In this episode, I’ll discuss new orders for fentanyl patches in the hospital setting. Subscribe on iTunes, Android, or Stitcher Transdermal fentanyl patches are contraindicated in the treatment of acute pain or in patients who are not opioid tolerant. This contraindication is in response to many reports of severe and fatal patient harm from the use […]

In this episode, I’ll discuss colchicine in patients admitted to hospital with COVID-19. Subscribe on iTunes, Android, or Stitcher When steroids like dexamethasone were found effective for COVID-19, it was logical to wonder whether colchicine, with its anti-inflammatory properties, would also help improve outcomes of patients with COVID-19. The RECOVERY Trial, which is a randomized, controlled, […]

In this episode, I’ll discuss the dose of dexamethasone for patients with COVID-19. Subscribe on iTunes, Android, or Stitcher Current recommendations are for a daily dose of 6 mg dexamethasone for up to 10 days in patients with severe and critical COVID-19. This dose was not determined by a dose-finding study, rather it was the single-dose […]

In this episode, I’ll discuss the risk factors for invasive candida infection in critically ill patients. Subscribe on iTunes, Android, or Stitcher The sepsis guidelines recommend using empiric antifungal therapy for adults with sepsis or septic shock at high risk of fungal infection. However, the risk assessment is not well defined in the guidelines beyond a […]

In this episode, I’ll discuss the European Society of Intensive Care Medicine’s recommendations on using PCC in bleeding critically ill adults. Subscribe on iTunes, Android, or Stitcher The journal Intensive Care Medicine has recently published a clinical practice guideline from the European Society of Intensive Care Medicine on transfusion strategies in bleeding critically ill adults. […]

In this episode, I’ll discuss why I think the journal Intensive Care Medicine is of high quality. Subscribe on iTunes, Android, or Stitcher In episode 654 I discussed a study recently published in the journal Intensive Care Medicine about the effects of oral chlorhexidine vs an oral care bundle on mortality for mechanically ventilated patients […]

In this episode, I’ll discuss 4 changes to vasopressor recommendations in the 2021 Sepsis Guidelines. Subscribe on iTunes, Android, or Stitcher The 2021 Sepsis Guidelines are out and there are some changes to vasopressor-related recommendations. First, the wording for the MAP goal was slightly changed. It now reads: For adults with septic shock on vasopressors, […]

In this episode, I’ll discuss the effects of oral chlorhexidine vs an oral care bundle on mortality for mechanically ventilated patients in the ICU. Subscribe on iTunes, Android, or Stitcher In recent years, the journal Intensive Care Medicine has published a cohort study and editorial that call into question the safety and efficacy of oral […]

In this episode, I’ll discuss how 5 units of insulin works for hyperkalemia instead of 10. Subscribe on iTunes, Android, or Stitcher While insulin is an effective way to lower potassium during hyperkalemia treatment, hypoglycemia may result even if dextrose is given along with insulin treatment. This is especially likely in patients with renal dysfunction […]

In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin? Subscribe on iTunes, Android, or Stitcher Quickly administering appropriate empiric antibiotic therapy is essential in the treatment of severe infections. If multiple antibiotics are required for empiric therapy to treat a severe infection (such as for […]

In this episode, I’ll discuss the Sepsis-Induced Coagulopathy (SIC) Score. Subscribe on iTunes, Android, or Stitcher The Sepsis-Induced Coagulopathy (SIC) Score predicts likelihood of sepsis-induced coagulopathy. This scoring system is specifically designed for predicting coagulation disturbances in sepsis using the Sepsis-3 definition. The SIC score addresses 3 domains for a possible 0 to 6 points […]

In this episode, I’ll discuss whether vasopressin should be started sooner rather than later in septic shock. Subscribe on iTunes, Android, or Stitcher Sepsis guidelines recommend starting vasopressin once the norepinephrine dose reaches 0.25 to 0.5 mcg/kg/min if the patient’s MAP is not adequate. However the best timing for the addition of vasopressin is still […]