In this episode, I’ll discuss which overdose patients with prolonged QTc are most likely to experience ventricular dysrhythmia. Subscribe on iTunes, Android, or Stitcher Among overdose patients who present to the emergency department, those with a severely prolonged QTc of over 500 milliseconds represent a cohort that is at an elevated risk of a poor […]

In this episode, I’ll discuss hyper and hypokalemia thresholds that are associated with in-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher Both hyperkalemia and hypokalemia are potentially reversible causes of cardiac arrest. A group of authors published a registry-based matched case-control study in the journal Critical Care Medicine to determine how the risk of in-hospital […]

In this episode, I’ll discuss treating diphenhydramine overdose in the absence of physostigmine. Subscribe on iTunes, Android, or Stitcher The usual antidote for anticholinergic drug toxicity is physostigmine, however it is no longer available in the US. Even though the FDA has authorized the importation of an equivalent product, pharmacists may face the need to treat […]

In this episode, I’ll discuss whether there is an association between the sedative dose and postintubation hypotension and rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher When a patient who requires sedation for intubation also has hemodynamic instability, a common recommendation is to lower the dose of sedative given in hopes of preventing further […]

In this episode, I’ll discuss sodium bicarbonate to treat metabolic acidosis in ICU patients. Subscribe on iTunes, Android, or Stitcher Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however, evidence to support this indication has been lacking and sodium bicarb is not a benign intervention without risk of adverse effects. Back in episode […]

In this episode, I’ll discuss parenteral medication considerations for the ketogenic diet. Subscribe on iTunes, Android, or Stitcher A high-fat, low-carbohydrate diet may be prescribed to induce ketosis and help patients with epilepsy that is refractory to medical treatment. While dietary carbohydrate intake is tightly controlled in these patients, small amounts of carbohydrate from non-dietary sources […]

In this episode, I’ll discuss things a pharmacist should keep in mind when managing a patient with a caustic ingestion. Subscribe on iTunes, Android, or Stitcher According to an article in Intensive Care Medicine, caustic or corrosive ingestion in adult patients is a rare but potentially life-threatening condition with a mortality of 10% among intensive care […]

In this episode, I’ll discuss outcomes with doxycycline vs azithromycin for community-acquired pneumonia. Subscribe on iTunes, Android, or Stitcher Doxycycline is used as an alternative to azithromycin in combination with a beta-lactam to treat community-acquired pneumonia severe enough to be hospitalized. Reasons for avoiding azithromycin include allergy or concern about effects related to prolonged QTc intervals. […]

In this episode, I’ll discuss five circumstances that should make an ICU pharmacist stop what they are doing to investigate further. Subscribe on iTunes, Android, or Stitcher One thing that critical care pharmacists develop over time is their “Pharmacy Spidey-Sense” – that feeling they get when something happens in the ICU that means they should drop […]

In this episode, I’ll discuss expectations for the onset of action of IM medications used for acute agitation. Subscribe on iTunes, Android, or Stitcher When caring for an acutely agitated patient, the delay between IM medication administration and the onset of action can seem exceedingly long. Staff and patient safety continue to be at risk until […]

In this episode, I’ll discuss adding dexmedetomidine to lidocaine for topical application to prevent cough during extubation of thyroidectomy patients. Subscribe on iTunes, Android, or Stitcher The cough reflex that occurs with extubation can be especially problematic in thyroidectomy patients, as it may lead to bleeding and subsequent hemodynamic instability. Topical lidocaine has been used […]

In this episode, I’ll discuss a systematic review of the ketorolac dose ceiling for ED analgesia. Subscribe on iTunes, Android, or Stitcher Ketorolac is FDA approved for a dose of 30 mg IV for analgesia however there is extensive research dating back as far as 30 years that supports a ceiling dose in the 10 […]