In this episode, I’ll discuss whether albumin infusions improve outcomes in hospitalized patients with decompensated cirrhosis. Subscribe on iTunes, Android, or Stitcher Albumin is frequently used for various indications in hospitalized patients, but in some use cases the evidence of benefit is unclear. Albumin may fall under the laboratory or pharmacy budget depending on how […]

In this episode, I’ll discuss prehospital antibiotics for severe sepsis. Subscribe on iTunes, Android, or Stitcher Back in episode 185, I discussed a study that looked at Delays From First Medical Contact to Antibiotic Administration for Sepsis.  The authors found that the median time from first medical contact to antibiotic administration was 4.2 hours with a […]

In this episode, I’ll discuss whether patients taking beta-blockers require increased doses of epinephrine for anaphylaxis. Subscribe on iTunes, Android, or Stitcher Animal data suggests that patients taking beta-blockers have more severe anaphylaxis, possibly by decreasing the threshold for mast cell activation. With beta-blockers interfering with the same receptors epinephrine needs to activate in order […]

In this episode, I’ll discuss a possible syndrome that might herald vaccine-induced immune thrombotic thrombocytopenia. Subscribe on iTunes, Android, or Stitcher The two adeno-vector vaccines for COVID-19 are associated with the rare but serious adverse effect of vaccine-induced immune thrombotic thrombocytopenia. With this condition, cerebral venous sinus thrombosis is a significant concern. A group of […]

In this episode, I’ll discuss the analgesic ceiling dose of ibuprofen in ED patients. Subscribe on iTunes, Android, or Stitcher NSAIDs (including ibuprofen) have a ceiling dose beyond which, no additional analgesic effect is seen.  I must have missed that part of the lecture in pharmacy school because I don’t remember encountering this concept in […]

In this episode, I’ll discuss whether epinephrine infusions are associated with worse mortality. Subscribe on iTunes, Android, or Stitcher Many clinicians will remember the old phrase “leave ’em dead with Levophed” – a suggestion that norepinephrine was to be used as a last-line vasopressor. Guidelines for sepsis and septic shock have recommended norepinephrine as first-line […]

In this episode, I’ll discuss why I think ketamine and propofol don’t belong in the same syringe. Subscribe on iTunes, Android, or Stitcher Ketamine and propofol are compatible in the same syringe, and several published studies have specifically stated that the two medications were placed in the same syringe. But just because we can, doesn’t […]

In this episode, I’ll discuss new data on intermediate-risk PE treatment. Subscribe on iTunes, Android, or Stitcher Intermediate-risk pulmonary embolism is usually defined as a patient with a PE and right ventricular heart strain but without hemodynamic instability. This patient population is considered under-studied and management strategies vary. A group of researchers recently published in […]

In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. Subscribe on iTunes, Android, or Stitcher Despite epinephrine clearly being recommended as the first line of treatment for an acute episode of anaphylaxis, glucocorticoids continue to be given by many providers. The mechanism of action for glucocorticoids is […]

In this episode, I’ll discuss the optimal timing of remdesivir initiation in hospitalized COVID-19 patients administered with dexamethasone. Subscribe on iTunes, Android, or Stitcher Research on remdesivir and dexamethasone for COVID-19 patients began in parallel, and information on the timing of starting these therapies has not been available. However, researchers recently published in Clinical Infectious […]

In this episode, I’ll discuss the fastest way to sedate an aggressive or violent patient in the ED. Subscribe on iTunes, Android, or Stitcher When acutely agitated patients present to the ED, one way to measure the severity of the agitation is with the Richmond Agitation and Sedation Scale. At the upper end of the […]