In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity. Subscribe on iTunes, Android, or Stitcher Intravenous lipid emulsion (ILE) or “lipid rescue” therapy is used in local anesthetic systemic toxicity (LAST) and enteral drug toxicity. Anesthesia, toxicology, and ACLS guidelines recommend intravenous fat emulsion with various levels of evidence. Ever […]

In this episode, I’ll discuss an article on using MRSA nasal swab testing to optimize pneumonia treatment with empiric vancomycin. Subscribe on iTunes, Android, or Stitcher Many patients who are critically ill with community-acquired pneumonia are given vancomycin due to concern for MRSA as a causative pathogen. MRSA polymerase chain reaction (PCR) nasal swab testing […]

In this episode, I’ll discuss using a heparin bolus in the prehospital setting for patients with STEMI. Subscribe on iTunes, Android, or Stitcher Back in episode 1124, I discussed a study on the use of peripheral vasopressors in the prehospital setting that found they were feasible and safe with no peripheral tissue damage. While the […]

In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher While ketamine is often considered a hemodynamically neutral induction agent for rapid sequence intubation, there are reports of post-induction hypotension and hemodynamic collapse occurring occasionally with ketamine use. […]

In this episode, I’ll discuss an article about which vasopressor is best in early traumatic brain injury patients. Subscribe on iTunes, Android, or Stitcher Patients who have severe traumatic brain injury and develop hypotension that requires vasopressor therapy are already at risk for mortality and poor long term outcomes. But could the choice of vasopressor […]

In this episode, I’ll discuss an article about the pharmacokinetic and pharmacodynamic properties of IV push cefepime in critically ill patients with sepsis. Subscribe on iTunes, Android, or Stitcher IV push cefepime has become a desirable method of administration, but data on the pharmacokinetic and pharmacodynamic properties of this administration technique in critically ill patients […]

In this episode, I’ll discuss an article about using fondaparinux in critically ill patients with severe renal dysfunction. Subscribe on iTunes, Android, or Stitcher   Evaluating options for venous thromboembolism (VTE) prophylaxis in critically ill patients is challenging and many issues can limit options including renal failure, bleeding risk, and thrombocytopenia. Fondaparinux use is often […]

In this episode, I’ll discuss a case report of the effects of ketamine on the clearance of tacrolimus and sirolimus. Subscribe on iTunes, Android, or Stitcher Beyond ex vivo models showing that ketamine induces the clearance of CYP450 substrates, little is known about its effects in patients. A group of authors present in Pharmacotherapy a […]

In this episode, I’ll discuss how obesity affects SC and IM medication administration. Subscribe on iTunes, Android, or Stitcher The thickness of the subcutaneous layer increases with obesity and this has potential implications for both subcutaneous and intramuscular medication administration. The AJHP recently published a review article on the implications of obesity for drug administration […]

In this episode, I’ll discuss the use of an initial 6 mg vs 12 mg dose of adenosine for supraventricular tachycardia. Subscribe on iTunes, Android, or Stitcher One of my least favorite recommendations to give “by the book” is what dose of adenosine to use to terminate supraventricular tachycardia. While 6 mg is the recommended […]

In this episode, I’ll discuss the incidence of torsades from low-dose ondansetron in perioperative patients. Subscribe on iTunes, Android, or Stitcher Ondansetron prescribing information has a warning that Electrocardiogram (ECG) changes including QT interval prolongation have been seen in patients receiving ondansetron. Some references list this as a concern, but many clinicians believe that a […]

In this episode, I’ll discuss an article about the incidence of acute kidney injury with the use of nafcillin versus oxacillin. Subscribe on iTunes, Android, or Stitcher Nafcillin and oxacillin are both antistaphylococcal penicillins used for the treatment of MSSA infections. Efficacy, cost, spectrum of activity, and pharmacokinetics are all similar between these two antibiotics. […]