In this episode, I’ll discuss the antibiotics that inhibit bacterial toxin production. Subscribe on iTunes, Android, or Stitcher Some bacteria produce microbial toxins that significantly contribute to infection severity. Notable examples include Clostridioides difficile, Staphylococcus aureus, and Streptococcus pyogenes. During infection with these organisms, it is possible that therapies that suppress toxin production may lessen […]

In this episode, I’ll discuss the continuation of newly prescribed gabapentin for acute pain management after hospital discharge. Subscribe on iTunes, Android, or Stitcher The frequency of gabapentin use for the treatment of inpatient postoperative pain has increased due to the promotion of multimodal analgesia with the goal of reducing the use of opioids. A […]

In this episode, I’ll discuss a meta-analysis of controlled trials evaluating induction agents for tracheal intubation of critically ill patients. Subscribe on iTunes, Android, or Stitcher When critically ill patients require an induction agent to tolerate tracheal intubation, clinicians must balance induction-agent effectiveness with potential adverse effects. Clinical endpoints of the various studies of induction […]

In this episode, I’ll discuss acetazolamide instead of metolazone as an adjunct to loop diuretics. Subscribe on iTunes, Android, or Stitcher When a patient with volume overload has an insufficient response to loop diuretics, adjunctive therapy with a 2nd diuretic is used. This is referred to as sequential nephron blockade which uses two different mechanisms […]

In this episode, I’ll discuss how early you should start vasopressin after the norepinephrine infusion rate reaches 0.25 μg/kg/min or higher in a patient with septic shock. Subscribe on iTunes, Android, or Stitcher   The best time to add vasopressin after norepinephrine in septic shock is still unclear. A group of authors recently published a […]

In this episode, I’ll discuss whether there is a benefit from switching to dexmedetomidine when sedation is started with midazolam. Subscribe on iTunes, Android, or Stitcher Sedation guidelines recommend light sedation with a non-benzodiazepine agent such as dexmedetomidine or propofol. However, many ICU patients are started on midazolam-based sedation regimens either due to a compelling […]

In this episode, I’ll discuss differences in heart rate in patients with sepsis and AFib between phenylephrine and norepineprhine. Subscribe on iTunes, Android, or Stitcher Phenylephrine, unlike norepinephrine, does not stimulate beta receptors and therefore should not raise a patient’s heart rate. This is often used as a reason to administer phenylephrine to patients with […]

In this episode, I’ll discuss the effect of high-dose versus standard-dose influenza vaccines on hospitalization outcomes and mortality in older adults. Subscribe on iTunes, Android, or Stitcher The effects of high-dose vs standard-dose influenza vaccine in patients over 65 is uncertain. A group of authors published in The Lancet a systematic review and meta-analysis to […]

In this episode, I’ll discuss the use of phenobarbital in severe alcohol withdrawal. Subscribe on iTunes, Android, or Stitcher Severe alcohol withdrawal is a result of both the lack of GABA activity AND overstimulation of glutamate receptors. While benzodiazepines are considered the first-line treatment option, phenobarbital is used as an adjunct and, in recent years, […]

In this episode, I’ll discuss the pharmacist’s role if malignant hyperthermia is suspected outside of the operating room. Subscribe on iTunes, Android, or Stitcher Malignant hyperthermia is a rare event, occurring in about 1 out of 100,000 administrations of anesthesia. While MH is usually thought of as occurring in the operating room, it can occur […]

In this episode, I’ll discuss high-dose IV vitamin C to mitigate brain injury and organ dysfunction after out-of-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher After initial excitement on the promise of improving outcomes in sepsis with high-dose IV vitamin C, research ended up settling on the idea that vitamin C either did nothing […]

In this episode, I’ll discuss the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients. Subscribe on iTunes, Android, or Stitcher The standard urine output threshold to identify acute kidney injury (AKI) in critically ill patients is 0.5 ml/kg/hr. However, this threshold may be too high. A group of researchers […]