In this episode, I’ll discuss a recent trial of nebulized ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher A case series of 5 patients that received nebulized ketamine for analgesia in the emergency department has previously been published. Each patient experienced a decrease in pain from the baseline up to 120 […]

In this episode, I’ll discuss the importance of external validation of clinical prediction models. Subscribe on iTunes, Android, or Stitcher When a prediction model is developed, it is only known to be valid in the data set that it was developed from. In order to determine a prediction model’s reproducibility and generalizability to new and […]

In this episode, I’ll discuss the connection (or lack thereof) between respiratory drive and sedation depth. Subscribe on iTunes, Android, or Stitcher When mechanically ventilated patients have spontaneous respiratory effort, it is often assumed that providing a deeper level of sedation will depress the respiratory effort and allow compliance with the ventilator. This is a […]

In this episode, I’ll discuss early dexmedetomidine use and body temperature elevation. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine has previously been identified as a cause of drug fever in the ICU in case reports, and in my practice, this has seemingly come up often. Investigators recently published a post-hoc analysis of body temperature elevations […]

In this episode, I’ll discuss whether subcutaneous VTE prophylaxis should be given during therapeutic hypothermia. Subscribe on iTunes, Android, or Stitcher Shout out to Hospital Pharmacy Academy member, “Pharmacy Yor” for inspiring this episode. During therapeutic hypothermia, subcutaneous drug absorption may be reduced due to low perfusion to the skin. This may be especially true […]

In this episode, I’ll discuss whether 3 days of beta-lactam use is enough to treat CAP in non-ICU hospitalized patients. Subscribe on iTunes, Android, or Stitcher Presumably, if a shorter duration of antibiotic therapy can be used for patients admitted to hospital with community-acquired pneumonia, then the adverse consequences associated with antibiotic use (bacterial resistance, […]

In this episode, I’ll discuss the management of antiretrovirals in critically ill patients. Subscribe on iTunes, Android, or Stitcher Management decisions regarding antiretroviral therapies in critically ill patients are complex. Drug interactions, lack of variety of dosage forms and decreased absorption threaten to expose patients to unintended monotherapy. This can promote the emergence of resistance, […]

In this episode, I’ll discuss whether resistance against 1 antipseudomonal beta lactam means the others can’t be used. Subscribe on iTunes, Android, or Stitcher The anti-pseudomonal beta-lactams commonly used are ceftazidime, cefepime, meropenem, and piperacillin-tazobactam. Since the resistance mechanisms are similar between these antibiotics, investigators recently examined whether resistance to 1 or more of these […]

In this episode, I’ll discuss when prophylactic anticoagulation, is not prophylactic anticoagulation. Subscribe on iTunes, Android, or Stitcher When clinicians refer to prophylactic levels of anticoagulation in hospitalized patients, this usually refers to doses of anticoagulants that are meant to prevent venous thromboembolism such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Both enoxaparin […]

In this episode, I’ll discuss whether it is ever appropriate for a patient to be on oral and IV vancomycin. Subscribe on iTunes, Android, or Stitcher While IV vancomycin is indicated to treat a variety of infectious diseases, oral vancomycin is primarily used to treat C diff infection (CDI). Unlike IV metronidazole, which achieves therapeutic […]

In this episode, I’ll discuss aspirin for VTE prophylaxis in orthopedic surgery. Subscribe on iTunes, Android, or Stitcher When balancing bleeding and clotting risks, I find anecdotally that surgeons often place more emphasis on avoiding bleeding. Years ago, when the CHEST Guidelines expanded the recommended medications for VTE prophylaxis in orthopedic surgery to include aspirin, […]

In this episode, I’ll discuss which works better for agitation in the ED – droperidol, ziprasidone, or lorazepam? Subscribe on iTunes, Android, or Stitcher When treating acutely agitated ED patients that need sedation because they are a physical danger to themselves or others, clinicians may have a preference for the choice of sedative based on […]