In this episode, I’ll discuss why beta-blockers should be tapered before clonidine. Subscribe on iTunes, Android, or Stitcher For patients taking concomitant beta-blocker and clonidine therapy who require tapering, the recommendation is to taper the beta-blocker first, followed by the clonidine.  The concern if this taper order is not followed is the development of severe […]

In this episode, I’ll discuss cefazolin and ertapenem combination therapy for refractory MSSA bacteremia. Subscribe on iTunes, Android, or Stitcher A recent case series published in Clinical Infectious Diseases describes the successful treatment of 11 patients with persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The authors had an index case where they discovered apparent synergy against […]

In this episode, I’ll discuss why IV phenytoin cannot be diluted lower than 5 mg/mL. Subscribe on iTunes, Android, or Stitcher When it comes time to convincing a clinician to do or not do something, the “why” often becomes very important. This is for good reason, as there are many examples of unnecessary information placed […]

In this episode, I’ll discuss whether adult critically ill patients benefit from inline filters. Subscribe on iTunes, Android, or Stitcher Several studies (1,2,3&4) in pediatric patients have suggested that reducing particles in IV infusions results in positive patient outcomes. Although not all studies have found a benefit, those that have signal a reduction in ICU […]

In this episode, I’ll discuss adjunctive cholestyramine therapy for thyroid storm. Subscribe on iTunes, Android, or Stitcher Both thyroxine (T4) and triiodothyronine (T3) undergo enterohepatic recycling. Cholestyramine is known to bind many medications in the lumen of the GI tract that undergo enterohepatic recycling. Studies of thyrotoxicosis and Grave’s hyperthyroidism have evaluated the effect of […]

In this episode, I’ll discuss whether results from trials that were stopped early are trustworthy. Subscribe on iTunes, Android, or Stitcher The short answer to this question is: It depends on why the trial was stopped early. Perhaps the biggest pitfall is in using evidence from a trial stopped early for benefit. It has been […]

In this episode, I’ll discuss the loading dose of dexamethasone for vasogenic edema. Subscribe on iTunes, Android, or Stitcher Vasogenic cerebral edema is associated with primary or metastatic brain tumors and, depending on the severity of symptoms, may present as an emergency. Dexamethasone is the corticosteroid of choice to treat vasogenic cerebral edema as it’s […]

In this episode, I’ll discuss an article comparing respiratory events with sugammadex vs neostigmine. Subscribe on iTunes, Android, or Stitcher Article Neostigmine Versus Sugammadex for Reversal of Neuromuscular Blockade and Effects on Reintubation for Respiratory Failure or Newly Initiated Noninvasive Ventilation Lead author: Martin Krause Published in Anesthesia & Analgesia November 2019 Background Occasionally, after […]

In this episode, I’ll discuss the use of ketamine in status asthmaticus. Subscribe on iTunes, Android, or Stitcher Because of its bronchodilator properties, the dissociative anesthetic ketamine is sometimes used as an adjunct in the treatment of status asthmaticus. While there is not enough data for ketamine to be routinely recommended for status asthmaticus, there […]

In this episode, I’ll discuss an article comparing different methods of administering adenosine. Subscribe on iTunes, Android, or Stitcher Article Single Syringe Administration of Diluted Adenosine Lead author: Marc McDowell Published in Academic Emergency Medicine October 2019 Background Because the half-life of adenosine is measured in seconds, administration must be rapid and followed by a […]

In this episode, I’ll discuss using higher than normal doses of naloxone for opioid overdose. Subscribe on iTunes, Android, or Stitcher A recent publication in the American Journal of Health-System Pharmacy described two case reports of opioid overdose where very high doses of naloxone were required to reverse respiratory depression. The first patient received 4 […]

In this episode, I’ll discuss why the new CAP guidelines do not recommend treating most cases of suspected aspiration pneumonia with broadening antibiotic therapy. Subscribe on iTunes, Android, or Stitcher Broadening therapy in community-acquired pneumonia to cover potential anaerobes in the case of suspected aspiration pneumonia is a common occurrence. This results in the use […]