In this episode, I’ll discuss 5 steps an ED or ICU pharmacist can take to prevent awareness with paralysis. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis occurs when a patient receives a paralytic for rapid sequence intubation but does not receive ongoing sedation before the induction agent wears off. In the context of […]

In this episode, I’ll discuss recent expert recommendations regarding the use of dialysis to treat isoniazid poisoning. Subscribe on iTunes, Android, or Stitcher When taken in excess, isoniazid can cause severe toxicity, primarily in the form of seizure. Isoniazid inhibits pyridoxine metabolism and conversion of glutamate to GABA. This creates two problems that lead to […]

In this episode, I’ll play an excerpt from one of my Hospital Pharmacy Academy trainings on using the Seagull Sign to identify a patient at risk of clinical deterioration. Subscribe on iTunes, Android, or Stitcher . You can get access to the full-length training as well as more than 150 other practical hospital pharmacy trainings, […]

In this episode, I’ll discuss the latest trial on vitamin C, thiamine, and hydrocortisone for sepsis. Subscribe on iTunes, Android, or Stitcher Using vitamin C, thiamine, and hydrocortisone to treat septic shock was heralded as a cure to sepsis by authors of a 2016 retrospective article. I reviewed this article back in episode 177. Unfortunately, subsequent […]

In this episode, I’ll discuss bacterial density as a therapeutic indicator for ventilator-associated tracheobronchitis due to pseudomonas. Subscribe on iTunes, Android, or Stitcher Bacterial density refers to how many colony-forming units of bacteria are found in a given culture and is reported as log10 CFU/mL. The bacterial density of Pseudomonas relates to its pathogenicity. Authors in […]

In this episode, I’ll discuss the effects of haloperidol and clonidine on the resolution of delirium in critically ill patients. Subscribe on iTunes, Android, or Stitcher My practice when treating patients with delirium has been to avoid using any medications unless they are necessary for the safety of either the patient or staff members. This has […]

In this episode, I’ll discuss the CDC Recommendations if a patient develops COVID-19 before receiving the 2nd vaccine dose. Subscribe on iTunes, Android, or Stitcher As with most clinical decisions during the current pandemic, CDC recommendations on what to do if a patient gets COVID-19 before receiving their 2nd vaccine dose is based on expert opinion, […]

In this episode, I’ll discuss whether tranexamic acid reduces the need for nasal packing in epistaxis. Subscribe on iTunes, Android, or Stitcher Epistaxis in ED patients is first treated with topical measures, usually a vasoconstrictor, and if unsuccessful treatment progresses to anterior packing. Anterior packing has risks including toxic shock syndrome and the inconvenience of needing […]

In this episode, I’ll discuss whether a nasal MRSA screen is useful for choosing antibiotics in critically ill patients with an intraabdominal infection. Subscribe on iTunes, Android, or Stitcher A recent multicenter, retrospective, cohort study looking at the performance of a nasal MRSA screen in predicting intraabdominal infection with MRSA was published in the journal Pharmacotherapy. […]

In this episode, I’ll discuss the first update to the Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU. Subscribe on iTunes, Android, or Stitcher Published recently in the journal Critical Care Medicine is the first update to the Surviving Sepsis Campaign Guidelines on the Management of Adults With […]

In this episode, I’ll discuss why hypokalemia can result from digoxin immune fab fragment administration. Please note, in the recording, I call this “episode 588” however it is in fact episode 582. Subscribe on iTunes, Android, or Stitcher In the setting of digoxin toxicity, the sodium-potassium ATPase pump is impaired and potassium shifts from the intracellular […]

In this episode, I’ll discuss a case of antidepressant discontinuation syndrome in the ICU. Subscribe on iTunes, Android, or Stitcher Antidepressant discontinuation syndrome has a significant potential to occur in ICU patients. This could be from unrecognized withdrawal from the antidepressant when home medications are stopped during the initial treatment of critical illness or from […]