In this episode, I’ll discuss the IV vs nebulized route for tranexamic acid to treat hemoptysis. Subscribe on iTunes, Android, or Stitcher In the treatment of hemoptysis, tranexamic acid has been given via the IV route and topically via nebulization. These two routes of administration were compared in a randomized controlled trial for the first […]

In this episode, I’ll discuss a scenario where phenylephrine may be a preferred vasopressor. Subscribe on iTunes, Android, or Stitcher Because of poor effects in patients with septic shock, phenylephrine is often thought of as a poor first-line vasopressor choice. However, not all causes of hypotension are equal and there may be circumstances where phenylephrine […]

In this episode, I’ll discuss what dose of norepinephrine is safe for patient mobilization. Subscribe on iTunes, Android, or Stitcher While patient mobilization is important to avoiding complications of an ICU stay, the use of vasopressors like norepinephrine is often perceived as a reason to not mobilize a patient since it indicates hemodynamic instability. A […]

In this episode, I’ll discuss alternatives to etomidate during the shortage. Subscribe on iTunes, Android, or Stitcher Despite there being multiple manufacturers, some institutions are unable to resupply etomidate stock due to shortages at nearly all manufacturers. The most common uses of etomidate are for sedation – either an anesthetic dose for rapid sequence intubation […]

In this episode, I’ll discuss how propofol appears to interfere with monitoring heparin using aPTT. Subscribe on iTunes, Android, or Stitcher Heparin and propofol have been used together in critically ill patients for decades, but is it possible that there has been a lab interference interaction between these two medications the whole time? A group […]

In this episode, I’ll discuss N-acetylcysteine in non-acetaminophen-induced acute liver failure. Subscribe on iTunes, Android, or Stitcher Treatment of acute liver failure with N-acetylcysteine is the first thing that comes to mind if the liver failure is due to acetaminophen. However acute liver failure from causes other than acetaminophen may also respond to treatment with […]

In this episode, I’ll discuss why vaccines aren’t given in the 14 days after non-elective splenectomy. Subscribe on iTunes, Android, or Stitcher This recommendation is based on a small study of 59 splenectomy patients where pneumococcal vaccine response at 1, 7, and 14 days post-splenectomy were compared. Better functional antibody responses against the serogroup and […]

In this episode, I’ll discuss amiodarone vs lidocaine for in-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher The ACLS guidelines suggest either amiodarone or lidocaine for in-hospital cardiac arrest that is due to ventricular tachycardia or ventricular fibrillation (VT/VF). However this recommendation has always been based on data from out-of-hospital cardiac arrest studies. A […]

In this episode, I’ll discuss what an inpatient pharmacist needs to know about the outpatient CDC opioid guidelines. Subscribe on iTunes, Android, or Stitcher The CDC has updated its Clinical Practice Guideline for Prescribing Opioids for Pain and published it in the first Morbidity and Mortality Weekly Report of November 2022. The guideline specifically states […]

In this episode, I’ll discuss four potential reasons for a false heparin anti-Xa level. Subscribe on iTunes, Android, or Stitcher Monitoring heparin infusions using anti-Xa levels instead of aPTT is becoming a widespread strategy in hospital laboratories. The main benefits of monitoring heparin by anti-Xa are said to be: Better correlation to actual heparin level […]

In this episode, I’ll discuss haloperidol for the treatment of delirium in ICU patients. Subscribe on iTunes, Android, or Stitcher Despite there not being strong literature support to justify use to improve outcomes, haloperidol is frequently used to treat ICU patients with delirium. A systematic review of the available evidence published in 2020 identified only […]

In this episode, I’ll discuss cefazolin and ertapenem combination therapy for refractory MSSA bacteremia. Subscribe on iTunes, Android, or Stitcher A recent case series published in Clinical Infectious Diseases describes the successful treatment of 11 patients with persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The authors had an index case where they discovered apparent synergy against […]