In this episode, I’ll discuss the dose of insulin to use when treating hyperkalemia. Subscribe on iTunes, Android, or Stitcher Hyperkalemia treatment generally includes 3 steps: 1. Protect the cardiac membrane with IV calcium 2. Hide the potassium from the heart 3. Remove the excess potassium from the patient Insulin works in step #2. I […]

In this episode, I’ll discuss bayesian vancomycin monitoring in the critically ill. Subscribe on iTunes, Android, or Stitcher In order to use AUC to monitor vancomycin, the 2020 Vancomycin guidelines recommend using either 2 vancomycin levels with first-order kinetic calculations or Bayesian software programs to estimate AUC. The guidelines also state: As part of their […]

In this episode, I’ll discuss what phenotype of patients are most affected by delays in antibiotic therapy. Subscribe on iTunes, Android, or Stitcher For patients with sepsis, the link between a delay in antibiotic therapy and increased risk of mortality is well-established. However, it is possible that not all patients are affected the same way […]

In this episode, I’ll discuss whether remdesivir can be used in patients with COVID-19 and Myasthenia Gravis (MG). Subscribe on iTunes, Android, or Stitcher Myasthenia Gravis is a neuromuscular junction disease that results from the production of autoantibodies directed against the nicotinic acetylcholine receptor. The Myasthenia Gravis Foundation of America keeps a list of medications that […]

In this episode, I’ll discuss Low dose versus standard dose four-factor prothrombin complex concentrate for factor‐Xa inhibitor reversal in spontaneous and traumatic intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher While guidelines recommend 50 units/kg when 4 factor prothrombin complex concentrate (4FPCC) is used for factor‐Xa inhibitor reversal in intracranial hemorrhage, lower doses of 25 […]

In this episode, I’ll discuss the unwarranted continuation of antipsychotics after ICU and hospital discharge. Subscribe on iTunes, Android, or Stitcher Although the use of antipsychotics to treat ICU delirium does not have robust patient-focused outcomes data, they are frequently used. Usually antipsychotics are started when a patient with ICU delirium becomes agitated to the […]

In this episode, I’ll discuss the bioavailability of methadone. Subscribe on iTunes, Android, or Stitcher Popular tertiary references suggest a conversion ratio of oral to IV methadone of 2:1, meaning 10 mg of oral methadone is equivalent to 5 mg of IV methadone. But a team of researchers recently published a scoping review on the […]

In this episode, I’ll discuss the protamine shortage. Subscribe on iTunes, Android, or Stitcher In March 2021 the ASHP Shortage list reported that the manufacturer of protamine was experiencing delays leading to a shortage. Protamine can be used as an emergency reversal agent for heparin and partial reversal agent for low molecular weight heparin. Significant […]

In this episode, I’ll discuss why warfarin needs overlap with another anticoagulant when treating VTE. Subscribe on iTunes, Android, or Stitcher The CHEST guidelines state: It is now standard practice to start anticoagulant treatment after VTE with a heparin (unfractionated or low molecular weight) together with a VKA, overlap the two drugs for at least […]

In this episode, I’ll discuss the incidence of anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher Concerns over the rate of anaphylaxis to sugammadex delayed the US approval of the drug, with the FDA issuing a not approvable letter in 2008 citing in part concerns about allergic reactions. When sugammadex was approved in 2015 […]

In this episode, I’ll discuss whether using haloperidol for ICU delirium reduces mortality. Subscribe on iTunes, Android, or Stitcher While many pharmacologic therapies have been studied to treat ICU delirium, the recommendations from the latest SCCM PADIS guidelines is: We suggest not routinely using haloperidol, an atypical antipsychotic, or a HMG-CoA reductase inhibitor (i.e., a […]