In this episode, I’ll discuss whether gram stain–guided initial antibiotic therapy for VAP is better than guideline recommended therapy. Subscribe on iTunes, Android, or Stitcher VAP guidelines recommend initial broad spectrum coverage often with an anti-MRSA and anti-pseudomonal agent. These antibiotics are then to be narrowed as more clinical information becomes available. Gram-stain guided therapy […]
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Episode 705: How well does subcutaneous insulin work for DKA treatment?
In this episode, I’ll discuss subcutaneous insulin for the treatment of diabetic ketoacidosis (DKA). Subscribe on iTunes, Android, or Stitcher Diabetic ketoacidosis (DKA) is a serious condition with high mortality if not treated properly. The usual treatment for DKA involves IV insulin with frequent monitoring. For most hospitals this means admission to the ICU is […]
Episode 704: Are there some patient populations that should not receive fixed dose 4FPCC?
In this episode, I’ll discuss a recent retrospective review that has implications for fixed dose 4FPCC. Subscribe on iTunes, Android, or Stitcher Fixed dosing of 4-factor prothrombin complex concentrate has several potential advantages, including faster availability of the product, the potential elimination of the need to wait for a pretreatment INR result, and reduced cost. […]
Episode 703: How does the use of dopamine for shock affect mortality rates?
In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates. Subscribe on iTunes, Android, or Stitcher Surviving Sepsis Guidelines do not list dopamine as one of the vasopressors to use for the treatment of septic shock, and other types of shock are usually treated with non-dopamine vasopressors as well due […]
Episode 702: Risk Factors Associated With the Development of Venous Thromboembolism in ICU Patients
In this episode, I’ll discuss the risk factors associated with the development of venous thromboembolism in ICU patients. Subscribe on iTunes, Android, or Stitcher A recent review and systematic analysis published in Critical Care Medicine evaluated 39 observational cohort studies involving over 700,000 patients to identify what risk factors were associated with the development of […]
Episode 701: Mannitol administration for elevated intracranial pressure
In this episode, I’ll discuss the administration of mannitol for elevated intracranial pressure. Subscribe on iTunes, Android, or Stitcher The definitive treatment for elevated intracranial pressure is to fix the underlying cause. Common causes are traumatic brain injury, intracranial hemorrhage, CNS infection, or intracranial neoplasm. Until definitive treatment can be arranged, temporary treatments to lower […]
Episode 700: Can melatonin prevent ICU delirium?
In this episode, I’ll discuss whether melatonin can prevent ICU delirium. Subscribe on iTunes, Android, or Stitcher Numerous medications have been studied in an attempt to find something that prevents the development of ICU delirium. Studies involving melatonin have produced mixed results, and a group of authors from Australia sought to determine via a high […]
Episode 699: Can non-verbal ICU pain scales indicate the severity of pain?
In this episode, I’ll discuss whether non-verbal ICU pain scales can indicate the severity of pain. Subscribe on iTunes, Android, or Stitcher The use of pain assessments for patients who are unable to verbally communicate are recommended in the SCCM Pain, Agitation & Delirium Guidelines. 2 examples of such assessments are the Behavioral Pain Scale […]
Episode 698: Does Tranexamic Acid Have a Role In Aneurysmal Subarachnoid Hemorrhage?
In this episode, I’ll discuss whether tranexamic acid has a role in the treatment of aneurysmal subarachnoid hemorrhage. Subscribe on iTunes, Android, or Stitcher Tranexamic acid is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin. This results in the inhibition of fibrinolysis and should promote the stabilization of a clot that is […]
Episode 697: Lipid Rescue Dosing for LAST vs Enteral Drug Toxicity
In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity. Subscribe on iTunes, Android, or Stitcher Intravenous lipid emulsion (ILE) or “lipid rescue” therapy is used in local anesthetic systemic toxicity (LAST) and enteral drug toxicity. Anesthesia, toxicology, and ACLS guidelines recommend intravenous fat emulsion with various levels […]
Episode 696: Is your micro lab hiding susceptibility data from you?
In this episode, I’ll discuss the suppression of antimicrobial susceptibility results. Subscribe on iTunes, Android, or Stitcher When a hospital microbiology laboratory performs antimicrobial susceptibility testing using microdilution or disk diffusion methods, not all of the results are presented to clinicians in the medical record. Some of the data is ‘suppressed’ meaning the micro lab […]
Episode 695: Why does ketamine for RSI sometimes cause post-induction hemodynamic instability?
In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher While ketamine is often considered a hemodynamically neutral induction agent for rapid sequence intubation, there are reports of post-induction hypotension and hemodynamic collapse occurring occasionally with ketamine use. […]
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