In this episode, I’ll discuss empiric vs pre-emptive antifungal therapy. Subscribe on iTunes, Android, or Stitcher The current standard of care for high-risk neutropenic patients with persistent fever is to start empiric antifungal therapy. This is done because the potential of missing a fungal infection in such patients can be catastrophic, so some unnecessary antifungal […]

In this episode, I’ll discuss a study about a restrictive fluid strategy for patients with sepsis presenting to the emergency department. Subscribe on iTunes, Android, or Stitcher For over 2 decades aggressive fluid resuscitation has been a mainstay of treatment recommendations for patients with sepsis. And while there is little debate that strict fluid restriction […]

In this episode, I’ll discuss whether the manner of tranexamic acid application changes the effectiveness for epistaxis. Subscribe on iTunes, Android, or Stitcher Epistaxis in ED patients is first treated with topical measures (usually a vasoconstrictor), and if it is unsuccessful, treatment progresses to anterior packing. Anterior packing has risks including toxic shock syndrome and the […]

In this episode, I’ll discuss how a pharmacist can ensure the best possible outcomes for status epilepticus. Subscribe on iTunes, Android, or Stitcher Whenever I encounter a hospital inpatient with an acute seizure, I make sure that I have IV lorazepam available. Most seizures stop after about 2 minutes. In reality, this means that by […]

In this episode, I’ll discuss an article that suggests the vancomycin – piperacillin-tazobactam AKI interaction is just pseudotoxicity. Subscribe on iTunes, Android, or Stitcher For many years there have been publications suggesting an association between the combination of vancomycin and piperacillin-tazobactam and the development of acute kidney injury. Studies that draw this conclusion typically compare […]

In this episode, I’ll discuss a company-sponsored indirect comparative study looking at andexanet alfa vs 4 factor prothrombin complex concentrate (4FPCC) for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher There are two methods used for reversing acute major bleeding from factor Xa inhibitors: 1. Prothrombin Complex Concentrate (PCC), […]

In this episode, I’ll discuss whether the bispectral index (BIS) correlates well to commonly used sedation scales. Subscribe on iTunes, Android, or Stitcher Bispectral index is commonly used by anesthesia providers as a tool to ensure adequate loss of consciousness in the operating room and lessen the chance of accidental awareness during anesthesia. The use […]

In this episode, I’ll discuss what works best for toxin-related status epilepticus. Subscribe on iTunes, Android, or Stitcher While benzodiazepines are first line treat for status epilepticus, they do not work in as many as one-third of patients. Early termination of convulsive status epilepticus is important because it lowers the chance of cardiac and respiratory […]

In this episode, I’ll discuss acetazolamide’s use as a respiratory stimulant in ICU patients. Subscribe on iTunes, Android, or Stitcher Acetazolamide is a carbonic anhydrase inhibitor that has indications for use in altitude sickness, edema, and elevated intraocular pressure. However, acetazolamide also has potentially useful properties as a respiratory stimulant for certain ICU patients. Patients […]

In this episode, I’ll discuss dealing with and preventing negative interactions with other professionals. Subscribe on iTunes, Android, or Stitcher We’ve all been yelled at or had a professional interaction go sour at some point in our career. Perhaps it was when trying to deliver a recommendation to a physician, ask a question of a […]

In this episode, I’ll discuss Paxlovid and other novel dosage forms that should not be crushed but look like they can be. Subscribe on iTunes, Android, or Stitcher One of the worst phrases in a medication’s prescribing information is “do not do ___” without an explanation of why. This is because without a “why” clinicians […]

In this episode, I’ll discuss the final 4 questions of a recent survey of intensive care professionals about clinically relevant pharmacokinetic knowledge on antibiotic dosing. This is part 3 of a 3 part series that began with episode 723. Subscribe on iTunes, Android, or Stitcher The survey was published in May 2019 in the journal […]