In this episode, I’ll discuss the role for ketamine in status epilepticus. Subscribe on iTunes, Android, or Stitcher The initial therapy for status epilepticus is to use one of the following benzodiazepines: Lorazepam 0.1 mg/kg capped at 4 mg IV Midazolam 0.2 mg/kg capped at 10 mg IM Diazepam 0.15 mg/kg capped at 10 mg […]

This podcast has recently past the 5-year milestone, something that couldn’t be possible without all of the support and kind words of encouragement from you, the listeners of the podcast and readers of the blog. Thank you so much to those that have been there from the beginning, the middle and to those that are […]

In this episode, I’ll discuss the dose of IV levothyroxine used for myxedema coma. Subscribe on iTunes, Android, or Stitcher   Myxedema coma is a rare medical emergency with in-hospital mortality of ~30% When it occurs, myxedema coma is often a result of either: 1. Withdrawal of thyroid therapy or 2. The first sign of thyroid […]

In this episode, I’ll discuss the dose of inhaled tranexamic acid used for nonmassive hemoptysis. Subscribe on iTunes, Android, or Stitcher   Tranexamic acid (TA) is an antifibrinolytic medication. It forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis. Tranexamic acid is commonly used systemically to reduce bleeding in trauma or […]

In this episode, I’ll discuss the duration of DOAC interference with heparin anti-Xa levels. Subscribe on iTunes, Android, or Stitcher DOACs that are Xa inhibitors such as apixaban and rivaroxaban interfere with heparin anti-Xa level monitoring by causing falsely elevated levels. While many references cite this interaction as lasting up to 48-72 hours, I have […]

In this episode, I’ll discuss an injection technique for lidocaine that reduces pain. Subscribe on iTunes, Android, or Stitcher Lidocaine is an anesthetic with a time to onset of about a minute. For this reason, subcutaneous injections of lidocaine can be painful because it has not had a chance to work when the needle puncture […]

In this episode, I’ll discuss the incidence of hypotension for etomidate vs ketamine during rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher Hypotension is an undesirable effect of rapid sequence intubation, and can occur from the medications used to facilitate intubation or from decreased venous return due to positive pressure ventilation. Because ketamine has […]

In this episode, I’ll discuss Bayesian dosing. Subscribe on iTunes, Android, or Stitcher New vancomycin guidelines were published in March 2020. These guidelines have recommended that AUC/MIC be used to monitor vancomycin instead of trough values, and that Bayesian dosing software may be used to dose vancomycin and achieve the desired AUC/MIC. Bayesian dosing is […]

In this episode, I’ll discuss why the new vancomycin guidelines made the switch to AUC/MIC based dosing. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Hany” for inspiring this episode. A trough is only a single point estimate of drug exposure at the end of the dosing interval, while AUC/MIC refers to the […]

In this episode, I’ll discuss alternatives to ampicillin for empiric listeria coverage. Subscribe on iTunes, Android, or Stitcher   Shout out to “Pharmacy Alex” for inspiring this episode. Bacterial meningitis treatment guidelines suggest adding ampicillin for empiric coverage against listeria in patients above age 50, and Swedish guidelines include this coverage for all adults. But […]

In this episode, I’ll discuss a case of drug-induced liver injury in a COVID-19 patient taking remdesivir and a PGP inhibitor. Subscribe on iTunes, Android, or Stitcher   A case report of apparent drug-induced liver injury from remdesivir and PGP inhibitors was published in the journal Clinical Infectious Diseases in June 2020. A 64-year old […]

In this episode, I’ll discuss whether immediate vs early antibiotic administration improves outcomes in severe sepsis. Subscribe on iTunes, Android, or Stitcher For patients with severe sepsis, it is logical to start antibiotic therapy as soon as possible. This concept is supported by studies that show increases in mortality for every hour that antibiotic therapy […]