In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. Subscribe on iTunes, Android, or Stitcher NSAIDs (including ibuprofen) have a ceiling dose beyond which, no additional analgesic effect is seen.  I must have missed that part of the lecture in pharmacy school because I don’t remember encountering this concept in […]

In this episode, I’ll discuss why I think ketamine and propofol don’t belong in the same syringe. Subscribe on iTunes, Android, or Stitcher Ketamine and propofol are compatible in the same syringe, and several published studies have specifically stated that the two medications were placed in the same syringe. But just because we can, doesn’t […]

In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. Subscribe on iTunes, Android, or Stitcher Despite epinephrine clearly being recommended as the first line of treatment for an acute episode of anaphylaxis, glucocorticoids continue to be given by many providers. The mechanism of action for glucocorticoids is […]

In this episode, I’ll discuss the impact of giving epinephrine before defibrillation to in-hospital cardiac arrest (IHCA) patients with shockable rhythms. Subscribe on iTunes, Android, or Stitcher Knowing when a medication is the first-line treatment for a condition should be easy for pharmacists, as this is exactly what we spend our time on during training […]

In this episode, I’ll discuss whether ICU patients benefit from daily QTc interval monitoring during antipsychotic use for delirium. Subscribe on iTunes, Android, or Stitcher QTc prolongation is a known side effect of antipsychotic use. While the QTc itself is only a number on a sheet of paper, a prolonged QTc is often used as […]

In this episode, I’ll discuss the effect of unnecessary long-term continuation of newly initiated stress ulcer prophylaxis in the ICU on morbidity and mortality after hospital discharge. Subscribe on iTunes, Android, or Stitcher ICU patients are routinely started on proton pump inhibitor therapy for the purpose of stress ulcer prophylaxis. However, PPI use often continues […]

In this episode, I’ll discuss why glucagon is not recommended in the calcium channel blocker poisoning guidelines. Subscribe on iTunes, Android, or Stitcher Critical Care Medicine has published in 2017 Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. These guidelines list the following first line therapies prioritized based on desired […]

In this episode, I’ll discuss how correction of hypokalemia in a hyponatremic patient makes inadvertent overcorrection of hyponatremia more likely. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Alex” for inspiring this episode! During the correction of hyponatremia, care is taken to not correct the serum sodium too quickly. This is because the […]

In this episode, I’ll discuss adding fludrocortisone to hydrocortisone to treat patients with septic shock. Subscribe on iTunes, Android, or Stitcher There is a discordance in steroid recommendations for patients with septic shock between the Surviving Sepsis Guidelines, which recommend giving hydrocortisone and the 2020 Japanese Clinical Practice Guidelines for Sepsis and Septic Shock which […]

In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation. Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. The only difference between infiltration and extravasation is that the […]

In this episode, I’ll discuss an article comparing half-dose to full-dose alteplase for pulmonary embolism. Subscribe on iTunes, Android, or Stitcher The risk of hemorrhage is the major drawback to therapy with alteplase for any indication. When used for pulmonary embolism, a long-standing research question has been whether 50 mg of alteplase can treat PE […]