In this episode, I’ll discuss adding dexmedetomidine to lidocaine for topical application to prevent cough during extubation of thyroidectomy patients. Subscribe on iTunes, Android, or Stitcher The cough reflex that occurs with extubation can be especially problematic in thyroidectomy patients, as it may lead to bleeding and subsequent hemodynamic instability. Topical lidocaine has been used […]

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 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 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 hallucinations from low-dose ketamine use in the ICU. Subscribe on iTunes, Android, or Stitcher Low-dose ketamine was recommended in the 2018 PADIS guidelines for the purpose of reducing opioid use in ICU patients. But, this was based on very thin evidence – some systematic reviews in non-ICU patients and a […]

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 the use of adjuvant midodrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher   Using midodrine to wean ICU patients off of vasopressors is a common strategy and one that I have used in my practice and discussed in previous episodes. The general principle is that some […]

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 animal data on the rate of correction for acute hypernatremia. Subscribe on iTunes, Android, or Stitcher Acute hypernatremia is a common occurrence in ICU patients. Whenever there is an acute and significant change in sodium levels – whether high or low – there is concern about the safe speed of […]

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 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 with IV insulin and then develop a normal anion gap, standard practice is to transition the patient to subcutaneous insulin. This transition […]

In this episode, I’ll discuss whether the composition of the first few liters of resuscitation fluid is most important for patients with sepsis. Despite the biological plausibility that using balanced crystalloid solutions for resuscitation in sepsis over normal saline should result in better outcomes due to less hyperchloremic acidosis, results from trials looking at this […]