In this episode, I’ll discuss anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher The rate of anaphylactic reaction to the use of sugammadex has historically been put at somewhere between 1 in 2000 and 1 in 4000 patients; however, one article that used population statistics suggests it is more like 1 in 25,000 patients. This […]

In this episode, I’ll discuss using actual vs ideal body weight for dosing of sedatives in critically ill patients. Subscribe on iTunes, Android, or Stitcher The majority of sedative medications used in critically ill patients to allow them to tolerate mechanical ventilation and other aspects of ICU care are lipophilic.  As such, the medications have […]

In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates. Subscribe on iTunes, Android, or Stitcher Surviving Sepsis Guidelines do not list dopamine as one of the vasopressors to use for the treatment of septic shock, and other types of shock are usually treated with non-dopamine vasopressors as well due […]

In this episode, I’ll discuss cefazolin for methicillin-susceptible staphylococcus aureus bacteremia. Subscribe on iTunes, Android, or Stitcher Until recently, the strongest data on what to use to treat MSSA bacteremia has always been for the penicillinase-resistant penicillins like nafcillin and cloxacillin. But these antibiotics have high rates of adverse events. Cefazolin has a much more […]

In this episode, I’ll discuss the risk factors associated with the development of venous thromboembolism in ICU patients. Subscribe on iTunes, Android, or Stitcher An review and systematic analysis published in Critical Care Medicine evaluated 39 observational cohort studies involving over 700,000 patients to identify what risk factors were associated with the development of VTE […]

In this episode, I’ll discuss sodium bicarbonate for critically ill adult patients with metabolic acidosis and shock. Subscribe on iTunes, Android, or Stitcher The tale as old as time with sodium bicarbonate is that while it corrects plasma pH in critically ill patients with metabolic acidosis, whether clinically meaningful outcomes are improved remains uncertain. To […]

In this episode, I’ll discuss whether non-verbal ICU pain scales can indicate the severity of pain. Subscribe on iTunes, Android, or Stitcher The use of pain assessments for patients who are unable to verbally communicate are recommended in the SCCM Pain, Agitation & Delirium Guidelines. 2 examples of such assessments are the Behavioral Pain Scale […]

In this episode, I’ll discuss an article on the use of tranexamic acid to reduce transfusion in major noncardiac surgery. Subscribe on iTunes, Android, or Stitcher Plenty of surgical protocols have incorporated the use of tranexamic acid to reduce the need for transfusion, especially in cardiac surgical procedures. A group of authors recently published a […]

In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity. Subscribe on iTunes, Android, or Stitcher Intravenous lipid emulsion (ILE) or “lipid rescue” therapy is used in local anesthetic systemic toxicity (LAST) and enteral drug toxicity. Anesthesia, toxicology, and ACLS guidelines recommend intravenous fat emulsion with various levels of evidence. Ever […]

In this episode, I’ll discuss an article on using MRSA nasal swab testing to optimize pneumonia treatment with empiric vancomycin. Subscribe on iTunes, Android, or Stitcher Many patients who are critically ill with community-acquired pneumonia are given vancomycin due to concern for MRSA as a causative pathogen. MRSA polymerase chain reaction (PCR) nasal swab testing […]

In this episode, I’ll discuss using a heparin bolus in the prehospital setting for patients with STEMI. Subscribe on iTunes, Android, or Stitcher Back in episode 1124, I discussed a study on the use of peripheral vasopressors in the prehospital setting that found they were feasible and safe with no peripheral tissue damage. While the […]

In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher While ketamine is often considered a hemodynamically neutral induction agent for rapid sequence intubation, there are reports of post-induction hypotension and hemodynamic collapse occurring occasionally with ketamine use. […]