In this episode, I’ll discuss what happens if you accidentally get rocuronium in your eye. Subscribe on iTunes, Android, or Stitcher While the Material Safety Data Sheet for rocuronium states “…inadvertent eye contact with this product may produce irritation with redness and discomfort,” there were no reports of accidental ocular exposure to rocuronium until recently. […]

In this episode, I’ll discuss when using IV bicarb in the ICU is actually helpful. Subscribe on iTunes, Android, or Stitcher If used to attempt to normalize pH without correcting the underlying problem, sodium bicarbonate use is essentially pointless as its effects will be short-lived.  In addition, indiscriminate bicarb use should be avoided due to potential adverse […]

In this episode, I’ll discuss the effects of ED length of stay when using either midazolam+haloperidol or lorazepam+haloperidol for acute agitation. Subscribe on iTunes, Android, or Stitcher Midazolam has a faster onset and shorter time to awakening than lorazepam. ED treatment of acute agitation often includes haloperidol given in combination with a benzodiazepine, and it is […]

In this episode, I’ll discuss the effects of morbid obesity on filgrastim pharmacokinetics. Subscribe on iTunes, Android, or Stitcher The prescribing information for filgrastim recommends dosing based on actual body weight, but this results in large doses for morbidly obese patients. The original data for filgrastim only used patients who were at an ideal body weight, […]

In this episode, I’ll discuss one hospital’s evolution of the U-500 insulin use process. Subscribe on iTunes, Android, or Stitcher Medication errors with U-500 insulin can be serious, and ensuring the safe use of this medication in a hospital setting has presented hospital pharmacies with considerable challenges. Recently, more tools have become available to facilitate the […]

In this episode, I’ll discuss new orders for fentanyl patches in the hospital setting. Subscribe on iTunes, Android, or Stitcher Transdermal fentanyl patches are contraindicated in the treatment of acute pain or in patients who are not opioid tolerant. This contraindication is in response to many reports of severe and fatal patient harm from the use […]

In this episode, I’ll discuss colchicine in patients admitted to hospital with COVID-19. Subscribe on iTunes, Android, or Stitcher When steroids like dexamethasone were found effective for COVID-19, it was logical to wonder whether colchicine, with its anti-inflammatory properties, would also help improve outcomes of patients with COVID-19. The RECOVERY Trial, which is a randomized, controlled, […]

In this episode, I’ll discuss the dose of dexamethasone for patients with COVID-19. Subscribe on iTunes, Android, or Stitcher Current recommendations are for a daily dose of 6 mg dexamethasone for up to 10 days in patients with severe and critical COVID-19. This dose was not determined by a dose-finding study, rather it was the single-dose […]

In this episode, I’ll discuss the risk factors for invasive candida infection in critically ill patients. Subscribe on iTunes, Android, or Stitcher The sepsis guidelines recommend using empiric antifungal therapy for adults with sepsis or septic shock at high risk of fungal infection. However, the risk assessment is not well defined in the guidelines beyond a […]

In this episode, I’ll discuss the European Society of Intensive Care Medicine’s recommendations on using PCC in bleeding critically ill adults. Subscribe on iTunes, Android, or Stitcher The journal Intensive Care Medicine has recently published a clinical practice guideline from the European Society of Intensive Care Medicine on transfusion strategies in bleeding critically ill adults. […]

In this episode, I’ll discuss why I think the journal Intensive Care Medicine is of high quality. Subscribe on iTunes, Android, or Stitcher In episode 654 I discussed a study recently published in the journal Intensive Care Medicine about the effects of oral chlorhexidine vs an oral care bundle on mortality for mechanically ventilated patients […]

In this episode, I’ll discuss 4 changes to vasopressor recommendations in the 2021 Sepsis Guidelines. Subscribe on iTunes, Android, or Stitcher The 2021 Sepsis Guidelines are out and there are some changes to vasopressor-related recommendations. First, the wording for the MAP goal was slightly changed. It now reads: For adults with septic shock on vasopressors, […]