes in these critically ill patients. Methods: This study was a single-center, retrospective evaluation of the implementation of pharmacist-guided, unit-specific dornase alfa guidelines. The guidelines were piloted on November 1, 2015. Pre-guideline implementation data were collected from February 1, 2015 to October 31, 2015. Post-guideline implementation data were collected from December 1, 2016 to August 31, 2016. We included patients admitted to the PICU and PCICU who had received at least 1 dose of dornase alfa and did not have a medical history or suspicion of cystic fibrosis. Results: During the pre-guideline data collection period, 1067 doses of dornase alfa were administered, and following guideline implementation, 239 doses were administered. The average total admission length of stay for patients admitted to the PICU or PCICU before guideline implementation and after implementation was 16.22 and 13.14 days, respectively ( P = .042). Conclusions: The implementation of pharmacist-guided, unit-specific dornase alfa guidelines within the PICU and PCICU resulted in a 77.6% reduction in the use of dornase alfa among these units. The implementation of these guidelines led to a cost reduction of approximately US $87 707.76 over a 9-month period for the health system. During the study, the length of stay for patients admitted to the PICU and PCICU did not increase, indicating that the reduction in use of dornase alfa did not negatively affect the overall hospital length of stay for patients.