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 […]

In this episode, I’ll discuss whether apixaban’s loading dose duration should ever be shortened. Subscribe on iTunes, Android, or Stitcher A common clinical scenario in hospitals is the following: You have a patient with DVT or PE that has been on a therapeutic heparin infusion for several days, the physician wants to switch the patient […]

In this episode, I’ll discuss the treatment of norepinephrine extravasation. Subscribe on iTunes, Android, or Stitcher Central line access is often preferred for vasopressor administration due to the risk of extravasation. Extravasation of a vasopressor such as norepinephrine can cause tissue necrosis and ultimately, the loss of a limb due to local vasoconstriction. The terms […]

In this episode, I’ll discuss a clinical prediction model for augmented renal clearance in adult mixed critically ill patients. Subscribe on iTunes, Android, or Stitcher Augmented or enhanced renal clearance is a phenomenon in some critically ill patients whereby their kidney function becomes supranormal. Awareness of clinicians to the possibility of augmented renal clearance in critically […]

In this episode, I’ll discuss a case report of enoxaparin overdose. Subscribe on iTunes, Android, or Stitcher A group of authors recently published their experience treating an overdose of 900 mg enoxaparin with a protamine bolus and infusion in the American Journal of Health System Pharmacy. There is little data available on managing large enoxaparin […]

In this episode, I’ll discuss how aggressively extremely high blood pressure should be managed in patients with ICH. Subscribe on iTunes, Android, or Stitcher AHA guidelines for the management of spontaneous intracerebral hemorrhage (ICH) split hypertension management recommendations into two groups based on the strength of available evidence.  The first group is those with a blood […]

In this episode, I’ll discuss the pharmacist’s role in predicting the need for intubation. Subscribe on iTunes, Android, or Stitcher Because of how drug delivery systems are set up in most US hospitals with medications stored in automated dispensing cabinets, there can be a considerable delay between the time a physician makes a decision to […]

In this episode, I’ll discuss the risk factors for not attaining target beta-lactam levels in ICU patients. Subscribe on iTunes, Android, or Stitcher For beta-lactam antibiotics, an adequate time above the MIC is essential to achieve clinical success. However, critically ill patients undergo physiologic changes that may make achieving adequate time above MIC difficult. This […]

In this episode, I’ll discuss opportunities for antibiotic stewardship before hospital discharge. Subscribe on iTunes, Android, or Stitcher A primary focus of antibiotic stewardship programs is to reduce unnecessary antibiotic use among hospital inpatients. Reducing unnecessary antibiotic use upon hospital discharge is not a popular focus among the majority of stewardship programs. However, a significant […]

In this episode, I’ll discuss 3 reasons to consider holding lithium in critically ill patients. Subscribe on iTunes, Android, or Stitcher Chronic medications, especially neuro-active ones, are often resumed in the ICU as soon as critically ill patients can tolerate them.  Lithium, however, has a particularly narrow therapeutic range and the potential for toxicity to […]