In this episode, I’ll discuss ketamine vs ketorolac for pain management in ED patients with chest trauma. Subscribe on iTunes, Android, or Stitcher Chest trauma is a frequent cause of hospitalization for trauma patients, and more than a third of such patients have rib fractures. Pain management is important in these patients to ensure they […]

In this episode, I’ll discuss whether recent laxative use should preclude testing for C diff. Subscribe on iTunes, Android, or Stitcher The IDSA C Diff guidelines make the following recommendation regarding C Diff testing in a patient who recently received a laxative: Patients with unexplained and new-onset ≥3 unformed stools in 24 hours are the preferred […]

In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor. Subscribe on iTunes, Android, or Stitcher Corticosteroid administration before elective extubation has been used to prevent post-extubation stridor and reintubation. Multiple steroid regimens have been studied to prevent post-extubation stridor and re-intubation. No one regimen has been proven superior. Three example regimens […]

In this episode, I’ll discuss the lowest effective dose of IV or IM haloperidol for elderly hospitalized patients with agitation. Subscribe on iTunes, Android, or Stitcher Despite the black box warning that antipsychotics can increase mortality in elderly patients, medications like haloperidol are sometimes needed to control agitation from hospitalized elderly patients that have delirium […]

In this episode, I’ll discuss delayed QTc prolongation in overdose patients. Subscribe on iTunes, Android, or Stitcher   Patients who present to the ED with acute drug overdose and a QTc above 500 msec are known to have an increased risk of adverse cardiac event and are therefore proactively monitored for this development. However some […]

In this episode, I’ll discuss neostigmine plus anticholinergics vs sugammadex and the incidence of postoperative delirium. Subscribe on iTunes, Android, or Stitcher When the cholinesterase inhibitor neostigmine is administered to reverse neuromuscular blockade after surgery, an anticholinergic such as glycopyrrolate or atropine must also be given to attenuate the cholinergic side effects from neostigmine. However […]

In this episode, I’ll discuss recommendations on the dose of cefazolin for a CNS infection. Subscribe on iTunes, Android, or Stitcher When a CNS infection such as meningitis, ventriculitis, or a brain abscess is due to methicillin susceptible staph aureus, an antistaphylococcal penicillin such as nafcillin has been considered the first-line therapy. With the long […]

In this episode, I’ll discuss whether the beta-lactam should be given before vancomycin in patients with sepsis that need both antibiotics. Subscribe on iTunes, Android, or Stitcher While there is plenty of data to justify efforts to administer antibiotics to patients with sepsis quickly, there is little information to guide whether the order of administration […]

In this episode, I’ll discuss the IV vs nebulized route for tranexamic acid to treat hemoptysis. Subscribe on iTunes, Android, or Stitcher In the treatment of hemoptysis, tranexamic acid has been given via the IV route and topically via nebulization. These two routes of administration were compared in a randomized controlled trial for the first […]

In this episode, I’ll discuss N-acetylcysteine in non-acetaminophen-induced acute liver failure. Subscribe on iTunes, Android, or Stitcher Treatment of acute liver failure with N-acetylcysteine is the first thing that comes to mind if the liver failure is due to acetaminophen. However acute liver failure from causes other than acetaminophen may also respond to treatment with […]

In this episode, I’ll discuss four potential reasons for a false heparin anti-Xa level. Subscribe on iTunes, Android, or Stitcher Monitoring heparin infusions using anti-Xa levels instead of aPTT is becoming a widespread strategy in hospital laboratories. The main benefits of monitoring heparin by anti-Xa are said to be: Better correlation to actual heparin level […]

In this episode, I’ll discuss whether psychotropic medications other than benzodiazepines enhance respiratory depression from opioids. Subscribe on iTunes, Android, or Stitcher Benzodiazepines are known to increase the risk of respiratory depression in patients who are taking opioids, and the FDA mandates a boxed warning to this effect in the prescribing information for both opioids […]