In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. Subscribe on iTunes, Android, or Stitcher Despite epinephrine clearly being recommended as the first line of treatment for an acute episode of anaphylaxis, glucocorticoids continue to be given by many providers. The mechanism of action for glucocorticoids is […]

In this episode, I’ll discuss the optimal timing of remdesivir initiation in hospitalized COVID-19 patients administered with dexamethasone. Subscribe on iTunes, Android, or Stitcher Research on remdesivir and dexamethasone for COVID-19 patients began in parallel, and information on the timing of starting these therapies has not been available. However, researchers recently published in Clinical Infectious […]

In this episode, I’ll discuss the fastest way to sedate an aggressive or violent patient in the ED. Subscribe on iTunes, Android, or Stitcher When acutely agitated patients present to the ED, one way to measure the severity of the agitation is with the Richmond Agitation and Sedation Scale. At the upper end of the […]

In this episode, I’ll discuss checking DOAC activity before reversal agent administration. Subscribe on iTunes, Android, or Stitcher Anti-Xa inhibitors such as apixaban, rivaroxaban, fondaparinux, and danaparoid do not have readily available assays, yet there is often a clinical need to determine their presence or absence. Back in episode 536 I discussed how heparin anti-Xa […]

In this episode, I’ll discuss why glucagon is not recommended in the calcium channel blocker poisoning guidelines. Subscribe on iTunes, Android, or Stitcher Critical Care Medicine has published in 2017 Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. These guidelines list the following first line therapies prioritized based on desired […]

In this episode, I’ll discuss prehospital tranexamic acid (TXA) for trauma patients. Subscribe on iTunes, Android, or Stitcher The CRASH-2 study solidified the role of TXA in trauma patients once they get to the hospital, and many investigators have since examined whether moving TXA administration earlier in care to the prehospital setting is beneficial. The […]

In this episode, I’ll discuss milrinone vs dobutamine for cardiogenic shock. Subscribe on iTunes, Android, or Stitcher There is broad consensus that inotropic support is a mainstay of medical therapy for cardiogenic shock, but there is little high-quality data to support which inotrope is superior. Researchers recently published in NEJM a randomized double-blinded trial to […]

In this episode, I’ll discuss how rifampin affects hydromorphone levels. Subscribe on iTunes, Android, or Stitcher A recent review article published in Pharmacotherapy concluded that: …Decreased effect of opioids with concomitant rifampin therapy manifested as…a decreased analgesic effect from tramadol, morphine, and, most notably, oxycodone… However, this systematic review did not identify any articles that […]

In this episode, I’ll discuss how correction of hypokalemia in a hyponatremic patient makes inadvertent overcorrection of hyponatremia more likely. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Alex” for inspiring this episode! During the correction of hyponatremia, care is taken to not correct the serum sodium too quickly. This is because the […]

In this episode, I’ll discuss whether kinetic GFR equations can be used in patients with shock. Subscribe on iTunes, Android, or Stitcher A well-recognized problem when using equations such as cockcroft-gault or MDRD to estimate renal function is that validation studies for these equations all involved patients that were at steady-state renal function. In critical […]

In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy BA” for inspiring this episode! Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. The […]

In this episode, I’ll discuss which beta-blockers should be dialyzed to treat toxicity. Subscribe on iTunes, Android, or Stitcher   Beta-blocker toxicity is often severe, causing bradycardia, hypotension, and cardiogenic shock.  Beta blockers are responsible for a sizeable portion of fatal poisonings in the US. Supportive therapy is the mainstay of care.  Treatments like high-dose insulin […]