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Sara J. Hyland PharmD

@sarajpharmd.bsky.social
488 followers 1K following 351 posts

Periop and Emergency Medicine PharmD | Homesteader, cook, yogi, mama | Peaceful free-thinker trying to do some good✌ #FOAMed #MedSky #PharmSky scholar.google.com/citations?user=N…

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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 13/08/2026
Hm I've not seen recs to target higher range, the purpose of loading dose is usually to achieve therapeutic level quickly. Sometimes a "re-load" as you describe could make sense in setting of breakthrough seizures and suspicion that the previous regimen was not achieving sufficient therapeutic level
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/07/2026
low-dose vasopressin early in hemorrhagic shock was also associated with less transfusion need and fewer VTEs. pubmed.ncbi.nlm.nih.gov/31461138/ Who benefits and who is harmed seems extraordinarily complex and also timing-dependant..
pubmed.ncbi.nlm.nih.gov
Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial - PubMed
ClinicalTrials.gov identifier: NCT01611935.
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/07/2026
This is really interesting. Perhaps there are differential effects in acute shock phenotypes vs chronic effects, similar to as seen with some other hormonal mediators. Interestingly, in addition to the septic shock literature,
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/07/2026
Mechanistic explorations in cardiogenic shock seem comparatively quite limited though theoretical benefits in select phenotypes as discussed, enjoyed this review from earlier this year- pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/07/2026
I think vasopressin mechanisms in septic shock have become quite complex. Highly recommend these authors and podcast episode on the topic- podcasts.apple.com/us/podcast/a... pharmacytodose.com/wp-content/u...
podcasts.apple.com
AVP: All Vasopressin Podcast
Podcast Episode · Pharmacy to Dose: The Critical Care Podcast · November 9, 2023 · 1h 28m
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
of arbitrary NE thresholds and the deleterious effects of sudden unmatched increases in SVR relative to inotropy!
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
I think the challenge here is many pts will not tolerate the NE regimen necessary to achieve this balance without tachyarrhythmias, and then catecholamine sparing becomes more attractive. The comparative risk-benefit of these strategies desperately needs explored further across different phenotypes.
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Amen 🙌
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Though in septic shock, I think low early doses of vasopressin with the NE and corticosteroid are likely the optimal use, because there are other hormonal/pleotropic mechanisms that likely drive the benefit as opposed to vasopressor activity, that is another story. Definitely agree with the points
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Yes! I agree this situation happens and may not represent careful attention to tailoring the vasoactive regimen to the predominant pathophysiology
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Jentzer discusses this phenotype in these reviews www.jacc.org/doi/10.1016/... And pharmacotherapy incl use cases for vasopressin here pubmed.ncbi.nlm.nih.gov/32281470/ As does Bruno here that I feel are all good discussions pubmed.ncbi.nlm.nih.gov/35697151/
jacc.org
Advances in the Staging and Phenotyping of Cardiogenic Shock: Part 1 of 2
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
phenotype for which vasopressin may be advantageous, though trials are very much lacking pubmed.ncbi.nlm.nih.gov/23760155/ pmc.ncbi.nlm.nih.gov/articles/PMC... pubmed.ncbi.nlm.nih.gov/39501911/
pubmed.ncbi.nlm.nih.gov
The systemic inflammatory response syndrome in patients with ST-segment elevation myocardial infarction - PubMed
The diagnosis of systemic inflammatory response syndrome and the cumulative number of systemic inflammatory response syndrome criteria were independently associated with 90-day clinical outcomes in a ...
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Yes fulminant vasoplegia in this setting certainly seems rare, but I raise the point here that plaque rupture can trigger SIRS to various degrees depending on plaque composition and comorbidity, which can progress to mixed/vasodilatory cardiogenic shock in a subset of patients, thereby creating a
pubmed.ncbi.nlm.nih.gov
The systemic inflammatory response syndrome in patients with ST-segment elevation myocardial infarction - PubMed
The diagnosis of systemic inflammatory response syndrome and the cumulative number of systemic inflammatory response syndrome criteria were independently associated with 90-day clinical outcomes in a ...
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
I discuss this topic in detail in the first section of this paper if of interest- pubmed.ncbi.nlm.nih.gov/39450744/
pubmed.ncbi.nlm.nih.gov
Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 2: Complications, post-revascularization care, and quality improvement - PubMed
Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilizati...
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
many cardiogenic shock phenotypes, considering inherent cardiotoxicity of first-line agents especially when needed for prolonged periods, though data here is admittedly lacking beyond post-cardiotomy setting.
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
in RV failure and/or PH, vasopressin can be used to augment SVR while sparing PVR due to its unique receptor distribution (vasopressin+milrinone can be an elegant regimen in RV-dominant failure when inotropy also needed). Lastly, I think use as a catecholamine -sparing adjunct can have merit in
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 07/07/2026
Yes thank you Dr. Saxhaug, I think there are several use cases for vasopressin in this arena. Firstly, as you note in mixed cardiogenic shock, which I think is more common than realized (eg, plaque rupture in AMI causes SIRS, or post-CPB when vasoplegia can become a sig contributor). Secondly,
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 05/07/2026
I did realize an error in one of my PMIDs (incorrect VANCS trial cited)
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 05/07/2026
My OR/ICU satellite pharmacy whiteboard on vasoactive medication management in #cardiogenicshock. What's your approach? #medsky #emimcc #cardsky
Educational whiteboard on cardiogenic shock pharmacotherapy
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Reposted by Sara J. Hyland PharmD
Sara J. Hyland PharmD @sarajpharmd.bsky.social · 28/10/2025
Do you have experience and/or opinions regarding sugammadex use in the ICU or Emergency department? We'd be grateful if you took our practice survey here- t.co/GHiaYoGzqK #Medsky #PharmSky #EMIMCC #FOAMed
t.co
https://redcap.ohiohealth.com/surveys/?s=CY9RLM4T9JPDKF38
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 06/11/2025
Yup lol. Also Ancef
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 06/11/2025
We do a tremendous disservice to people with penicillin allergies in jumping to second- or third-line antibiotics, and this practice has demonstrated worse clinical outcomes
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 06/11/2025
Don't even need to jump to carbapenem d/t PCN allergy. I would have proceeded with ceftriaxone or cefepime depending on what we're treating. Advise them to check out the AAAAI guidelines and any number of side chain charts. education.aaaai.org/penicillin-a... foamed.ebmedicine.net/rapid-refere...
education.aaaai.org
Penicillin Allergy Center | AAAAI Education Center
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 28/10/2025
Thank you for your time and consideration, and please share this survey link broadly! All hospital HCWs who take care of and/or supply medications for critically ill patients are invited, including physicians, prescribers, and hospital pharmacists/pharmacy leadership.
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 28/10/2025
The purpose of this IRB-exempt research study is to characterize current perceptions and practices relating to sugammadex across ED and ICU settings. It is voluntary, anonymous, and should take about 10 minutes to complete. (sorry it is only intended for U.S. practitioners)
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 28/10/2025
Do you have experience and/or opinions regarding sugammadex use in the ICU or Emergency department? We'd be grateful if you took our practice survey here- t.co/GHiaYoGzqK #Medsky #PharmSky #EMIMCC #FOAMed
t.co
https://redcap.ohiohealth.com/surveys/?s=CY9RLM4T9JPDKF38
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 06/09/2025
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
hmpgloballearningnetwork.com
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 20/08/2025
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 02/07/2025
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 · 17/06/2025
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
media.tenor.com
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 17/06/2025
I know we're like hidden unicorns sometimes😂❤️ accpjournals.onlinelibrary.wiley.com/doi/abs/10.1...
media.tenor.com
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 17/06/2025
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 17/06/2025
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 · 17/06/2025
Though is a topic of active research by my group and hopefully others! Interested in the discussion here /end
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 17/06/2025
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 · 17/06/2025
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 · 17/06/2025
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 · 17/06/2025
Thanks @mdaware.org here's that paper - pubmed.ncbi.nlm.nih.gov/36407180/
pubmed.ncbi.nlm.nih.gov
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...
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 17/06/2025
💯 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 · 10/06/2025
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/
pubmed.ncbi.nlm.nih.gov
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...
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 10/06/2025
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 abxEvolution and controversies in sepsis managementInfluence of the appropriateness of abx on sepsis mortalityChallenges with interpreting influence of time-to-abx influence on mortality
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/06/2025
@dybspharmd.bsky.social
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/06/2025
14) our #ketamine in the ED infographic #emimcc
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 08/06/2025
13) STEMI pharmacotherapy reviews academic.oup.com/ajhp/advance... academic.oup.com/ajhp/advance...
academic.oup.com
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 19/05/2025
I know, super lame ;P Send me your email
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 19/05/2025
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...
academic.oup.com
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 19/05/2025
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...
academic.oup.com
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
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 19/05/2025
#cardiosky
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Sara J. Hyland PharmD @sarajpharmd.bsky.social · 19/05/2025
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 · 19/05/2025
💔 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
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