In this episode, I’ll discuss hallucinations from low-dose ketamine use in the ICU. Subscribe on iTunes, Android, or Stitcher Low-dose ketamine was recommended in the 2018 PADIS guidelines for the purpose of reducing opioid use in ICU patients. But, this was based on very thin evidence – some systematic reviews in non-ICU patients and a […]

In this episode, I’ll discuss an alternative definition of oliguria. Subscribe on iTunes, Android, or Stitcher   The commonly used definition of oliguria is a urine output of 0.5 mL/kg/hr over a 6 hr period. However some small studies have suggested that this definition of oliguria is too liberal. To bring clarity to this clinical […]

In this episode, I’ll discuss the use of adjuvant midodrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher   Using midodrine to wean ICU patients off of vasopressors is a common strategy and one that I have used in my practice and discussed in previous episodes. The general principle is that some […]

In this episode, I’ll discuss the dose of inhaled tranexamic acid used for nonmassive hemoptysis. Subscribe on iTunes, Android, or Stitcher   Tranexamic acid (TA) is an antifibrinolytic medication. It forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis. Tranexamic acid is commonly used systemically to reduce bleeding in trauma or […]

In this episode, I’ll discuss animal data on the rate of correction for acute hypernatremia. Subscribe on iTunes, Android, or Stitcher Acute hypernatremia is a common occurrence in ICU patients. Whenever there is an acute and significant change in sodium levels – whether high or low – there is concern about the safe speed of […]

In this episode, I’ll discuss the duration of DOAC interference with heparin anti-Xa levels. Subscribe on iTunes, Android, or Stitcher DOACs that are Xa inhibitors such as apixaban and rivaroxaban interfere with heparin anti-Xa level monitoring by causing falsely elevated levels. While many references cite this interaction as lasting up to 48-72 hours, I have […]

In this episode, I’ll discuss how to predict failure of insulin transition in critically ill patients with diabetic ketoacidosis. Subscribe on iTunes, Android, or Stitcher When patients with diabetic ketoacidosis (DKA) are treated with IV insulin and then develop a normal anion gap, standard practice is to transition the patient to subcutaneous insulin. This transition […]

In this episode, I’ll discuss whether the composition of the first few liters of resuscitation fluid is most important for patients with sepsis. Despite the biological plausibility that using balanced crystalloid solutions for resuscitation in sepsis over normal saline should result in better outcomes due to less hyperchloremic acidosis, results from trials looking at this […]

In this episode, I’ll discuss andexanet vs. prothrombin complex concentrate for reversal of factor Xa inhibitor-related intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher Direct, randomized comparisons of andexanet vs prothrombin complex concentrate for reversal of factor Xa inhibitor-related intracranial hemorrhage are rare but questions about the effects of these treatments perisist, especially because of […]

In this episode, I’ll discuss 10 tips for providing effective feedback to PGY-1 residents. Subscribe on iTunes, Android, or Stitcher When providing feedback, choose a location where both parties will be comfortable openly speaking.  This may be done on the unit as long as others are not actively listening, but be especially sensitive to giving […]

In this episode, I’ll discuss the use of melatonin in ICU patients. Subscribe on iTunes, Android, or Stitcher The Society of Critical Care Medicine has published a focused update to its 2018 Pain, Agitation, Delirium, Immobility, and Sleep guidelines. One of the big changes in this update was regarding the author’s recommendations on the use […]

In this episode, I’ll discuss mannitol extravasation. Subscribe on iTunes, Android, or Stitcher When given as a bolus, mannitol is an osmotic diuretic that does not cross the blood-brain barrier. Mannitol lowers intracranial pressure by osmotically drawing free water out of the brain and into circulation where it can be eliminated. If given as a continuous infusion, mannitol […]