In this episode, I’ll discuss anti-Xa monitoring of enoxaparin in VTE prophylaxis. Subscribe on iTunes, Android, or Stitcher An advantage of using enoxaparin for VTE prophylaxis is that it has predictable pharmacokinetics and pharmacodyamics which allow for either fixed dosing of 40 mg subQ once daily or 0.5 mg/kg in the case of obese patients. […]

In this episode, I’ll discuss the bioavailability of methadone. Subscribe on iTunes, Android, or Stitcher Popular tertiary references suggest a conversion ratio of oral to IV methadone of 2:1, meaning 10 mg of oral methadone is equivalent to 5 mg of IV methadone. But a team of researchers recently published a scoping review on the […]

In this episode, I’ll discuss the prediction of hypotension from propofol when used as an ICU sedative. Subscribe on iTunes, Android, or Stitcher Hypotension from ICU sedatives like propofol and dexmedetomidine can complicate patient management.  I discussed predicting hypotension from dexmedetomidine back in Episode 563. Hypotension from propofol in the ICU can also be reasonably […]

In this episode, I’ll discuss the AHA/NCS scientific statement on critical care management of patients after cardiac arrest. Subscribe on iTunes, Android, or Stitcher There is a lack of high-quality published research to support the critical care management of patients after cardiac arrest, and as a result there are few guideline recommendations in this area. […]

In this episode, I’ll discuss IV levothyroxine in unstable brain-dead heart donors. Subscribe on iTunes, Android, or Stitcher Observational data has been used to support giving hemodynamically unstable brain-dead organ donors high-dose infusions of levothyroxine. However a 2020 study cast some doubt on whether levothyroxine has the desired effect, giving support to the design of […]

In this episode, I’ll discuss whether diuretics are safe for reducing fluid balance in critically ill patients. Subscribe on iTunes, Android, or Stitcher Interest in fluid balance and the associated adverse effects in ICU patients has grown considerably over the last decade. The general practice of reducing fluid balance, sometimes referred to as deresuscitation, is […]

In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. Subscribe on iTunes, Android, or Stitcher The Impella device is a miniature ventricular assist device that is placed using a catheter into the left ventricle across the aortic valve. It works by pumping blood from left […]

In this episode, I’ll discuss 5 steps an ED or ICU pharmacist can take to prevent awareness with paralysis. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis occurs when a patient receives a paralytic for rapid sequence intubation but does not receive ongoing sedation before the induction agent wears off. In the context of […]

In this episode, I’ll discuss how to obtain penicillin G benzathine during a national shortage. Subscribe on iTunes, Android, or Stitcher Due to increased demand, there is currently a shortage of long-acting penicillin G benzathine injectable suspension products.  Pfizer is the sole penicillin G benzathine injection manufacturer for the US market.  This is not the first time […]

In this episode, I’ll discuss whether a nasal MRSA screen is useful for choosing antibiotics in critically ill patients with an intraabdominal infection. Subscribe on iTunes, Android, or Stitcher A recent multicenter, retrospective, cohort study looking at the performance of a nasal MRSA screen in predicting intraabdominal infection with MRSA was published in the journal Pharmacotherapy. […]

In this episode, I’ll discuss a case of antidepressant discontinuation syndrome in the ICU. Subscribe on iTunes, Android, or Stitcher Antidepressant discontinuation syndrome has a significant potential to occur in ICU patients. This could be from unrecognized withdrawal from the antidepressant when home medications are stopped during the initial treatment of critical illness or from […]

In this episode, I’ll discuss haloperidol for ICU delirium. Subscribe on iTunes, Android, or Stitcher Despite efforts to reduce the incidence of ICU delirium with light sedation techniques, many patients still end up with delirium during their stay in the ICU. Some of these patients develop agitated delirium that requires treatment so the patient does […]