In this episode, I’ll discuss the duration of DOAC interference with heparin anti-Xa levels. Subscribe on iTunes, Android, or Stitcher DOACs that are Xa inhibitors such as apixaban and rivaroxaban interfere with heparin anti-Xa level monitoring by causing falsely elevated levels. While many references cite this interaction as lasting up to 48-72 hours, I have […]

In this episode, I’ll discuss vasopressin vs hydrocortisone as an adjunct to norepinephrine in sepsis. Subscribe on iTunes, Android, or Stitcher When patients with septic shock require increasing doses of norepinephrine to maintain adequate perfusion, both hydrocortisone and vasopressin are potential second agents to add. A group of authors recently published a multicenter, retrospective, observational […]

In this episode, I’ll discuss how to predict failure of insulin transition in critically ill patients with diabetic ketoacidosis. Subscribe on iTunes, Android, or Stitcher When patients with diabetic ketoacidosis (DKA) are treated and develop a normal anion gap, common practice is to transition the patient to subcutaneous insulin. However some patients fail this transition […]

In this episode, I’ll discuss a randomized controlled trial about delayed sequence intubation. Subscribe on iTunes, Android, or Stitcher In a typical rapid sequence intubation, there is a period of time referred to as “pre-oxygenation” where the patient needs to breath 100% oxygen for 3 minutes in order to extend the safe apnea time and […]

In this episode, I’ll discuss lactic acidosis from epinephrine. Subscribe on iTunes, Android, or Stitcher Epinephrine is a treatment for disease states that can cause elevated lactate such as anaphylaxis and sepsis, but epinephrine also has a known side effect of raising lactic acid levels. This leaves clinicians having to determine whether elevated lactate after […]

In this episode, I’ll discuss 10 tips for providing effective feedback to PGY-1 residents. Subscribe on iTunes, Android, or Stitcher When providing feedback, choose a location where both parties will be comfortable openly speaking.  This may be done on the unit as long as others are not actively listening, but be especially sensitive to giving […]

In this episode, I’ll discuss giving lactated ringer’s solution to a patient with elevated lactate. Subscribe on iTunes, Android, or Stitcher Lactated ringers is considered a suitable fluid for resuscitation in sepsis.  In fact, it is becoming more common to use it as a resuscitation fluid as it contains a more physiologic level of chloride […]

In this episode, I’ll discuss an article about IV push piperacillin-tazobactam. Subscribe on iTunes, Android, or Stitcher Article Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department Lead author: William Blake Hays Published in American Journal of Health-System Pharmacy May 2020 Background Piperacillin/tazobactam is typically administered via IV piggyback over 30 minutes or […]

In this episode, I’ll discuss mannitol extravasation. Subscribe on iTunes, Android, or Stitcher When given as a bolus, mannitol is an osmotic diuretic that does not cross the blood-brain barrier. Mannitol lowers intracranial pressure by osmotically drawing free water out of the brain and into circulation where it can be eliminated. If given as a continuous infusion, mannitol […]

In this episode, I’ll discuss the use of sugammadex in myasthenia gravis patients undergoing thymectomy. Subscribe on iTunes, Android, or Stitcher A group of authors in Japan recently analyzed the association between the use of sugammadex and postoperative myasthenic crisis in patients with myasthenia gravis using a national inpatient database. 506 patients who received sugammadex […]

In this episode, I’ll discuss high-dose insulin euglycemic therapy in the treatment of a patient with massive caffeine overdose. Subscribe on iTunes, Android, or Stitcher Many cardiotoxic medication overdoses appear to respond to high dose insulin euglycemia therapy, including beta-blockers, calcium channel blockers, and tricyclic antidepressants. The practice of high dose insulin euglycemia therapy involves […]

In this episode, I’ll discuss the dose of methylene blue for the treatment of acquired methemoglobinemia. Subscribe on iTunes, Android, or Stitcher Acquired methemoglobinemia is typically a reaction to medications. The ferric hemes of methemoglobin are unable to bind oxygen therefore causing a functional anemia. Suspect methemoglobinemia when the following occur: 1. Sudden cyanosis after […]