Medical Staff Pulse Newsletter

FDA lowers recommended dose of zolpidem products

Pharmacy focus

The U.S. Food and Drug Administration is notifying the public of new information about zolpidem, a widely prescribed insomnia drug. FDA recommends that the bedtime dose be lowered because new data show that blood levels in some patients may be high enough the morning after use to impair activities that require alertness, including driving.

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The baby was a surprise, the teamwork an inspiration

It was Friday night when things started to go wrong for a 25-year-old woman in the Antelope Valley. Her family said she appeared confused, but she insisted nothing was wrong. The next morning, she was worse, and by the time an ambulance raced her to a local hospital, she had lost consciousness.

Medical tests delivered a series of shocks to the woman's family – her systolic blood pressure was a life-threatening 200-plus, and her high blood pressure had caused a brain bleed. And unbeknownst to her mother and sister, the young woman was 30 weeks pregnant.

"That's when we got the call," said Asma Moheet, MD, a neurocritical care intensivist in the Department of Neurology at Cedars-Sinai. "With the baby in danger, she had to be moved."

When the air ambulance left for Cedars-Sinai, the woman had been outfitted with a heart monitor and a fetal monitor, she was on a ventilator, and her local doctors had drilled a hole in her skull to relieve intracranial pressure. At the Cedars-Sinai helipad, she was met by nurses and doctors from the neurology department, the Neuro ICU, the NICU, the high-risk OB team, and hospital security.

"She went from the helipad straight to the CT scanner, with everyone from the different departments working together as a single team," Moheet said. "She was unconscious and close to comatose, and we didn't even stop at the ICU."

Thanks to advance phone calls by the Neuro ICU's Kimberly Alva, NP, the team at the CT scanner was ready and waiting. The test revealed a very large hemorrhage, which went beyond her brain tissue and into the fluid-filled spaces of her skull.

A drain was placed into her brain, and an experimental drug was used to clear out the hemorrhage. This sort of life-saving drainage procedure, funded through a grant from the National Institutes of Health, is available only in selected Comprehensive Stroke Centers in the United States.

"One thing we knew was that if the mom didn't survive, the baby wouldn't survive either," Alva said. "We knew we had to quickly determine how critical the situation was, and then make a clinical decision based on that."

Moheet, along with the OB team, determined that the mother was stable enough to survive a Cesarean section to deliver the baby. The woman was rushed to OR 8, where the high-risk OB team successfully delivered a girl. John Williams, MD, was the attending physician at the C-section and participated in the patient's care at the medical center.

"The baby came out very well for only 30 weeks, and she went straight to the NICU," said labor and delivery nurse Scout Hebinck, RN. "Once we got the baby delivered and the mother was stable, we took her up to Saperstein for more treatment."

Hebinck, who has worked eight of her 18 years as an RN at Cedars-Sinai, said even as the emergency played out, she was aware of the remarkable teamwork that was saving two lives.

"Everyone worked together, NICU, Neuro ICU, OB, the anesthesia team, all communicating, all working for the best outcome for the mother and the baby," she said. "Without everyone working the way they did, it couldn't have gone so well."

"I've been a nurse for 12 years, and I can say from working other places – this kind of teamwork, it's something that would only happen at Cedars-Sinai," said Hussein Dakhlallah, RN. "It was very fulfilling, that they both survived, and it's because of the care the teams here gave them."