In this episode, I’ll discuss parenteral medication considerations for the ketogenic diet. Subscribe on iTunes, Android, or Stitcher A high-fat, low-carbohydrate diet may be prescribed to induce ketosis and help patients with epilepsy that is refractory to medical treatment. While dietary carbohydrate intake is tightly controlled in these patients, small amounts of carbohydrate from non-dietary sources […]

In this episode, I’ll discuss whether meropenem should be given by continuous infusion in critically ill patients. Subscribe on iTunes, Android, or Stitcher A continuous infusion of meropenem helps to ensure 100% time above MIC and is often employed for resistant infections. This has led some to question whether it is better to routinely give meropenem […]

In this episode, I’ll discuss the results of a pilot trial of sodium bicarbonate for metabolic acidosis in the ICU. Subscribe on iTunes, Android, or Stitcher Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however evidence to support this indication is lacking and sodium bicarb is not a benign intervention without risk […]

In this episode, I’ll discuss expectations for the onset of action of IM medications used for acute agitation. Subscribe on iTunes, Android, or Stitcher When caring for an acutely agitated patient, the delay between IM medication administration and the onset of action can seem exceedingly long. Staff and patient safety continue to be at risk until […]

In this episode, I’ll discuss three tips for inpatient medical emergencies. Subscribe on iTunes, Android, or Stitcher Please note: There is an error in the recording that indicates this is episode 831 but it is, in fact, episode 833. Tip #1: ACE Inhibitor-Induced Angioedema When taking care of a patient with ACE inhibitor-induced angioedema, I focus […]

In this episode, I’ll discuss a cost-avoidance study of a redistribution process to reduce waste of emergency medications in drug boxes. Subscribe on iTunes, Android, or Stitcher Placing emergency medications throughout the hospital in drug boxes is essential to ensure their availability when emergencies arise. However, this leads to a large number of medications that […]

In this episode, I’ll discuss the role for ketamine in status epilepticus. Subscribe on iTunes, Android, or Stitcher The initial therapy for status epilepticus is to use one of the following benzodiazepines: Lorazepam 0.1 mg/kg capped at 4 mg IV Midazolam 0.2 mg/kg capped at 10 mg IM Diazepam 0.15 mg/kg capped at 10 mg IV […]

In this episode, I’ll discuss using heparin anti-Xa levels to evaluate apixaban, rivaroxaban, fondaparinux, and danaparoid levels. Subscribe on iTunes, Android, or Stitcher Anti-Xa inhibitors such as apixaban, rivaroxaban, fondaparinux, and danaparoid do not have readily available assays, yet there is often a clinical need to determine their presence or absence. Because heparin anti-Xa assays are […]

In this episode, I’ll discuss three ways to tell the difference between serotonin syndrome and neuroleptic malignant syndrome. Subscribe on iTunes, Android, or Stitcher Muscular rigidity, significant hyperthermia, and autonomic instability are all common features of serotonin syndrome and neuroleptic malignant syndrome. While these two syndromes are very similar in presentation, they can usually be differentiated by looking […]

In this episode, I’ll discuss a systematic review of the ketorolac dose ceiling for ED analgesia. Subscribe on iTunes, Android, or Stitcher Ketorolac is FDA approved for a dose of 30 mg IV for analgesia however there is extensive research dating back as far as 30 years that supports a ceiling dose in the 10 […]

In this episode, I’ll discuss early as compared with later initiation of direct oral anticoagulants (DOACs) in patients with atrial fibrillation who have had an acute ischemic stroke. Subscribe on iTunes, Android, or Stitcher   How soon to start anticoagulation after stroke due to afib is a matter of significant debate as there is a […]

In this episode, I’ll discuss probiotic-associated central venous catheter bloodstream infections in the ICU. Subscribe on iTunes, Android, or Stitcher   While probiotics are typically seen as a harmless intervention that may have benefits related to antibiotic-associated diarrhea, bloodstream infections caused by organisms contained within probiotics have been reported in ICU patients. A group of […]