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 […]

In this episode, I’ll discuss the importance of timely ordering and administration of antiparkinsonian medications for patients in the ED. Subscribe on iTunes, Android, or Stitcher It is well established that maintaining the medication regimen for a patient with Parkinson’s disease is essential and that not doing so can have deleterious effects on morbidity and […]

In this episode, I’ll discuss the problem with hypo-osmolar solutions in neurological patients. Subscribe on iTunes, Android, or Stitcher The administration of hypo-osmolar IV solutions causes an increase in water into the brain.  This is because an intact blood-brain barrier is permeable to water but not electrolytes.  When the blood brain barrier is intact, and […]

In this episode, I’ll discuss the impact two new recommendations in the Surviving Sepsis guidelines on hospital pharmacy practice. Subscribe on iTunes, Android, or Stitcher The new Surviving Sepsis Guidelines are out and at least two new recommendations are going to keep hospital pharmacists busy implementing. The first is on extended infusions of beta-lactam antibiotics: […]

In this episode, I’ll discuss the impact of achieving an aggressive PK/PD target for beta-lactams in critically ill patients. Subscribe on iTunes, Android, or Stitcher Therapeutic drug monitoring for beta-lactams has not yet made it to the mainstream in all hospitals, but data continues to accumulate that I believe will eventually compel clinicians to check […]

In this episode, I’ll discuss suppressing unnecessary allergy alerts for beta-lactams with dissimilar side chains. Subscribe on iTunes, Android, or Stitcher Hospital laboratories routinely suppress antibiotic sensitivity data on microbiology reports in the name of antibiotic stewardship. The practice is fairly straightforward – if E. coli is sensitive to ceftriaxone, there is no reason to […]