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. […]

In this episode, I’ll discuss an article about nebulized vs IV ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher Subdissociative-dose ketamine can be used for its analgesic effect in acute pain in patients in the ED. Both the IV and nebulized route of administration can be used for ketamine, and a […]

In this episode, I’ll discuss an article about risk factors for serious and general opioid-related adverse drug events. Subscribe on iTunes, Android, or Stitcher Opioid-related adverse effects in hospital inpatients can be a significant cause of morbidity and resource expenditure in the form of rapid response calls, transfers to higher levels of care, and extended […]

In this episode, I’ll discuss prehospital administration of epinephrine and norepinephrine infusions. Subscribe on iTunes, Android, or Stitcher While vasopressor infusions are a mainstay of supportive care of critically ill patients, these therapies are usually started once the patient arrives at the hospital. With the increased amount of data supporting the peripheral administration of vasopressors, […]

In this episode, I’ll discuss what blood gas parameters can make you suspect methemoglobinemia. Subscribe on iTunes, Android, or Stitcher Methemoglobin is formed when the ferrous irons of heme are oxidized to the ferric state. The ferric hemes of methemoglobin are unable to bind oxygen, therefore, causing a functional anemia. Acquired methemoglobinemia is typically a reaction […]

In this episode, I’ll discuss using sodium bicarbonate instead of hypertonic saline to treat severe hyponatremia. Subscribe on iTunes, Android, or Stitcher Severe hyponatremia requires prompt treatment with a bolus of 100mL 3% hypertonic saline to raise serum sodium by 4-6 mEq/L to prevent morbidity and mortality. The main problem with this treatment is that […]

In this episode, I’ll discuss what if it is not the sedative class that causes delirium – just the depth of sedation? Subscribe on iTunes, Android, or Stitcher SCCM guidelines for sedation in the ICU recommend avoiding benzodiazepine infusions for sedation in the ICU. The reason for this is in part concern that benzodiazepines cause […]