Jarrett Lefberg, DO
Emergency Medicine

Michael Doyle, MD
Psychiatry

Brad Green, MD
Department of Emergency Medicine

Joydeep Ghosh, MD
Cardiology/Electrophysiology

Michael Rynn, DPM
Podiatry

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Pharmacy News:

Warfarin Reversal with Vitamin K
Multiple articles as well as the practice guidelines set forth by the American College of Chest Physicians, American Heart Association, and the American College of Cardiology provide recommendations for dosing of vitamin K. The lowest possible dose should be used, especially in patients for whom re-anticoagulation will be necessary at a later date. Oral administration of vitamin K is preferred and provides the most predictable response to therapy. Intravenous vitamin K should be administered slowly (over at least 30 minutes) to avoid potential anaphylactic reactions. Subcutaneous and intramuscular administration of vitamin K should be avoided due to erratic absorption. Reversal of elevated INRs with vitamin K takes approximately 24 hours for maximum effect, regardless of the route of administration.

Source: IDSA, Clinical Infectious Diseases Guidelines; compiled by Amena Murtuza, PharmD Candidate 2013

ED News

Congratulations!
Laura Nicholson RN, BSN, MS who has completed her Nurse Practitioner Masters at Mount Saint Mary College; and Ron Ramirez RN, BSN, MS who has completed his Nurse Practitioner Masters at Dominican College

Keep up the good work:
Robin Gumaer who is working towards completion of her degree for Nurse Practitioner and Masters; Heather Sloane who is working towards completion of her Nurse Practitioner and Masters; Melissa Zielinski who is working towards completion of her BSN; Stacey Muller who is working toward completion of her BSN
Kim Dixon who is working toward completion of her BSN; and Caroline Zeoli who is working toward completion of her Business Management Bachelors. Congratulations and keep up the great work!

Hyperbaric Oxygen Therapy Has Several AHA Class Recommendations

Did you know HBO has a several AHA Class recommendations as an adjunctive therapy for multiple indications?  At the Wound Center we use HBO as an adjunctive therapy to treat patients with infected diabetic foot ulcers, radiation proctopathy/cystitis, and chronic osteomyelitis.  For patients with radiation proctopathy or diabetics with infected foot ulcers, HBO receives an AHA class I recommendation based on Level A evidence meaning it should be performed.  For patients with chronic osteomyelitis or radiation cystitis, HBO receives an AHA Class IIa recommendation based on Level B evidence meaning it is reasonable to perform such a procedure.  Consider HBO as an adjunctive treatment of choice the next time you encounter one of these patients.

1. Clarke RE, Tenorio LM, Hussey JR et al (2008) Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a ran- domized and controlled double-blind crossover trial with long-term follow-up. Int J Radiat Oncol Biol Phys 72:134–143
2. Feldmeier JJ, editor.  Hyperbaric oxygen 2003: indications and results: the Hyperbaric Oxygen Therapy Committee Report. Kensington (MD):Undersea and Hyperbaric Medical Society; 2003.
3. Sidik et al (2007) Does hyperbaric oxygen administration decrease side effect and improve quality of life after pelvic radiation? Acta Med Indones 39(4):169–173
4. S Allen, C Kilian, J Phelps, HT Whelan. The use of hyperbaric oxygen for treating delayed radiation injuries in gynecologic malignancies: a review of literature and report of radiation injury incidence. Support Care Cancer. 2012 Oct;20(10):2467-72. Epub 2012 Jan 14.