In this episode, I’ll discuss the effects of oral chlorhexidine vs an oral care bundle on mortality for mechanically ventilated patients in the ICU. Subscribe on iTunes, Android, or Stitcher In recent years, the journal Intensive Care Medicine has published a cohort study and editorial that call into question the safety and efficacy of oral […]

In this episode, I’ll discuss how 5 units of insulin works for hyperkalemia instead of 10. Subscribe on iTunes, Android, or Stitcher While insulin is an effective way to lower potassium during hyperkalemia treatment, hypoglycemia may result even if dextrose is given along with insulin treatment. This is especially likely in patients with renal dysfunction […]

In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin? Subscribe on iTunes, Android, or Stitcher Quickly administering appropriate empiric antibiotic therapy is essential in the treatment of severe infections. If multiple antibiotics are required for empiric therapy to treat a severe infection (such as for […]

In this episode, I’ll discuss the Sepsis-Induced Coagulopathy (SIC) Score. Subscribe on iTunes, Android, or Stitcher The Sepsis-Induced Coagulopathy (SIC) Score predicts likelihood of sepsis-induced coagulopathy. This scoring system is specifically designed for predicting coagulation disturbances in sepsis using the Sepsis-3 definition. The SIC score addresses 3 domains for a possible 0 to 6 points […]

In this episode, I’ll discuss whether vasopressin should be started sooner rather than later in septic shock. Subscribe on iTunes, Android, or Stitcher Sepsis guidelines recommend starting vasopressin once the norepinephrine dose reaches 0.25 to 0.5 mcg/kg/min if the patient’s MAP is not adequate. However the best timing for the addition of vasopressin is still […]

In this episode, I’ll discuss whether albumin infusions improve outcomes in hospitalized patients with decompensated cirrhosis. Subscribe on iTunes, Android, or Stitcher Albumin is frequently used for various indications in hospitalized patients, but in some use cases the evidence of benefit is unclear. Albumin may fall under the laboratory or pharmacy budget depending on how […]

In this episode, I’ll discuss prehospital antibiotics for severe sepsis. Subscribe on iTunes, Android, or Stitcher Back in episode 185, I discussed a study that looked at Delays From First Medical Contact to Antibiotic Administration for Sepsis.  The authors found that the median time from first medical contact to antibiotic administration was 4.2 hours with a […]

In this episode, I’ll discuss whether patients taking beta-blockers require increased doses of epinephrine for anaphylaxis. Subscribe on iTunes, Android, or Stitcher Animal data suggests that patients taking beta-blockers have more severe anaphylaxis, possibly by decreasing the threshold for mast cell activation. With beta-blockers interfering with the same receptors epinephrine needs to activate in order […]

In this episode, I’ll discuss a possible syndrome that might herald vaccine-induced immune thrombotic thrombocytopenia. Subscribe on iTunes, Android, or Stitcher The two adeno-vector vaccines for COVID-19 are associated with the rare but serious adverse effect of vaccine-induced immune thrombotic thrombocytopenia. With this condition, cerebral venous sinus thrombosis is a significant concern. A group of […]

In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. Subscribe on iTunes, Android, or Stitcher NSAIDs (including ibuprofen) have a ceiling dose beyond which, no additional analgesic effect is seen.  I must have missed that part of the lecture in pharmacy school because I don’t remember encountering this concept in […]

In this episode, I’ll discuss whether epinephrine infusions are associated with worse mortality. Subscribe on iTunes, Android, or Stitcher Many clinicians will remember the old phrase “leave ’em dead with Levophed” – a suggestion that norepinephrine was to be used as a last-line vasopressor. Guidelines for sepsis and septic shock have recommended norepinephrine as first-line […]

In this episode, I’ll discuss why I think ketamine and propofol don’t belong in the same syringe. Subscribe on iTunes, Android, or Stitcher Ketamine and propofol are compatible in the same syringe, and several published studies have specifically stated that the two medications were placed in the same syringe. But just because we can, doesn’t […]