In this episode, I’ll discuss when rabies immune globulin is indicated. Subscribe on iTunes, Android, or Stitcher Rabies immune globulin (RIG) administration is part of successful rabies post-exposure prophylaxis. The rabies vaccine produces active immunity beginning about 7 to 10 days after the vaccine series is started. However, when RIG is given, passive immunity is […]

In this episode, I’ll discuss an article about serious and general opioid-related adverse drug events. Subscribe on iTunes, Android, or Stitcher Opioid-related adverse effects in hospital inpatients can be a significant cause of morbidity and resource expenditure in the form of rapid response calls, transfers to higher levels of care, and extended length of stay. […]

In this episode, I’ll discuss an article about low-concentration peripheral norepinephrine infusion. Subscribe on iTunes, Android, or Stitcher Peripheral vasopressor administration is generally considered desirable by clinicians in 2 scenarios: 1. A patient’s blood pressure is severely low and waiting for a central line to be placed could cause organ damage due to low perfusion. […]

In this episode, I’ll discuss an article about patiromer for hyperkalemia in hospitalized patients. Subscribe on iTunes, Android, or Stitcher Everybody dislikes using sodium polystyrene sulfate due to its potential for rare but serious side effects like intestinal necrosis. But newer agents for removing excess potassium from the body have limited data in patients with […]

In this episode, I’ll discuss if phentolamine the only thing you can use for vasopressor extravasation. Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. Infiltration can be done purposefully with therapeutic intent, such as […]

In this episode, I’ll discuss what happens if you add fentanyl to ketamine+rocuronium for rapid sequence intubation? Subscribe on iTunes, Android, or Stitcher Rapid sequence intubation includes providing sedation, analgesia, and paralysis to achieve adequate intubating conditions and to ensure the patient tolerates the procedure. When ketamine is used for rapid sequence intubation, some clinicians […]

In this episode, I’ll discuss what if it is not the sedative class that causes delirium – just the depth of sedation? Subscribe on iTunes, Android, or Stitcher Both the 2013 and 2018 SCCM guidelines for sedation in the ICU recommend avoiding benzodiazepine infusions for sedation in the ICU. The reason for this is in […]

In this episode, I’ll discuss what blood gas parameters can make you suspect methemoglobinemia. Subscribe on iTunes, Android, or Stitcher Methemoglobin is formed when the ferrous irons of heme are oxidized to the ferric state. The ferric hemes of methemoglobin are unable to bind oxygen, therefore, causing a functional anemia. Acquired methemoglobinemia is typically a reaction […]

In this episode, I’ll discuss the problem with hypo-osmolar solutions in neurological patients. Subscribe on iTunes, Android, or Stitcher The administration of hypo-osmolar IV solutions causes an increase in water into the brain.  This is because an intact blood-brain barrier is permeable to water but not electrolytes.  When the blood brain barrier is intact, and […]

In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A recent commentary published in AJHP argues for abandoning the use of extremely hypo-osmolar intravenous solutions to treat hypernatremia. The authors consider extremely hypotonic solutions to be 0.225% sodium chloride (also called one-quarter […]

In this episode, I’ll discuss the efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease. Subscribe on iTunes, Android, or Stitcher The prescribing information for apixaban recommends not reducing the dose when being used in patients with end-stage renal disease and atrial fibrillation. However, renal elimination accounts for 27% of apixaban clearance. […]

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack […]