In this episode, I’ll discuss andexanet vs. prothrombin complex concentrate for reversal of factor Xa inhibitor-related intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher Direct, randomized comparisons of andexanet vs prothrombin complex concentrate for reversal of factor Xa inhibitor-related intracranial hemorrhage are rare but questions about the effects of these treatments perisist, especially because of […]

In this episode, I’ll discuss 10 tips for providing effective feedback to PGY-1 residents. Subscribe on iTunes, Android, or Stitcher When providing feedback, choose a location where both parties will be comfortable openly speaking.  This may be done on the unit as long as others are not actively listening, but be especially sensitive to giving […]

In this episode, I’ll discuss the use of melatonin in ICU patients. Subscribe on iTunes, Android, or Stitcher The Society of Critical Care Medicine has published a focused update to its 2018 Pain, Agitation, Delirium, Immobility, and Sleep guidelines. One of the big changes in this update was regarding the author’s recommendations on the use […]

In this episode, I’ll discuss mannitol extravasation. Subscribe on iTunes, Android, or Stitcher When given as a bolus, mannitol is an osmotic diuretic that does not cross the blood-brain barrier. Mannitol lowers intracranial pressure by osmotically drawing free water out of the brain and into circulation where it can be eliminated. If given as a continuous infusion, mannitol […]

In this episode, I’ll discuss using thrombin time to transition patients from dabigatran to unfractionated heparin. Subscribe on iTunes, Android, or Stitcher When a hospitalized patient on chronic dabigatran therapy for VTE treatment develops acute kidney injury, they are typically transitioned to a continuous heparin infusion. However deciding when to stop the dabigatran and when […]

In this episode, I’ll discuss inhaled sedation for ICU patients with acute respiratory distress syndrome. Subscribe on iTunes, Android, or Stitcher Using inhaled sedatives such as sevoflurane in ICU patients who require mechanical ventilation has been explored more in research settings in the hopes that it will result in fewer episodes of ICU delirium. A […]

In this episode, I’ll discuss 7 vs 14 days of antibiotic therapy for gram-negative bacteremia. Subscribe on iTunes, Android, or Stitcher A 14-day duration of therapy to treat gram-negative bacteremia has been a common recommendation, but some recent randomized trials have suggested that a 7-day duration is noninferior to 14. A group of authors has […]

In this episode, I’ll discuss high-dose insulin euglycemic therapy in the treatment of a patient with massive caffeine overdose. Subscribe on iTunes, Android, or Stitcher Many cardiotoxic medication overdoses appear to respond to high dose insulin euglycemia therapy, including beta-blockers, calcium channel blockers, and tricyclic antidepressants. The practice of high dose insulin euglycemia therapy involves […]

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 […]