The Pharm So Hard Emergency Medicine & Hospital Pharmacy Podcast

In this episode of the Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Brian Gilbert, PharmD, MBA, FCCM, FNCS, FCCP, FASHP, FKCHP, Heather Blue, PharmD, BCPS, FMSHP, BCEMP, Alyssa Robertson, PharmD, BCPS, BCCCP, BCEMP, and David Zimmerman, PharmD, BCCCP, BCEMP, FASHP, FCCP, to discuss one of the most pressing operational challenges facing emergency medicine pharmacists today: ED boarding.Drawing from their recent publication in the Journal of the American College of Clinical Pharmacy, the panel explores the growing tension between ensuring high-quality pharmacy care for boarded patients and protecting the core responsibilities of the emergency medicine pharmacist. As admitted patients remain in the emergency department for longer periods, many institutions have unintentionally shifted inpatient pharmacy responsibilities onto ED pharmacists without clearly defining ownership, creating challenges for patient safety, workflow efficiency, and pharmacist role sustainability.The discussion examines what emergency medicine pharmacists should own, what responsibilities belong to inpatient pharmacy teams, and how health systems can build workflows that provide appropriate care for boarded patients without compromising critical ED services such as resuscitations, time-sensitive medication decision-making, protocol development, and bedside emergency care. The panel also shares practical strategies for pharmacy leaders, directors, and frontline clinicians to address role drift, improve accountability, and create sustainable staffing models that support both boarded patients and emergency department operations. Whether you practice in an academic medical center, community hospital, or resource-limited setting, this episode provides actionable insights for defining pharmacy ownership and preserving the highest-impact contributions of emergency medicine pharmacists. ★ Support this podcast ★

In Episode 130 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Hunter Rondeau, PharmD, BCIDP, AAHIVP, antimicrobial stewardship coordinator at SSM Health, to explore the growing role of single-dose aminoglycosides for urinary tract infections with limited oral treatment options.Hunter shares how this strategy gained traction through emergency department culture-callback programs and antimicrobial stewardship efforts, highlighting real-world scenarios where a single IV dose can prevent unnecessary admissions, PICC placement, and prolonged antibiotic exposure. The discussion dives into the evolving resistance landscape, the rise of ESBL and CRE organisms, and the clinical decision-making needed to identify the right patients for this approach.Jimmy and Hunter also review key evidence, including systematic reviews, IDSA guidance, and emerging emergency medicine data that support the safety and effectiveness of single-dose aminoglycosides. From patient selection and workflow implementation to provider education and follow-up, this episode offers practical insights for pharmacists looking to expand their impact in the ED and beyond.If you’re interested in antimicrobial stewardship, emergency medicine pharmacy, and innovative ways to manage resistant UTIs while keeping patients out of the hospital, this episode is packed with pearls you can apply in practice. ★ Support this podcast ★

In Episode 129 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, is joined by Oscar Santalo, PharmD, MBA, MHA, BCPS, to discuss his recently published study in the Journal of Acute Care Pharmacotherapy (JACP) examining prescription abandonment after emergency department discharge. Jimmy and Oscar walk through the motivation behind the research and explore how automated pharmacy kiosks may serve as a practical solution to improve medication access at the point of discharge. The conversation focuses on why prescription abandonment remains a persistent challenge in emergency care and how pharmacy-led innovations can help bridge gaps during transitions from the ED to home. This episode also takes a broader look at the role of clinical pharmacy in emergency medicine, highlighting how system-level approaches can support adherence, continuity of care, and better patient experiences. If you’re interested in how evidence published in JACP can inform real-world practice, this episode offers thoughtful insight from the study’s author himself. ★ Support this podcast ★

They tackle why intramuscular epinephrine in the deltoid often fails and how thigh injections produce much higher plasma levels. They review pharmacokinetic data, absorption physiology, and needle length problems. They debate weight-based versus fixed dosing and argue for larger IM doses in adults to avoid risky IV boluses.

In Episode 127 of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, breaks down the long-awaited RSI Trial comparing ketamine versus etomidate for rapid sequence intubation in critically ill patients. Challenging more than two decades of dogma, Jimmy explores why ketamine was associated with more early cardiovascular collapse—including higher rates of vasopressor escalation and significant blood pressure drops—despite its reputation as the “safer” agent in shock. Using real-world scenarios from the ED and ICU, this episode unpacks the concept of the ketamine hemodynamic paradox, catecholamine depletion, dosing considerations, and how these findings should change your airway preparation strategy. If you care about making intubations as boring—and as safe—as possible, this is a must-listen. ★ Support this podcast ★

Dr. Cait Kulig, a cardiology clinician-educator specializing in heart failure management, returns to delve into diuretics and resistance strategies. She highlights the adverse effects of diuresis, including electrolyte imbalances and ototoxicity. Cait discusses innovative solutions like SGLT2s and inotropes, comparing critical options like milrinone and dobutamine. She emphasizes the importance of guideline-directed therapy for HFrEF and HFpEF and shares tips for optimizing treatment during inpatient care, ensuring safe and effective diuresis throughout.

Cait E. Kulig, a skilled clinical cardiology pharmacist and educator specializing in heart failure, joins host Jimmy Pruitt for an enlightening discussion. They unpack the complexities of heart failure, explaining ejection fraction and the Forrester plot in relatable terms. Cait shares key insights on distinguishing between systolic and diastolic heart failure and the importance of hospitalization in prognosis. Listeners learn practical questions to ask patients and strategies for managing guideline-directed medical therapy effectively.

The podcast dives into the intriguing debate over anticoagulation reversal for minor traumatic intracranial hemorrhages. It highlights a recent study that challenges existing guidelines, urging personalized approaches over one-size-fits-all solutions. Listeners will discover the complexities of clinical judgment in these cases and the potential impact on future treatment strategies. This nuanced discussion could change how emergency departments handle such delicate scenarios.

In this episode of The Pharm So Hard Podcast, host Jimmy Pruitt, PharmD, BCPS, BCCCP, BCEMP, introduces the Society of Emergency Medicine Pharmacists (SEMP), a newly established organization dedicated to advancing the practice of emergency medicine pharmacy. Jimmy discusses SEMP's mission to optimize pharmacotherapeutic care in emergency departments through practice improvement, education, advocacy, research, and international collaboration. He highlights the importance of creating a unified global community for emergency medicine pharmacists and explores how SEMP aims to provide tailored support and resources for practitioners in this dynamic field. Tune in to learn how SEMP plans to shape the future of emergency medicine pharmacy and how you can get involved.​ ★ Support this podcast ★

Daniella Abi Kheir, a critical care pharmacy resident and SGLT2 inhibitor expert, joins host Jimmy Pruitt to explore the revolutionary potential of these drugs in ICU settings. They discuss the DEFENDER trial, unveiling how SGLT2 inhibitors may prevent renal replacement therapy and enhance outcomes in sepsis. The duo addresses safety concerns, such as DKA, and emphasizes the need for healthcare professionals to rethink these agents' roles. Additionally, they highlight the multifaceted benefits of SGLT2 inhibitors beyond diabetes management.