Emergency Medicine Board Bombs 282. EM Pharmacy Pearls: High-Yield Drug Tips Every EM Doctor Must Know
Apr 13, 2026
Abbi Briscoe, an emergency medicine pharmacist known as Lil Pharma, shares high-yield ED medication tips. Short, practical takes on post-intubation sedation and paralytic choices. Clear guidance on anticoagulation and reversal strategies. Fast approaches for status epilepticus and sedation, thrombolysis for unstable PE, UTI stewardship, and preferred agents for SVT and alcohol withdrawal.
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Use PCC For Factor Xa Reversal
- For factor Xa inhibitor bleeds, use four-factor PCC (K-Centra) as the practical reversal now that andexanet alfa is off market.
- Abbi recommends a flat 2000-unit PCC dose up front and add 500 units later if bleeding continues or patient is large.
Reverse Dabigatran With Praxbind And Warfarin With PCC
- Dabigatran has a specific reversal agent, idarucizumab (Praxbind), and you can still use PCC alongside it if needed.
- For warfarin, give PCC for rapid reversal and add vitamin K to restore INR over time.
Maximize Benzo Then Rapidly Load Levetiracetam
- In status epilepticus, max benzodiazepines (eg, lorazepam 4 mg) then give levetiracetam 60 mg/kg up to 4.5 g without delay.
- Wait ~2 minutes after benzos, but start levetiracetam early because compounding and hang time add delay.