In this episode, I’ll discuss the effect of phenylephrine push prior to continuous infusion norepinephrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher Push dose vasopressors as a temporizing measure for profound hypotension in critically ill patients is frequently used in many institutions. However the extent of the data for this strategy […]

In this episode, I’ll discuss the available safety and efficacy data of Pfizer’s Covid-19 vaccine. Subscribe on iTunes, Android, or Stitcher On December 11, 2020 the FDA granted an emergency use authorization for Pfizer’s Covid-19 vaccine. A fact sheet for the vaccine is available from the FDA here. Data from the trial used to support […]

In this episode, I’ll discuss the danger of intubation in the setting of salicylate toxicity. Subscribe on iTunes, Android, or Stitcher During salicylate toxicity, the movement of salicylate into brain, liver, and other tissues is exacerbated by a low serum pH. This is because the more acidic the pH, the more salicylate becomes nonionized, and […]

In this episode, I’ll discuss how to predict hypotension from dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine is a popular sedative for use in critically ill patients. Hypotension is a common side effect that may limit the dose or even use of dexmedetomidine in critically ill patients.  Being able to predict hypotension in advance […]

In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. Subscribe on iTunes, Android, or Stitcher Stridor is an abnormal inspiratory sound and is a sign of airway obstruction that requires immediate attention. Stridor can be caused by a mass or foreign body in the upper airway, or by […]

In this episode, I’ll discuss the use of rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve. Subscribe on iTunes, Android, or Stitcher Atrial fibrillation is a common rhythm in patients that have bioprosthetic mitral valves. Life-long anticoagulation is often prescribed in such patients to manage the risk of valve thrombosis and thromboembolism […]

In this episode, I’ll discuss whether apixaban’s loading dose duration should ever be shortened. Subscribe on iTunes, Android, or Stitcher A common clinical scenario in hospitals is the following: You have a patient with DVT or PE that has been on a therapeutic heparin infusion for several days, the physician wants to switch the patient […]

In this episode, I’ll discuss how to prevent unnecessary vancomycin use if your ICU draws routine admission blood cultures. Subscribe on iTunes, Android, or Stitcher A recent before-after study published in Critical Care Medicine studied the diagnostic yield of routine blood culture collection for all nonelective ICU admissions (regardless of infection suspicion). The authors found […]

In this episode, I’ll discuss the use of haloperidol vs ondansetron for Cannabis Hyperemesis Syndrome. Subscribe on iTunes, Android, or Stitcher The mechanism behind Cannabis Hyperemesis Syndrome is unknown. It is a rarely occurring syndrome that seems to be associated with daily cannabis use for at least 1 year. It is a diagnosis of exclusion […]

In this episode, I’ll discuss the use of droperidol for acute agitation in the ED. Subscribe on iTunes, Android, or Stitcher After more than a decade in exile due to FDA black box warnings and medication shortages, droperidol is re-emerging as an option for acute agitation in the emergency department. A comprehensive review to help […]

In this episode, I’ll discuss the treatment of norepinephrine extravasation. Subscribe on iTunes, Android, or Stitcher Central line access is often preferred for vasopressor administration due to the risk of extravasation. Extravasation of a vasopressor such as norepinephrine can cause tissue necrosis and ultimately, the loss of a limb due to local vasoconstriction. The terms […]

In this episode, I’ll discuss stress ulcer prophylaxis recommendations from the AHA’s recent statement on Prevention of Complications in the Cardiac Intensive Care Unit. Subscribe on iTunes, Android, or Stitcher Stress ulcer prophylaxis guidelines are over 20 years old, and there is no sign anymore of an update of the 1999 ASHP guidelines on the horizon. […]