In this episode, I’ll discuss a titrated morphine algorithm that worked well in ED patients. Subscribe on iTunes, Android, or Stitcher A recent randomized trial in Academic Emergency Medicine showed that IV acetaminophen use didn’t alter morphine requirements vs placebo in ED patients with acute pain. This is another in a long line of studies […]

In this episode, I’ll discuss whether there is a benefit from switching to dexmedetomidine when sedation is started with midazolam. Subscribe on iTunes, Android, or Stitcher Sedation guidelines recommend light sedation with a non-benzodiazepine agent such as dexmedetomidine or propofol. However, many ICU patients are started on midazolam-based sedation regimens either due to a compelling […]

In this episode, I’ll discuss differences in heart rate in patients with sepsis and AFib between phenylephrine and norepineprhine. Subscribe on iTunes, Android, or Stitcher Phenylephrine, unlike norepinephrine, does not stimulate beta receptors and therefore should not raise a patient’s heart rate. This is often used as a reason to administer phenylephrine to patients with […]

In this episode, I’ll discuss a recent practice guideline on ketamine use for analgosedation in critically ill patients. Subscribe on iTunes, Android, or Stitcher The 2018 PADIS Guidelines published by the Society of Critical Care Medicine gave a positive recommendation for the use of ketamine saying: We suggest using low-dose ketamine (0.5 mg/kg IVP x […]

In this episode, I’ll discuss the possibility of vancomycin treatment failure with old CVVHDF dosing regimens. Subscribe on iTunes, Android, or Stitcher A very common starting regimen to attain target trough levels for vancomycin during CVVHDF is a 2 gram IV loading dose followed by 750 mg IV q12h. However a group of authors in […]

In this episode, I’ll discuss the use of phenobarbital in severe alcohol withdrawal. Subscribe on iTunes, Android, or Stitcher Severe alcohol withdrawal is a result of both the lack of GABA activity AND over stimulation of glutamate receptors. While benzodiazepines are considered the first-line treatment option, phenobarbital is used as an adjunct and, in recent […]

In this episode, I’ll discuss the ICU pharmacist’s role in recognizing and treating malignant hyperthermia. Subscribe on iTunes, Android, or Stitcher Malignant hyperthermia (MH) is a rare and life-threatening reaction to anesthesia that results in an uncontrolled rise of myoplasmic calcium,  leading to hyperkalemia and rhabdomyolysis.  It occurs in about 1 out of 100,000 administrations […]

In this episode, I’ll discuss an article about the side effects of sugammadex vs neostigmine. Subscribe on iTunes, Android, or Stitcher Despite its relatively higher cost, sugammadex is a very popular reversal agent for neuromuscular blockade in the perioperative setting compared to the alternative of neostigmine. A group of authors published a retrospective cohort study […]

In this episode, I’ll discuss the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients. Subscribe on iTunes, Android, or Stitcher The standard urine output threshold to identify acute kidney injury (AKI) in critically ill patients is 0.5 ml/kg/hr. However, this threshold may be too high. A group of researchers […]

In this episode, I’ll discuss how getting the depth of sedation correct in the ED might reduce mortality rates by half. Subscribe on iTunes, Android, or Stitcher A group of researchers from Washington University School of Medicine in St. Louis just published a prospective before-after pilot and feasibility trial of an educational initiative aimed at […]

In this episode, I’ll discuss subcutaneous insulin for the treatment of diabetic ketoacidosis (DKA). Subscribe on iTunes, Android, or Stitcher Diabetic ketoacidosis (DKA) is a serious condition with high mortality if not treated properly. The usual treatment for DKA involves IV insulin with frequent monitoring. For most hospitals this means admission to the ICU is […]