In this episode, I’ll discuss the use of phenobarbital in severe alcohol withdrawal. Subscribe on iTunes, Android, or Stitcher Severe alcohol withdrawal is a result of both the lack of GABA activity AND over stimulation of glutamate receptors. While benzodiazepines are considered the first-line treatment option, phenobarbital is used as an adjunct and, in recent […]

In this episode, I’ll discuss the ICU pharmacist’s role in recognizing and treating malignant hyperthermia. Subscribe on iTunes, Android, or Stitcher Malignant hyperthermia (MH) is a rare and life-threatening reaction to anesthesia that results in an uncontrolled rise of myoplasmic calcium,  leading to hyperkalemia and rhabdomyolysis.  It occurs in about 1 out of 100,000 administrations […]

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 the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients. Subscribe on iTunes, Android, or Stitcher The standard urine output threshold to identify acute kidney injury (AKI) in critically ill patients is 0.5 ml/kg/hr. However, this threshold may be too high. A group of researchers […]

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 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 postintubation hypotension following rapid sequence intubation with full vs. reduced-dose induction agent. Subscribe on iTunes, Android, or Stitcher One of the most common complications of rapid sequence intubation (RSI) in the setting of acutely ill patients in the emergency department (ED) is postintubation hypotension. While the cause of hypotension may […]

In this episode, I’ll discuss anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher The rate of anaphylactic reaction to the use of sugammadex is probably somewhere between 1 in 2000 and 1 in 4000 patients. This makes anaphylaxis to sugammadex probably 2-4 times more rare than anaphylaxis to rocuronium. Not to mention the rate […]

In this episode, I’ll discuss the effects of calcium during treatment of hyperkalemia. Subscribe on iTunes, Android, or Stitcher Using calcium in patients with severe hyperkalemia is recognized as the most critical first step of treatment. Textbooks and tertiary referenceswidely quote that the purpose of giving IV calcium in severe hyperkalemia is to stabilize the […]

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 new SCCM and ASHP joint guidelines on stress ulcer prophylaxis in critically ill patients. Subscribe on iTunes, Android, or Stitcher All the way back in episode 134 (nearly 8 years ago), I discussed the anticipated update to the 1999 stress ulcer prophylaxis guidelines that were first scheduled to come […]