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 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 […]

In this episode, I’ll discuss what I feel is the most important thing in hospital pharmacy practice. Subscribe on iTunes, Android, or Stitcher Twenty years ago I transitioned from community to hospital practice. A pharmacist named Andy was kind enough to mentor me and guide me through the process and he stressed the importance of […]

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 […]

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 […]

In this episode, I’ll discuss the effects of giving both andexanet alfa AND 4-factor prothrombin complex concentrate. Subscribe on iTunes, Android, or Stitcher There is scant literature on patient outcomes when both Four-factor prothrombin complex concentrate plus andexanet alfa are used for reversal of factor Xa inhibitor–associated bleeding. A case series detailing 5 patients who […]

In this episode, I’ll discuss whether gram stain–guided initial antibiotic therapy for VAP is better than guideline recommended therapy. Subscribe on iTunes, Android, or Stitcher VAP guidelines recommend initial broad spectrum coverage often with an anti-MRSA and anti-pseudomonal agent. These antibiotics are then to be narrowed as more clinical information becomes available. Gram-stain guided therapy […]

In this episode, I’ll discuss subcutaneous insulin for the treatment of diabetic ketoacidosis (DKA). Subscribe on iTunes, Android, or Stitcher Diabetic ketoacidosis (DKA) is a serious condition with high mortality if not treated properly. The usual treatment for DKA involves IV insulin with frequent monitoring. For most hospitals this means admission to the ICU is […]

In this episode, I’ll discuss a recent retrospective review that has implications for fixed dose 4FPCC. Subscribe on iTunes, Android, or Stitcher Fixed dosing of 4-factor prothrombin complex concentrate has several potential advantages, including faster availability of the product, the potential elimination of the need to wait for a pretreatment INR result, and reduced cost. […]

In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates. Subscribe on iTunes, Android, or Stitcher Surviving Sepsis Guidelines do not list dopamine as one of the vasopressors to use for the treatment of septic shock, and other types of shock are usually treated with non-dopamine vasopressors as well due […]

In this episode, I’ll discuss the risk factors associated with the development of venous thromboembolism in ICU patients. Subscribe on iTunes, Android, or Stitcher A recent review and systematic analysis published in Critical Care Medicine evaluated 39 observational cohort studies involving over 700,000 patients to identify what risk factors were associated with the development of […]

In this episode, I’ll discuss the administration of mannitol for elevated intracranial pressure. Subscribe on iTunes, Android, or Stitcher The definitive treatment for elevated intracranial pressure is to fix the underlying cause. Common causes are traumatic brain injury, intracranial hemorrhage, CNS infection, or intracranial neoplasm. Until definitive treatment can be arranged, temporary treatments to lower […]