In this episode, I’ll discuss sodium bicarbonate to treat metabolic acidosis in ICU patients. Subscribe on iTunes, Android, or Stitcher Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however, evidence to support this indication has been lacking and sodium bicarb is not a benign intervention without risk of adverse effects. Back in episode […]

In this episode, I’ll discuss parenteral medication considerations for the ketogenic diet. Subscribe on iTunes, Android, or Stitcher A high-fat, low-carbohydrate diet may be prescribed to induce ketosis and help patients with epilepsy that is refractory to medical treatment. While dietary carbohydrate intake is tightly controlled in these patients, small amounts of carbohydrate from non-dietary sources […]

In this episode, I’ll discuss things a pharmacist should keep in mind when managing a patient with a caustic ingestion. Subscribe on iTunes, Android, or Stitcher According to an article in Intensive Care Medicine, caustic or corrosive ingestion in adult patients is a rare but potentially life-threatening condition with a mortality of 10% among intensive care […]

In this episode, I’ll discuss outcomes with doxycycline vs azithromycin for community-acquired pneumonia. Subscribe on iTunes, Android, or Stitcher Doxycycline is used as an alternative to azithromycin in combination with a beta-lactam to treat community-acquired pneumonia severe enough to be hospitalized. Reasons for avoiding azithromycin include allergy or concern about effects related to prolonged QTc intervals. […]

In this episode, I’ll discuss five circumstances that should make an ICU pharmacist stop what they are doing to investigate further. Subscribe on iTunes, Android, or Stitcher One thing that critical care pharmacists develop over time is their “Pharmacy Spidey-Sense” – that feeling they get when something happens in the ICU that means they should drop […]

In this episode, I’ll discuss expectations for the onset of action of IM medications used for acute agitation. Subscribe on iTunes, Android, or Stitcher When caring for an acutely agitated patient, the delay between IM medication administration and the onset of action can seem exceedingly long. Staff and patient safety continue to be at risk until […]

In this episode, I’ll discuss adding dexmedetomidine to lidocaine for topical application to prevent cough during extubation of thyroidectomy patients. Subscribe on iTunes, Android, or Stitcher The cough reflex that occurs with extubation can be especially problematic in thyroidectomy patients, as it may lead to bleeding and subsequent hemodynamic instability. Topical lidocaine has been used […]

In this episode, I’ll discuss a systematic review of the ketorolac dose ceiling for ED analgesia. Subscribe on iTunes, Android, or Stitcher Ketorolac is FDA approved for a dose of 30 mg IV for analgesia however there is extensive research dating back as far as 30 years that supports a ceiling dose in the 10 […]

In this episode, I’ll discuss three ways to tell the difference between serotonin syndrome and neuroleptic malignant syndrome. Subscribe on iTunes, Android, or Stitcher Muscular rigidity, significant hyperthermia, and autonomic instability are all common features of serotonin syndrome and neuroleptic malignant syndrome. While these two syndromes are very similar in presentation, they can usually be differentiated by looking […]

In this episode, I’ll discuss probiotic-associated central venous catheter bloodstream infections in the ICU. Subscribe on iTunes, Android, or Stitcher   While probiotics are typically seen as a harmless intervention that may have benefits related to antibiotic-associated diarrhea, bloodstream infections caused by organisms contained within probiotics have been reported in ICU patients. A group of […]

In this episode, I’ll discuss hallucinations from low-dose ketamine use in the ICU. Subscribe on iTunes, Android, or Stitcher Low-dose ketamine was recommended in the 2018 PADIS guidelines for the purpose of reducing opioid use in ICU patients. But, this was based on very thin evidence – some systematic reviews in non-ICU patients and a […]

In this episode, I’ll discuss an alternative definition of oliguria. Subscribe on iTunes, Android, or Stitcher   The commonly used definition of oliguria is a urine output of 0.5 mL/kg/hr over a 6 hr period. However some small studies have suggested that this definition of oliguria is too liberal. To bring clarity to this clinical […]