The problem of drug shortages in the emergency department

I first experienced the impact of drug shortages in the U.S. in my first month of my residency training in emergency medicine. The most common drug used to sedate patients for intubation, etomidate, was on national shortage. I learned to use the second most common drug, Propofol, until it went on shortage too. We use it as the first line medication for sedation for painful procedures like re-aligning broken bones, draining painful abscesses and intubating. We resorted to using older combinations of medications that just didn’t work as well. That was over six years ago. And now, we have even more shortages all the time. Literally, I am aware of drugs I cannot use because they are on shortage, such as various blood pressure medications, sedatives, and antibiotics. Several of the shortages have been critical drugs like sodium bicarbonate which is used to correct acidosis in very sick patients, and 50 percent dextrose, used to revive hypoglycemic patients. When dextrose went on shortage, we had to do calculations to use the neonate formulation for adults. This is a high-risk situation for potential errors that puts patients’ safety at risk. At least once a week as I order life-saving antibiotics for a patient in sepsis, I must check for shortages of the preferred antibiotics first. Similarly, there is a shortage of normal saline (salt water) used for rehydration and to dissolve and deliver other drugs. There was a rumor that there was a “plastic sterile bag shortage...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Physician Emergency Medicine Infectious Disease Source Type: blogs