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 […]
Episode 961: Is that gabapentin just temporary?
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 […]
Episode 960: A titrated morphine algorithm that worked well in ED patients
In this episode, I’ll discuss a titrated morphine algorithm that worked well in ED patients. Subscribe on iTunes, Android, or Stitcher A recent randomized trial in Academic Emergency Medicine showed that IV acetaminophen use didn’t alter morphine requirements vs placebo in ED patients with acute pain. This is another in a long line of studies […]
Episode 959: Is there a benefit from switching to dexmedetomidine when sedation is started with midazolam?
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 […]
Episode 958: Sepsis and AFib heart rate differences with phenylephrine vs norepinephrine
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 […]
Episode 957: Not every professional critical care society is high on ketamine for analgosedation
In this episode, I’ll discuss a recent practice guideline on ketamine use for analgosedation in critically ill patients. Subscribe on iTunes, Android, or Stitcher The 2018 PADIS Guidelines published by the Society of Critical Care Medicine gave a positive recommendation for the use of ketamine saying: We suggest using low-dose ketamine (0.5 mg/kg IVP x […]
Episode 956: Beware of vancomycin treatment failure with old CVVHDF dosing regimens
In this episode, I’ll discuss the possibility of vancomycin treatment failure with old CVVHDF dosing regimens. Subscribe on iTunes, Android, or Stitcher A very common starting regimen to attain target trough levels for vancomycin during CVVHDF is a 2 gram IV loading dose followed by 750 mg IV q12h. However a group of authors in […]
Episode 955: Has Everyone Gotten the Mechanism of Phenobarbital in Alcohol Withdrawal Wrong?
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 over stimulation of glutamate receptors. While benzodiazepines are considered the first-line treatment option, phenobarbital is used as an adjunct and, in recent […]
Episode 954: Why should an ICU pharmacist be concerned about recognizing and treating malignant hyperthermia?
In this episode, I’ll discuss the ICU pharmacist’s role in recognizing and treating malignant hyperthermia. Subscribe on iTunes, Android, or Stitcher Malignant hyperthermia (MH) is a rare and life-threatening reaction to anesthesia that results in an uncontrolled rise of myoplasmic calcium, leading to hyperkalemia and rhabdomyolysis. It occurs in about 1 out of 100,000 administrations […]
Episode 953: Sugammadex Versus Neostigmine Side Effects
In this episode, I’ll discuss an article about the side effects of sugammadex vs neostigmine. Subscribe on iTunes, Android, or Stitcher Despite its relatively higher cost, sugammadex is a very popular reversal agent for neuromuscular blockade in the perioperative setting compared to the alternative of neostigmine. A group of authors published a retrospective cohort study […]
Episode 952: What is the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients?
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 […]
Episode 951: Getting the depth of sedation correct in the ED might reduce mortality rates by half
In this episode, I’ll discuss how getting the depth of sedation correct in the ED might reduce mortality rates by half. Subscribe on iTunes, Android, or Stitcher A group of researchers from Washington University School of Medicine in St. Louis just published a prospective before-after pilot and feasibility trial of an educational initiative aimed at […]
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