In this episode, I’ll discuss a case report of seizures precipitated by esmolol in sterile water formulation. Subscribe on iTunes, Android, or Stitcher A case report recently published in American Journal of Health-System Pharmacy highlights the potential for a drug diluent to have significant adverse clinical consequences. The case is that of a 34-year-old male […]

In this episode, I’ll discuss the 4 factors that predict agitation in lightly sedated ventilated patients. Subscribe on iTunes, Android, or Stitcher Light sedation is encouraged in ventilated patients due to less delirium. However agitation is one of the risks of a light sedation strategy. If the agitation is not treated in time, a patient […]

In this episode, I’ll discuss the SCCM Rapid Sequence Intubation Guidelines. Subscribe on iTunes, Android, or Stitcher The SCCM recently published Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. While any pharmacist that works in a critical care setting should take the time to read these new guidelines, there are […]

In this episode, I’ll discuss the optimal dosing of levetiracetam for seizure prophylaxis in critically ill patients. Subscribe on iTunes, Android, or Stitcher When used for seizure prophylaxis following traumatic brain injury, intracerebral hemorrhage, spontaneous subarachnoid hemorrhage, or supratentorial neurosurgery levetiracetam doses used are often very low. However, critically ill patients typically have higher clearance […]

In this episode, I’ll discuss two doses of ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher Low dose ketamine for analgesia is generally considered to be doses of 0.5 mg/kg IV or less. This dose is below the threshold that will cause dissociative anesthesia, and ketamine is considered to have a […]

In this episode, I’ll discuss the consensus statement published in CHEST on the Treatment of Community-Acquired Pneumonia in immunocompromised patients. Subscribe on iTunes, Android, or Stitcher Authors in the journal CHEST published a consensus statement on the Treatment of Community-Acquired Pneumonia in immunocompromised patients.  This patient population was left out of the updated IDSA CAP […]

In this episode, I’ll discuss the effect of phenylephrine push prior to continuous infusion norepinephrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher Push dose vasopressors as a temporizing measure for profound hypotension in critically ill patients is frequently used in many institutions. However the extent of the data for this strategy […]

In this episode, I’ll discuss the danger of intubation in the setting of salicylate toxicity. Subscribe on iTunes, Android, or Stitcher During salicylate toxicity, the movement of salicylate into brain, liver, and other tissues is exacerbated by a low serum pH. This is because the more acidic the pH, the more salicylate becomes nonionized, and […]

In this episode, I’ll discuss how to predict hypotension from dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine is a popular sedative for use in critically ill patients. Hypotension is a common side effect that may limit the dose or even use of dexmedetomidine in critically ill patients.  Being able to predict hypotension in advance […]

In this episode, I’ll discuss a study about the safety of apixaban in patients with renal insufficiency. Subscribe on iTunes, Android, or Stitcher The US FDA and the European Medicines Agency have discordant recommendations for apixaban dosing in chronic kidney disease. The US labeling states: Anti-FXa activity adjusted for exposure to apixaban was similar across […]

In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. Subscribe on iTunes, Android, or Stitcher Stridor is an abnormal inspiratory sound and is a sign of airway obstruction that requires immediate attention. Stridor can be caused by a mass or foreign body in the upper airway, or by […]