In this episode, I’ll discuss the use of dexmedetomidine to reduce vasopressor resistance in refractory septic shock. Subscribe on iTunes, Android, or Stitcher Subgroup and post-hoc trial analysis has hinted at dexmedetomidine having a surprising effect on enhancing vasopressor responsiveness in refractory septic shock patients. While this sounds paradoxical given that hypotension is a common […]

In this episode, I’ll discuss the dose of methylene blue for the treatment of acquired methemoglobinemia. Subscribe on iTunes, Android, or Stitcher Acquired methemoglobinemia is typically a reaction to medications. The ferric hemes of methemoglobin are unable to bind oxygen therefore causing a functional anemia. Suspect methemoglobinemia when the following occur: 1. Sudden cyanosis after […]

In this episode, I’ll discuss the time to delivery of sedation and analgesia after RSI using rocuronium vs succinylcholine. Subscribe on iTunes, Android, or Stitcher A new retrospective study looking at the timing of first-dose sedation and analgesia after rapid sequence intubation (RSI) in patients induced with etomidate and paralyzed with rocuronium or succinylcholine has […]

In this episode, I’ll discuss the SCCM’s updated guidelines on pain, agitation, delirium, immobility, and sleep and the new recommendation regarding melatonin. Subscribe on iTunes, Android, or Stitcher The 2018 SCCM guidelines on pain, agitation, delirium, immobility, and sleep have received a focused update which has been published in the journal Critical Care Medicine. One […]

In this episode, I’ll discuss a review article on the safety of peripheral vasopressors and hypertonic saline. Subscribe on iTunes, Android, or Stitcher When advances in medical knowledge are accompanied by aggressive marketing campaigns, the use of new information in patient care can occur rapidly. However not all new data is accompanied by a marketing […]

In this episode, I’ll discuss whether a pacemaker or implanted cardiac defibrillator (ICD) protects from medication-induced torsades. Subscribe on iTunes, Android, or Stitcher I’ve heard clinicians make this argument several times in my career – that because a patient has a pacemaker or ICD, a QTc prolonging drug interaction has little or no risk compared […]

In this episode, I’ll discuss oral sedation strategies for young patients presenting to the ED with acute severe behavioral disturbance. Subscribe on iTunes, Android, or Stitcher When treating children and adolescents who present to the ED with acute behavioral disturbances, the American Association for Emergency Psychiatry states: There is consensus that PO administration should be […]

In this episode, I’ll discuss 3 types of ICU patients and why they matter for making patient-focused risk:benefit assessments. Subscribe on iTunes, Android, or Stitcher I find that I make better patient focused risk:benefit assessments when I start off by figuring out the answer to the following question: Why is my patient in the ICU? […]

In this episode, I’ll discuss some possible negative effects of using low-dose ketamine to achieve an opioid-sparing effect in critically ill patients. Subscribe on iTunes, Android, or Stitcher Using a low-dose ketamine infusion has been recommended by recent sedation guidelines for the purpose of reducing opioid consumption. This is however a surrogate outcome that may […]

In this episode, I’ll discuss the impact of compounded oral vancomycin liquid on hospital readmission for C diff infection. Subscribe on iTunes, Android, or Stitcher The drug acquisition cost for oral vancomycin capsules is several orders of magnitude larger than for liquid vancomycin prepared from the IV formulation and given via the oral route. This […]

In this episode, I’ll discuss time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection. Subscribe on iTunes, Android, or Stitcher Two metrics are emerging as predictors of catheter-related infection with Pseudomonas as well as mortality risk: 1. Time to positivity, which is the time from when […]

In this episode, I’ll discuss whether delayed broad-spectrum antibiotics have an impact on clinical outcomes. Subscribe on iTunes, Android, or Stitcher From my experience with antimicrobial stewardship efforts, the biggest reason for overly broad antibiotic coverage is what I call the “what if” factor. What if it really is Pseudomonas even though risk factors might […]