What is a good pocket guide for emergency room (ER) cases in a general adult population?

Recommended Pocket Guides for Emergency Department Duty

For general adult ER cases, use the Tarascon Pocket Pharmacopoeia as your primary quick-reference guide, supplemented by electronic resources like Micromedex or Epocrates for real-time drug information and dosing. 1

Primary Pocket Reference

• Tarascon Pocket Pharmacopoeia is the most commonly utilized pocket guide among emergency medicine clinicians (18% usage rate), providing rapid access to medication dosing, contraindications, and basic prescribing information 1
• This portable reference fits in your white coat pocket and allows for quick bedside consultation without requiring electronic device access 1

Essential Electronic Supplements

• Micromedex is the most frequently used comprehensive drug information resource in emergency departments (29% usage rate) and should be your go-to for detailed pharmacology, drug interactions, and pregnancy/lactation information 1
• Epocrates (14% usage rate) provides mobile-accessible drug information, interaction checking, and clinical decision support tools that complement pocket guides 1

Critical Specialty-Specific Resources

For Pain, Agitation, and Delirium Management

• The PAD Guidelines pocket card from Critical Care Medicine provides evidence-based algorithms for assessing and managing pain (using NRS, BPS, CPOT scales), sedation (using RASS or SAS scales), and delirium (using CAM-ICU or ICDSC) in critically ill patients 2
• This pocket card includes specific treatment thresholds: treat pain when NRS ≥4, BPS >5, or CPOT ≥3, with reassessment within 30 minutes 2
• Target sedation goals are clearly defined: RASS -2 to 0 or SAS 3-4 for optimal sedation without over-sedation 2

For Geriatric Patients

• Implement the Identification of Seniors at Risk (ISAR) tool at triage, with >1 positive response indicating high-risk status requiring enhanced resources and closer monitoring 3
• Use large-font discharge instructions specifically designed for older adults to improve comprehension and adherence 2
• Access geriatric-specific protocols covering delirium screening, fall-risk assessment, polypharmacy review, and dementia evaluation 2

Protocol Development Framework

Your department should have written, evidence-based protocols that are multidisciplinary-reviewed and updated annually, covering resuscitation, triage, common emergencies, and population-specific considerations (pediatric, adult, geriatric) 3

Essential Protocol Categories

• Resuscitation protocols following American Heart Association guidelines: verify scene safety, check responsiveness, assess breathing/pulse within 10 seconds, and initiate CPR when indicated 3
• Triage assessment protocols that incorporate validated screening tools for high-risk populations 3
• Discharge planning protocols with 24-hour follow-up for at-risk patients, coordination with home health services, and home-safety assessments when indicated 3

Quality Assurance Integration

• Track key performance metrics including physical restraint utilization, benzodiazepine use in agitated delirium, fall-risk assessment documentation rates, and preventable adverse events 3
• Monitor pain assessment frequency (minimum 4 times per shift) and time to pain relief after detecting significant pain 2
• Document sedation assessments at least 4 times per shift using validated scales 2

Common Pitfalls to Avoid

• Do not rely solely on outdated pocket guides for high-risk prescribing situations (pregnancy, complex drug interactions, renal dosing), as these may place patients at risk 1
• Avoid using general references for pregnancy-specific prescribing—only 20% of EM clinicians acknowledge availability of pregnancy-specific references despite their presence in most EDs 1
• Do not assume all staff know how to access available resources—surveys show significant gaps between available resources and clinician awareness of their availability 1

Implementation Strategy

• Combine pocket references with front-end educational materials through self-learning modules or group didactics customized to your department's specific needs 2
• Ensure protocols are developed by multidisciplinary teams including emergency physicians, nurse managers, pharmacists, case managers, and social workers 3
• Use the GRADE framework (Grading of Recommendations, Assessment, Development, and Evaluation) for evidence-based protocol development 3