In this episode, I’ll discuss an article about the reversal of apixaban and rivaroxaban with andexanet alfa prior to invasive or surgical procedures. Subscribe on iTunes, Android, or Stitcher Andexanet alfa is a reversal agent that competitively binds to factor Xa inhibitors such as apixaban and rivaroxaban. Approval trials like ANNEXA-4 focused on using andexanet […]

In this episode, I’ll discuss an opt-out protocol for antibiotic de-escalation. Subscribe on iTunes, Android, or Stitcher Current guidelines for sepsis recommend a daily review of antibiotic therapy to de-escalate or discontinue antibiotics when appropriate. This however is an opt-in process that requires the provider to either make the assessment or for a different healthcare […]

In this episode, I’ll discuss an article about fecal microbiota transplantation for the first or second Clostridioides difficile infection. Subscribe on iTunes, Android, or Stitcher Gut microbiota restoration with fecal microbiota transplantation (FMT) is a recommended treatment option for patients with multiple recurring episodes of C difficile. Evidence surrounding the optimal timing of this treatment […]

In this episode, I’ll discuss an article about awareness with paralysis among critically ill emergency department patients. Subscribe on iTunes, Android, or Stitcher Rapid sequence intubation is a common procedure in the ED. After this procedure where a paralytic such as succinylcholine or rocuronium has been used along with a short-acting sedative such as propofol, […]

In this episode, I’ll discuss an article about starting DOACs early vs late in ischemic stroke patients with AFib. Subscribe on iTunes, Android, or Stitcher Patients with acute ischemic stroke are at risk of conversion to hemorrhagic stroke for a period of time after the initial event. For this reason, patients with a recent stroke […]

In this episode, I’ll discuss an article about aggressive vs moderate fluid resuscitation in acute pancreatitis. Subscribe on iTunes, Android, or Stitcher There has been a trend in research published over the last several years towards demonstrating that aggressive fluid resuscitation in septic patients without consideration to other factors is not necessarily associated with the […]

In this episode, I’ll discuss why the CAP guidelines do not recommend treating most cases of suspected aspiration pneumonia with broadening antibiotic therapy. Subscribe on iTunes, Android, or Stitcher Broadening therapy in community-acquired pneumonia to cover potential anaerobes in the case of suspected aspiration pneumonia is a common occurrence. This results in the use of […]

In this episode, I’ll discuss how the use of drug-specific factor Xa inhibitor levels can reduce major bleeding. Subscribe on iTunes, Android, or Stitcher Factor Xa inhibitors such as rivaroxaban and apixaban gained popularity over warfarin in part because of the lack of monitoring needed to provide reliable therapeutic anticoagulation. Because routine monitoring is not […]

In this episode, I’ll discuss the 4 clinical teaching roles for residency preceptors. Subscribe on iTunes, Android, or Stitcher The 4 teaching roles that ASHP wants PGY-1 residency preceptors to use are: 1. Instructing 2. Modeling 3. Coaching 4. Facilitating ASHP expects that PGY-1 residency preceptors have a working knowledge of these roles. During a […]

In this episode, I’ll discuss whether milrinone can be used in patients on CRRT. Subscribe on iTunes, Android, or Stitcher Occasionally ICU patients undergoing continuous renal replacement therapy (CRRT) will also require inotropic support for conditions like heart failure with reduced ejection fraction in the setting of decreased cardiac contractility. Dobutamine and milrinone are the […]