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Sara J. Hyland PharmD

@sarajpharmd.bsky.social

370 followers 540 following 330 posts

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

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jan 7

I'm here for #FOAMEd and #medsky #pharmsky discussions 🤓💊🏥💉✌️

Migrating in process 🐦🦋
Below is linked some previous content,
Will accumulate future content here⤵️

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Oct 17

Original #MedTweetorial and #FOAMed Content Index:

1) Volume Kinetics (I.e. "how to avoid killing your patients during 'fluid resuscitation'"):2) Patient-Centered Pain/Opioid Dosing Assessment Pearls:

x.com/SaraJPharmD/st… x.com/SaraJPharmD/st…

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Sep 6

VTE prophylaxis in foot & ankle surgery review-
www.hmpgloballearningnetwork.com/site/podiatr...

How can we best use limited data and tailor ppx to individual patient risk/benefit in this heterogenous surgical population? 🦶🔪💉💊

What's your approach? #Medsky #FOAMed #VTE #FAS #pharmsky

www.hmpgloballearningnetwork.com

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Aug 20

Had a great time chatting with you guys about residual NMB and reversal strategies in the ICU! Thanks so much for the conversation and for highlighting this topic.

#emimcc #medsky #pharmsky

Critical Concepts @critconcepts.bsky.social · Aug 20

The great @sarajpharmd.bsky.social tells us how to use sugammadex in the ICU, why we should, and how many of our patients may have occult residual paralysis. #medsky #emimcc icuscenarios.com/episode-90-s...

Episode 90: Sugammadex in the ICU – Critical Care Scenarios

icuscenarios.com

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jul 2

Probably Low at those doses but possible, probably risk/benefits and monitor
academic.oup.com/cid/article/...
pmc.ncbi.nlm.nih.gov/articles/PMC...

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Reposted by Sara J. Hyland PharmD

josh farkas 💊 @pulmcrit.bsky.social · Jun 17

Sugammadex in the ICU: let's talk about a *real* conundrum

Everyone always talks about the use of sugammadex for failed intubations (bad idea, lets move on)

But we overlook something we *should* be talking about: when we should use sugammadex for pre-extubation paralysis reversal... #1/4 #EMIMCC

a woman speaking into a microphone with the words " it 's up for debate " below her

ALT: a woman speaking into a microphone with the words " it 's up for debate " below her

media.tenor.com

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

I know we're like hidden unicorns sometimes😂❤️

accpjournals.onlinelibrary.wiley.com/doi/abs/10.1...

a woman in a polka dot dress is applauding in a crowd of people with snl written on the bottom

ALT: a woman in a polka dot dress is applauding in a crowd of people with snl written on the bottom

media.tenor.com

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

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

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

Totally. As can all of us OR pharmacists working with anesthesiologists in the pre-sug era;) 🤝

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

Though is a topic of active research by my group and hopefully others! Interested in the discussion here /end

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

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/

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

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/

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

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/

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

Thanks @mdaware.org here's that paper -
pubmed.ncbi.nlm.nih.gov/36407180/

Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: A Retrospective Analysis and Practical Guidance - PubMed

Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where...

pubmed.ncbi.nlm.nih.gov

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 17

💯

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

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 10

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/

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

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 10

Agree! Love your many prior reviews of this too. Some clips from my recent grand rounds on this topic-

Summary of SSC guidelines on time to abx

Evolution and controversies in sepsis management

Influence of the appropriateness of abx on sepsis mortality

Challenges with interpreting influence of time-to-abx influence on mortality

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 8

@dybspharmd.bsky.social

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 8

14) our #ketamine in the ED infographic
#emimcc

Sara J. Hyland PharmD @sarajpharmd.bsky.social · Jun 8

13) STEMI pharmacotherapy reviews

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization

AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

academic.oup.com

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

I know, super lame ;P Send me your email

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

It looks like they just moved the links for some reason, my thanks and apologies!

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization

AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

academic.oup.com

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

Oh my it looks like they just moved it for some reason, my thanks and apologies!

academic.oup.com/ajhp/advance...

academic.oup.com/ajhp/advance...

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist’s role, part 1: Patient presentation through revascularization

AbstractPurpose. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical

academic.oup.com

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

#cardiosky

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

Thank you to this amazing team of STEMI pharmacist queens 👑💖💊
@ Danielle Blais
@ Marnie Max
@ Rachael Eaton
@stephaniewong.bsky.social
@lichenlady94.bsky.social

#medsky #pharmsky #emimcc #cardsky

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

💔 Surgical med considerations if CABG
💊 Secondary prevention after STEMI
💔 Discharge and transition of care checklists
💊 Patient education
💔 Quality improvement in STEMI care
💊 Pharmacist roles across this continuum and on interventional heart teams

Sara J. Hyland PharmD @sarajpharmd.bsky.social · May 19

💔 Initial antithrombotics in ED
💊 Supportive therapies in ED
💔 Cath lab- antithrombotics, intraarterial/intracardiac meds
💊 Fibrinolysis- lytic and other med considerations
💔 Early complications- vasoactive and antiarrhythmic therapies
💊 Post-revascularization inpt mgmt