In this episode, I’ll discuss whether tranexamic acid has a role in the treatment of aneurysmal subarachnoid hemorrhage. Subscribe on iTunes, Android, or Stitcher Tranexamic acid is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin. This results in the inhibition of fibrinolysis and should promote the stabilization of a clot that is […]

In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity. Subscribe on iTunes, Android, or Stitcher Intravenous lipid emulsion (ILE) or “lipid rescue” therapy is used in local anesthetic systemic toxicity (LAST) and enteral drug toxicity. Anesthesia, toxicology, and ACLS guidelines recommend intravenous fat emulsion with various levels […]

In this episode, I’ll discuss the chance of cardiovascular toxicity from bupropion overdose. Subscribe on iTunes, Android, or Stitcher Bupropion overdose carries a risk of cardiovascular toxicity however the onset is often delayed. This presents an additional risk to patients if they are incorrectly presumed to be of low cardiac toxicity risk and have reduced […]

In this episode, I’ll discuss the suppression of antimicrobial susceptibility results. Subscribe on iTunes, Android, or Stitcher When a hospital microbiology laboratory performs antimicrobial susceptibility testing using microdilution or disk diffusion methods, not all of the results are presented to clinicians in the medical record. Some of the data is ‘suppressed’ meaning the micro lab […]

In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher While ketamine is often considered a hemodynamically neutral induction agent for rapid sequence intubation, there are reports of post-induction hypotension and hemodynamic collapse occurring occasionally with ketamine use. […]

In this episode, I’ll discuss an article about which vasopressor is best in early traumatic brain injury patients. Subscribe on iTunes, Android, or Stitcher Patients who have severe traumatic brain injury and develop hypotension that requires vasopressor therapy are already at risk for mortality and poor long term outcomes. But could the choice of vasopressor […]

In this episode, I’ll discuss an article about using fondaparinux in critically ill patients with severe renal dysfunction. Subscribe on iTunes, Android, or Stitcher   Evaluating options for venous thromboembolism (VTE) prophylaxis in critically ill patients is challenging and many issues can limit options including renal failure, bleeding risk, and thrombocytopenia. Fondaparinux use is often […]

In this episode, I’ll discuss tenecteplase for stroke from 4.5 to 24 hours after the time last know well. Subscribe on iTunes, Android, or Stitcher While the use of thrombolytics for patients with acute ischemic stroke is usually done if the patient presents within 4.5 hours of the time last know well, data specifically with […]

In this episode, I’ll discuss recent articles regarding stress ulcer prophylaxis. Subscribe on iTunes, Android, or Stitcher The use of acid-suppressing agents to prevent the development of stress ulcers has been an area of intense research as the exact benefits and harms of this strategy in the context of modern ICU care is uncertain. Several […]

In this episode, I’ll discuss an alternative to a dextrose-based purge solution for patients with an Impella ventricular assist device that also need a PET scan. Subscribe on iTunes, Android, or Stitcher Positron emission tomography (PET) scanning uses a tracer such as fluoro-deoxyglucose which gets picked up by cells in place of regular glucose for […]

In this episode, I’ll discuss how obesity affects SC and IM medication administration. Subscribe on iTunes, Android, or Stitcher The thickness of the subcutaneous layer increases with obesity and this has potential implications for both subcutaneous and intramuscular medication administration. The AJHP recently published a review article on the implications of obesity for drug administration […]

In this episode, I’ll discuss the incidence of torsades from low-dose ondansetron in peri-operative patients. Subscribe on iTunes, Android, or Stitcher Ondansetron prescribing information has a warning that Electrocardiogram (ECG) changes including QT interval prolongation have been seen in patients receiving ondansetron. Some references list this as a concern, but many clinicians believe that a […]