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 […]

In this episode, I’ll discuss an alternative definition of oliguria. Subscribe on iTunes, Android, or Stitcher   The commonly used definition of oliguria is a urine output of 0.5 mL/kg/hr over a 6 hr period. However some small studies have suggested that this definition of oliguria is too liberal. To bring clarity to this clinical […]

In this episode, I’ll discuss torsemide vs furosemide for symptoms and quality of life among patients hospitalized for heart failure. Subscribe on iTunes, Android, or Stitcher   Whether torsemide improves patient Heart Failure (HF) symptoms and quality of life better than furosemide is a matter of debate among clinicians, and a group of authors recently […]

In this episode, I’ll discuss the Management of muscle relaxation with rocuronium and reversal with neostigmine or sugammadex guided by quantitative neuromuscular monitoring. Subscribe on iTunes, Android, or Stitcher   Sugammadex is an effective but expensive neuromuscular blocking reversal agent compared with the previous standard of care, neostigmine. In many cases neostigmine will work adequately, […]

In this episode, I’ll discuss the dose of IV levothyroxine used for myxedema coma. Subscribe on iTunes, Android, or Stitcher   Myxedema coma is a rare medical emergency with in-hospital mortality of ~30% When it occurs, myxedema coma is often a result of either: 1. Withdrawal of thyroid therapy or 2. The first sign of thyroid […]

In this episode, I’ll discuss the dose of inhaled tranexamic acid used for nonmassive hemoptysis. Subscribe on iTunes, Android, or Stitcher   Tranexamic acid (TA) is an antifibrinolytic medication. It forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis. Tranexamic acid is commonly used systemically to reduce bleeding in trauma or […]

In this episode, I’ll discuss how soon hydrocortisone should be added to patients with septic shock. Subscribe on iTunes, Android, or Stitcher Back in episode 818, I discussed recently published data that suggested a mortality benefit for adding hydrocortisone to patients on norepinephrine for septic shock rather than adding vasopressin. To add to that data, […]

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 […]