In this episode, I’ll discuss awareness with paralysis in the ICU. Subscribe on iTunes, Android, or Stitcher In episode 578 I discussed the ED-AWARENESS study, a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients that found a 2.6% incidence of awareness with paralysis in ED patients. Recently in Critical Care Medicine a meta-analysis […]

In this episode, I’ll discuss 3 Alternative routes of administration for dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine is an alpha2 adrenergic agonist sedative agent commonly used in the ICU as a continuous IV infusion. However, alternative routes of administration for dexmedetomidine have been studied. In a study of 8 healthy volunteers, dexmedetomidine 1 […]

In this episode, I’ll discuss the frequency of awareness with paralysis in the ED. Subscribe on iTunes, Android, or Stitcher Rapid sequence intubation is a common procedure in the ED. After this procedure where a paralytic such as succinylcholine or rocuronium has been used along with a short-acting sedative such as propofol, ketamine, or etomidate, […]

In this episode, I’ll compare succinylcholine vs rocuronium with magnesium pretreatment. Subscribe on iTunes, Android, or Stitcher Succinylcholine and rocuronium are the two main neuromuscular blockers that are used in rapid sequence intubation. Many clinicians have a strong preference for one or the other based on how they value the small differences between them. Succinylcholine […]

In this episode, I’ll discuss predicting the success of dexmedetomidine as a sedative. Subscribe on iTunes, Android, or Stitcher Anecdotally, dexmedetomidine has always seemed like a hit-or-miss sedative, working wonderfully in many patients and barely or not at all in others. Researchers recently published in Pharmacotherapy a single-center, retrospective, cohort study of 158 critically ill […]

In this episode, I’ll discuss novel dosage forms that should not be crushed but look like they can be. Subscribe on iTunes, Android, or Stitcher Two relatively new dosage form technologies are nanocrystals and amorphous solid dispersions. These technologies are meant to address the problems of oral absorption of certain medications that have poor aqueous […]

In this episode, I’ll discuss the 4 factors that predict agitation in lightly sedated ventilated patients. Subscribe on iTunes, Android, or Stitcher Light sedation is encouraged in ventilated patients due to less delirium. However agitation is one of the risks of a light sedation strategy. If the agitation is not treated in time, a patient […]

In this episode, I’ll discuss the ceiling dose of ketorolac for renal colic in the ED. Subscribe on iTunes, Android, or Stitcher The analgesic ceiling dose of ketorolac is 10 mg, and this has been established in several articles going as far back as more than 30 years ago. In 1989, a study in the Journal […]

In this episode, I’ll discuss whether meropenem could theoretically work as an antidote for medications metabolized by UGT. Subscribe on iTunes, Android, or Stitcher One of my favorite antidote stories is octreotide as an antidote for sulfonylureas. Because of octreotide’s mechanism of action inhibiting insulin release from the pancreas, it was successfully applied as an […]

In this episode, I’ll discuss two doses of ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher Low dose ketamine for analgesia is generally considered to be doses of 0.5 mg/kg IV or less. This dose is below the threshold that will cause dissociative anesthesia, and ketamine is considered to have a […]

In this episode, I’ll discuss the possibility of euglycemic DKA occurring after stopping canagliflozin. Subscribe on iTunes, Android, or Stitcher Shout-out to “Pharmacy Ashley” for inspiring this episode! Sodium-glucose cotransporter-2 (SGLT2) inhibitors are known to carry an increased risk of diabetic ketoacidosis (DKA) which may occur with lower than usual glucose levels, even with euglycemia. […]

In this episode, I’ll discuss the evidence for gastrointestinal cation exchangers other than sodium polystyrene sulfate in acute hyperkalemia. Subscribe on iTunes, Android, or Stitcher In the treatment of acute hyperkalemia, IV calcium provides immediate cardioprotection and allows time for insulin to move potassium into the intracellular space and away from the heart. This is […]