Anthony Lau, PharmD BCPS
@alaurx.bsky.social
EM Pharmacist & Hockey Goalie & Travelist | Living & appreciating life to the fullest | Sharing what I learn everyday. Opinions are my own, RTs not endorsements #MedSky #EMsky #PharmSky
Reposted by Anthony Lau, PharmD BCPS
1/🧵what happens after stopping #glp1 agonists like #semaglutide (#Wegovy #Ozempic) or tirzepatide (#Mounjaro #Zepbound)?
Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle
Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle
a man with a beard is smiling and looking through a hole in a door .
ALT: a man with a beard is smiling and looking through a hole in a door .
media.tenor.com
January 27, 2026 at 8:22 AM
Reposted by Anthony Lau, PharmD BCPS
Avoid crystalloid in hemorrhagic shock
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
Crystalloids in Hemorrhagic Shock #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
January 30, 2026 at 2:44 PM
Avoid crystalloid in hemorrhagic shock
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting
Patients don’t bleed crystalloid so don’t give crystalloid
youtube.com/shorts/QltA6...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
The new 2026 AHA/ASA stroke guidelines include this table 👇 for the management of thrombolytic-induced angioedema.
There is NO discussion or any additional text about this topic.
I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC
There is NO discussion or any additional text about this topic.
I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC
January 30, 2026 at 10:23 PM
The new 2026 AHA/ASA stroke guidelines include this table 👇 for the management of thrombolytic-induced angioedema.
There is NO discussion or any additional text about this topic.
I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC
There is NO discussion or any additional text about this topic.
I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Bicarb Pushes
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
Bicarb Pushes Utility #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
January 28, 2026 at 2:41 PM
Bicarb Pushes
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available
youtube.com/shorts/gQrwA...
#EMIMCC
1/🧵what happens after stopping #glp1 agonists like #semaglutide (#Wegovy #Ozempic) or tirzepatide (#Mounjaro #Zepbound)?
Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle
Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle
a man with a beard is smiling and looking through a hole in a door .
ALT: a man with a beard is smiling and looking through a hole in a door .
media.tenor.com
January 27, 2026 at 8:22 AM
Reposted by Anthony Lau, PharmD BCPS
Had a great time running workshop on cardiogenic shock/critical care cardiology for early career cardiology trainees yesterday. A repeat question was wether I have a blood pressure limit for when I give diuretics. I don’t. If the patient is truly volume overloaded, the bp won’t ⬇️ from the diuretic
January 24, 2026 at 9:22 AM
Had a great time running workshop on cardiogenic shock/critical care cardiology for early career cardiology trainees yesterday. A repeat question was wether I have a blood pressure limit for when I give diuretics. I don’t. If the patient is truly volume overloaded, the bp won’t ⬇️ from the diuretic
Reposted by Anthony Lau, PharmD BCPS
No role for bicarb pushes in metabolic acidosis
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
Bicarb Pushes + Acidosis #criticalcare #emergencymedicine
YouTube video by EMSwami
youtube.com
January 23, 2026 at 2:31 PM
No role for bicarb pushes in metabolic acidosis
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation
youtube.com/shorts/uS2VN...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
antiseizure medications has a PK/PD profile similar to beta-lactam antibiotics:
-efficacy relates to the trough level
-toxicity relates to the peak level
so benefit/risk ratio is maximized with smaller, frequent dosing
hard to do outside the hospital re: adherence
but easy to do for inpatients
-efficacy relates to the trough level
-toxicity relates to the peak level
so benefit/risk ratio is maximized with smaller, frequent dosing
hard to do outside the hospital re: adherence
but easy to do for inpatients
a close up of a woman 's face with her eyes closed and her mouth open .
ALT: a close up of a woman 's face with her eyes closed and her mouth open .
media.tenor.com
January 6, 2026 at 1:43 PM
antiseizure medications has a PK/PD profile similar to beta-lactam antibiotics:
-efficacy relates to the trough level
-toxicity relates to the peak level
so benefit/risk ratio is maximized with smaller, frequent dosing
hard to do outside the hospital re: adherence
but easy to do for inpatients
-efficacy relates to the trough level
-toxicity relates to the peak level
so benefit/risk ratio is maximized with smaller, frequent dosing
hard to do outside the hospital re: adherence
but easy to do for inpatients
Reposted by Anthony Lau, PharmD BCPS
In ICH, should we be cautious w/ hydralazine for BP control?
Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect
Thoughts? #EMsky #EMIMCC #neurosky #pharmsky
Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect
Thoughts? #EMsky #EMIMCC #neurosky #pharmsky
a man in a suit is taking his blood pressure with a device that says tcm
ALT: a man in a suit is taking his blood pressure with a device that says tcm
media.tenor.com
January 2, 2026 at 10:03 AM
In ICH, should we be cautious w/ hydralazine for BP control?
Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect
Thoughts? #EMsky #EMIMCC #neurosky #pharmsky
Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect
Thoughts? #EMsky #EMIMCC #neurosky #pharmsky
a man in a suit is taking his blood pressure with a device that says tcm
ALT: a man in a suit is taking his blood pressure with a device that says tcm
media.tenor.com
January 2, 2026 at 10:03 AM
Reposted by Anthony Lau, PharmD BCPS
updated the IBCC chapter on BRASH
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC
December 30, 2025 at 1:27 PM
updated the IBCC chapter on BRASH
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC
added a treatment checklist that walks you through resus of a sick BRASH pt
BRASH is uncommon & there are lots of moving pieces, so the checklist is a helpful cue to provide comprehensive treatment of all the BRASH components
emcrit.org/ibcc/brash/ #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Reposted by Anthony Lau, PharmD BCPS
Hypotension + Bradycardia: Updated Differential
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
Hypotension + Bradycardia #criticalcare #emergencymedicine #trauma
YouTube video by EMSwami
youtube.com
December 19, 2025 at 3:39 PM
Hypotension + Bradycardia: Updated Differential
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
-HyperK
-Beta blocker/CCB tox (can occur outside overdose)
-Clonidine or digoxin tox
-Blood in belly (vagal stim)
-Neurogenic shock
-Severe hypothyroid
-HyperMg
-Inferior MI
-Advanced AV blocks
-BRASH Syndrome
youtube.com/shorts/S3ibt...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
RSI Trial(PMID:41369227): Etomidate vs Ketamine
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
The RSI Trial: Etomidate vs Ketamine #criticalcare #emergencymedicine #intubation
YouTube video by EMSwami
youtube.com
December 17, 2025 at 3:31 PM
RSI Trial(PMID:41369227): Etomidate vs Ketamine
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
-No diff 28d mortality
-Incr HD collapse w/ ketamine (driven by incr/new pressors)
-Not clear why (More aggressive resus in etomidate group?)
-Forces us to reconsider our induction agent choice
youtube.com/shorts/CFWOR...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
Inpatient pharm pearl:
Infusion durations for IV iron & bisphosphonates were designed to be *short* to improve patient throughput at *outpatient* infusion centers
For inpatients, SLOWING DOWN the infusion reduces infusion reactions/toxicity with *same* efficacy (these drugs work slowly) #EMIMCC
Infusion durations for IV iron & bisphosphonates were designed to be *short* to improve patient throughput at *outpatient* infusion centers
For inpatients, SLOWING DOWN the infusion reduces infusion reactions/toxicity with *same* efficacy (these drugs work slowly) #EMIMCC
December 11, 2025 at 3:42 PM
Inpatient pharm pearl:
Infusion durations for IV iron & bisphosphonates were designed to be *short* to improve patient throughput at *outpatient* infusion centers
For inpatients, SLOWING DOWN the infusion reduces infusion reactions/toxicity with *same* efficacy (these drugs work slowly) #EMIMCC
Infusion durations for IV iron & bisphosphonates were designed to be *short* to improve patient throughput at *outpatient* infusion centers
For inpatients, SLOWING DOWN the infusion reduces infusion reactions/toxicity with *same* efficacy (these drugs work slowly) #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
🔥Fresh blog🔥 Hot take on RSI trial of ketamine vs etomidate
RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine 🤔
Cause of BP drops with ketamine?
- Less pressor pre-intubation?
- Ketamine provides analgesia (eliminating pain-as-a-pressor)?
... #1/2
RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine 🤔
Cause of BP drops with ketamine?
- Less pressor pre-intubation?
- Ketamine provides analgesia (eliminating pain-as-a-pressor)?
... #1/2
December 10, 2025 at 4:00 PM
🔥Fresh blog🔥 Hot take on RSI trial of ketamine vs etomidate
RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine 🤔
Cause of BP drops with ketamine?
- Less pressor pre-intubation?
- Ketamine provides analgesia (eliminating pain-as-a-pressor)?
... #1/2
RSI & EvK trials both show *more* BP instability with ketamine *but* lower mortality with ketamine 🤔
Cause of BP drops with ketamine?
- Less pressor pre-intubation?
- Ketamine provides analgesia (eliminating pain-as-a-pressor)?
... #1/2
Here’s a short skeetorial to raise awareness about the surprisingly high sodium content in some IV antibiotics...clinically important for patients with CHF. Judicious use matters!💧🧂 #emimcc #medsky #EMsky #IDsky #pharmsky #AMSky #FOAMed
a man wearing sunglasses and a white t-shirt is holding something in his hands .
ALT: a man wearing sunglasses and a white t-shirt is holding something in his hands .
media.tenor.com
December 8, 2025 at 9:28 AM
Reposted by Anthony Lau, PharmD BCPS
Here’s a "shorter" (😅) tweetorial…why do we use a combination of beta-lactam + vancomycin for cellulitis or MSSA bacteremia?
If vancomycin covers both strep and staph, why not use it alone? Let’s dive in! 🧵 #medsky #pharmsky #EMsky #MedEd #IDsky #AMSky #nursesky
If vancomycin covers both strep and staph, why not use it alone? Let’s dive in! 🧵 #medsky #pharmsky #EMsky #MedEd #IDsky #AMSky #nursesky
maybe we could kill two birds with one stone
ALT: maybe we could kill two birds with one stone
media.tenor.com
February 18, 2025 at 8:59 AM
Thought I'd repost a relevant skeetorial from last year!
I often get asked about renal dosing adjustments of Abx in critically ill pts in the ED, so I'd thought I'd share my thought process & perspective. Caveat: only in ED! Lets dive in! 👇
#medsky #pharmsky #EMsky #IDsky #emimcc #MedEd
I often get asked about renal dosing adjustments of Abx in critically ill pts in the ED, so I'd thought I'd share my thought process & perspective. Caveat: only in ED! Lets dive in! 👇
#medsky #pharmsky #EMsky #IDsky #emimcc #MedEd
December 3, 2025 at 10:54 PM
In critically ill pts, avoid adjusting initial doses based solely on early bloodwork. When pts present to ED, SCr/eGFR may not accurately reflect kidney fxn. These early labs represent pre-treatment📷(before IV💧, Abxs & resus). W/ these interventions, SCr/eGFR often improves #emimcc #medsky #pharmsky
⚡💉Are We Jumping the Gun? Early Beta-Lactam Dose Cuts Risk Underdosing in AKI, Critical Care, 2025
link.springer.com/article/10.1...
Link to X post:
x.com/ABsteward/st...
#idsky #EMIMCC
link.springer.com/article/10.1...
Link to X post:
x.com/ABsteward/st...
#idsky #EMIMCC
Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review - Critical Care
Background Acute kidney injury is a common complication in critically ill patients, often coinciding with the need for antibiotic therapy. The dose of beta-lactam antibiotics is frequently adjusted an...
link.springer.com
December 3, 2025 at 10:51 PM
In critically ill pts, avoid adjusting initial doses based solely on early bloodwork. When pts present to ED, SCr/eGFR may not accurately reflect kidney fxn. These early labs represent pre-treatment📷(before IV💧, Abxs & resus). W/ these interventions, SCr/eGFR often improves #emimcc #medsky #pharmsky
Love to hear others’ experience...
How has IV push antibiotics been working in ur ED? Any challenges w/ nurses having to push over 2–5 min vs hanging infusion & multitasking? Has IV Abx use ↑ from AMS pov? Would love to learn from others’ workflows & outcomes☺️ #nursesky #medsky #EMsky #AMSSky #IDsky
How has IV push antibiotics been working in ur ED? Any challenges w/ nurses having to push over 2–5 min vs hanging infusion & multitasking? Has IV Abx use ↑ from AMS pov? Would love to learn from others’ workflows & outcomes☺️ #nursesky #medsky #EMsky #AMSSky #IDsky
December 3, 2025 at 4:15 PM
Love to hear others’ experience...
How has IV push antibiotics been working in ur ED? Any challenges w/ nurses having to push over 2–5 min vs hanging infusion & multitasking? Has IV Abx use ↑ from AMS pov? Would love to learn from others’ workflows & outcomes☺️ #nursesky #medsky #EMsky #AMSSky #IDsky
How has IV push antibiotics been working in ur ED? Any challenges w/ nurses having to push over 2–5 min vs hanging infusion & multitasking? Has IV Abx use ↑ from AMS pov? Would love to learn from others’ workflows & outcomes☺️ #nursesky #medsky #EMsky #AMSSky #IDsky
Reposted by Anthony Lau, PharmD BCPS
Be cautions intubating patients w/ severe metabolic acidosis
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
Critical DKA + Intubation #criticalcare #emergencymedicine #intubation #airway
YouTube video by EMSwami
youtube.com
December 1, 2025 at 2:37 PM
Be cautions intubating patients w/ severe metabolic acidosis
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
-Hyperperpnea drives CO2 down supporting pH
-Removing resp drive will drop pH ➡️ HD collapse
-Mech vent challenging as must mimic preintubation parameters
-Use NIV to support work of breathing instead
youtube.com/shorts/zn7hi...
#EMIMCC
Reposted by Anthony Lau, PharmD BCPS
in thyroid storm, treating sinus tach w/ a beta-blocker will occasionally cause death
many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock)
beta-blockers push them over the edge
what data supports B-bl in thyroid storm?
could we please stop doing this? #EMIMCC
many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock)
beta-blockers push them over the edge
what data supports B-bl in thyroid storm?
could we please stop doing this? #EMIMCC
December 1, 2025 at 4:05 PM
in thyroid storm, treating sinus tach w/ a beta-blocker will occasionally cause death
many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock)
beta-blockers push them over the edge
what data supports B-bl in thyroid storm?
could we please stop doing this? #EMIMCC
many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock)
beta-blockers push them over the edge
what data supports B-bl in thyroid storm?
could we please stop doing this? #EMIMCC
Reposted by Anthony Lau, PharmD BCPS
It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)
December 2, 2025 at 10:40 PM
It took us a while to recognize euglycemic diabetic ketoacidosis (euDKA) in patients treated with Na-glucose cotransporter-2 inhibitors. It seems that we may have to be on the lookout for euDKA in patients treated with glucagon-like peptide-1 receptor agonists (#Ozempic #Zepbound)