In this episode, I’ll discuss IV levothyroxine in unstable brain-dead heart donors. Subscribe on iTunes, Android, or Stitcher Observational data has been used to support giving hemodynamically unstable brain-dead organ donors high-dose infusions of levothyroxine. However a 2020 study cast some doubt on whether levothyroxine has the desired effect, giving support to the design of […]

In this episode, I’ll discuss whether diuretics are safe for reducing fluid balance in critically ill patients. Subscribe on iTunes, Android, or Stitcher Interest in fluid balance and the associated adverse effects in ICU patients has grown considerably over the last decade. The general practice of reducing fluid balance, sometimes referred to as deresuscitation, is […]

In this episode, I’ll discuss what Impella purge solution can be used if the patient has a contraindication to heparin. Subscribe on iTunes, Android, or Stitcher The Impella device is a miniature ventricular assist device that is placed using a catheter into the left ventricle across the aortic valve. It works by pumping blood from left […]

In this episode, I’ll discuss 5 steps an ED or ICU pharmacist can take to prevent awareness with paralysis. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis occurs when a patient receives a paralytic for rapid sequence intubation but does not receive ongoing sedation before the induction agent wears off. In the context of […]

In this episode, I’ll discuss how to obtain penicillin G benzathine during a national shortage. Subscribe on iTunes, Android, or Stitcher Due to increased demand, there is currently a shortage of long-acting penicillin G benzathine injectable suspension products.  Pfizer is the sole penicillin G benzathine injection manufacturer for the US market.  This is not the first time […]

In this episode, I’ll discuss whether a nasal MRSA screen is useful for choosing antibiotics in critically ill patients with an intraabdominal infection. Subscribe on iTunes, Android, or Stitcher A recent multicenter, retrospective, cohort study looking at the performance of a nasal MRSA screen in predicting intraabdominal infection with MRSA was published in the journal Pharmacotherapy. […]

In this episode, I’ll discuss a case of antidepressant discontinuation syndrome in the ICU. Subscribe on iTunes, Android, or Stitcher Antidepressant discontinuation syndrome has a significant potential to occur in ICU patients. This could be from unrecognized withdrawal from the antidepressant when home medications are stopped during the initial treatment of critical illness or from […]

In this episode, I’ll discuss haloperidol for ICU delirium. Subscribe on iTunes, Android, or Stitcher Despite efforts to reduce the incidence of ICU delirium with light sedation techniques, many patients still end up with delirium during their stay in the ICU. Some of these patients develop agitated delirium that requires treatment so the patient does […]

In this episode, I’ll discuss a pharmacist-driven deprescribing protocol for negative urine and sexually transmitted infection cultures in the emergency department. Subscribe on iTunes, Android, or Stitcher When pharmacists begin to provide in-person services to the Emergency Department, one of the first areas to achieve an impact that everyone is satisfied with is the ED […]

In this episode, I’ll discuss the frequency of awareness with paralysis in the ED. Subscribe on iTunes, Android, or Stitcher Rapid sequence intubation is a common procedure in the ED. After this procedure where a paralytic such as succinylcholine or rocuronium has been used along with a short-acting sedative such as propofol, ketamine, or etomidate, […]

In this episode, I’ll discuss inhaled amikacin to prevent VAP. Subscribe on iTunes, Android, or Stitcher The prevention of ventilator associated pneumonia has been a focus of research for many decades. The peak incidence of VAP appears to occur after about 7 days of ventilator use and this has led researchers to focus on whether […]

In this episode, I’ll discuss predicting the success of dexmedetomidine as a sedative. Subscribe on iTunes, Android, or Stitcher Anecdotally, dexmedetomidine has always seemed like a hit-or-miss sedative, working wonderfully in many patients and barely or not at all in others. Researchers recently published in Pharmacotherapy a single-center, retrospective, cohort study of 158 critically ill […]