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 […]
Episode 893: Should Fludrocortisone Always Be Added to Hydrocortisone in Patients With Septic Shock?
In this episode, I’ll discuss adding fludrocortisone to hydrocortisone to treat patients with septic shock. Subscribe on iTunes, Android, or Stitcher There is a discordance in steroid recommendations for patients with septic shock between the Surviving Sepsis Guidelines, which recommend giving hydrocortisone and the 2020 Japanese Clinical Practice Guidelines for Sepsis and Septic Shock which […]
Episode 892: Should hot or cold compresses be used to treat extravasation?
In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation. Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. The only difference between infiltration and extravasation is that the […]
Episode 891: The Half-Dose Alteplase Study You’ve Always Wanted
In this episode, I’ll discuss an article comparing half-dose to full-dose alteplase for pulmonary embolism. Subscribe on iTunes, Android, or Stitcher The risk of hemorrhage is the major drawback to therapy with alteplase for any indication. When used for pulmonary embolism, a long-standing research question has been whether 50 mg of alteplase can treat PE […]
Episode 890: How to Succeed at Journal Club Without Really Trying
In this episode, I’ll discuss how to guarantee you pick a great article for the journal club. Subscribe on iTunes, Android, or Stitcher There are two important criteria that are essential to fulfill when presenting an article to a journal club: 1. The article should be of high quality 2. The article should be relevant […]
Episode 889: Which beta-blockers should be dialyzed to treat toxicity?
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 […]
Episode 888: The Effects of Fluid Overload On the Pharmacokinetics of Extended Infusion Meropenem in Critically Ill Patients with Sepsis
In this episode, I’ll discuss how fluid overload affects the pharmacokinetics of extended infusion meropenem in critically ill patients with sepsis. Subscribe on iTunes, Android, or Stitcher Therapeutic monitoring of beta-lactams has not yet reached everyday practice in most hospitals, owing both to a lack of data and a lack of in-house test results that […]
Episode 887: Long Term Outcomes of Haloperidol Use in the Agents Intervening against Delirium in the ICU Trial
In this episode, I’ll discuss a pre-planned analysis of long term outcomes of haloperidol use in the Agents Intervening against Delirium in the ICU Trial. Subscribe on iTunes, Android, or Stitcher Back in episode 762 I discussed the AID-ICU trial which was a placebo-controlled randomized blinded trial of 1000 patients with ICU delirium published in NEJM. Patients […]
Episode 886: The ACEP Clinical Policy For Severe Agitation
In this episode, I’ll discuss the ACEP clinical policy on adult patients presenting to the ED with severe agitation. Subscribe on iTunes, Android, or Stitcher The issue of an extremely agitated patient in an emergency department has significant consequences for all present in the ED. The agitated patient is usually at risk of harming themselves […]
Episode 885: Don’t Automatically Assume This When Oral Vancomycin is Prescribed
In this episode, I’ll discuss whether it is ever appropriate for a patient to be on oral and IV vancomycin. Subscribe on iTunes, Android, or Stitcher While IV vancomycin is indicated to treat a variety of infectious diseases, oral vancomycin is primarily used to treat C diff infection (CDI). Unlike IV metronidazole, which achieves therapeutic […]
Episode 884: Do All Patients With Traumatic ICH on Anticoagulants Need to be Reversed?
In this episode, I’ll discuss whether the reversal of anticoagulants is necessary for neurologically intact patients with traumatic intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher While intracranial hemorrhage (ICH) has the potential to lead to a catastrophic outcome in patients with traumatic injury who are also taking oral anticoagulants, the reversal of anticoagulation is […]
Episode 883: What Are Characteristics of Patients That Are More Likely To Die If Antibiotic Therapy Is Delayed?
In this episode, I’ll discuss what phenotype of patients are most affected by delays in antibiotic therapy. Subscribe on iTunes, Android, or Stitcher For patients with sepsis, the link between a delay in antibiotic therapy and increased risk of mortality is well-established. However, it is possible that not all patients are affected the same way […]
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