In this episode, I’ll discuss lactic acidosis from epinephrine. Subscribe on iTunes, Android, or Stitcher Epinephrine is a treatment for disease states that can cause elevated lactate such as anaphylaxis and sepsis, but epinephrine also has a known side effect of raising lactic acid levels. This leaves clinicians having to determine whether elevated lactate after […]

In this episode, I’ll discuss 10 tips for providing effective feedback to PGY-1 residents. Subscribe on iTunes, Android, or Stitcher When providing feedback, choose a location where both parties will be comfortable openly speaking.  This may be done on the unit as long as others are not actively listening, but be especially sensitive to giving […]

In this episode, I’ll discuss giving lactated ringer’s solution to a patient with elevated lactate. Subscribe on iTunes, Android, or Stitcher Lactated ringers is considered a suitable fluid for resuscitation in sepsis.  In fact, it is becoming more common to use it as a resuscitation fluid as it contains a more physiologic level of chloride […]

In this episode, I’ll discuss an article about IV push piperacillin-tazobactam. Subscribe on iTunes, Android, or Stitcher Article Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department Lead author: William Blake Hays Published in American Journal of Health-System Pharmacy May 2020 Background Piperacillin/tazobactam is typically administered via IV piggyback over 30 minutes or […]

In this episode, I’ll discuss mannitol extravasation. Subscribe on iTunes, Android, or Stitcher When given as a bolus, mannitol is an osmotic diuretic that does not cross the blood-brain barrier. Mannitol lowers intracranial pressure by osmotically drawing free water out of the brain and into circulation where it can be eliminated. If given as a continuous infusion, mannitol […]

In this episode, I’ll discuss an article about hydroxychloroquine for prophylaxis after high-risk Covid-19 exposure. Subscribe on iTunes, Android, or Stitcher Article A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 Lead author: David R. Boulware Published in: New England Journal of Medicine June 2020 Background With in vitro data suggesting that hydroxychloroquine has […]

In this episode, I’ll discuss the use of sugammadex in myasthenia gravis patients undergoing thymectomy. Subscribe on iTunes, Android, or Stitcher A group of authors in Japan recently analyzed the association between the use of sugammadex and postoperative myasthenic crisis in patients with myasthenia gravis using a national inpatient database. 506 patients who received sugammadex […]

In this episode, I’ll discuss the Chest authors’ guidelines on the prevention, diagnosis, and treatment of venous thromboembolism in patients with COVID-19. Subscribe on iTunes, Android, or Stitcher The Chest Guideline authors have published a set of recommendations on the prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19. The following are some […]

In this episode, I’ll discuss high-dose insulin euglycemic therapy in the treatment of a patient with massive caffeine overdose. Subscribe on iTunes, Android, or Stitcher Many cardiotoxic medication overdoses appear to respond to high dose insulin euglycemia therapy, including beta-blockers, calcium channel blockers, and tricyclic antidepressants. The practice of high dose insulin euglycemia therapy involves […]

In this episode, I’ll discuss the two scenarios where asymptomatic bacteriuria (ASB) is treated with antibiotics in adult patients. Subscribe on iTunes, Android, or Stitcher Considerable focus has appropriately been placed on reducing unnecessary antibiotic use in patients with otherwise asymptomatic bacteriuria. However, there are a few scenarios in which treatment with antibiotics is considered […]

In this episode, I’ll discuss whether a pacemaker or implanted cardiac defibrillator (ICD) protects from medication-induced torsades. Subscribe on iTunes, Android, or Stitcher Shout out to Pharmacy Jeremy and Pharmacy Marci for inspiring this episode! While implantable cardiac devices are given to patients with long QT syndrome and other arrhythmias, there is no data on […]

In this episode, I’ll discuss why you can’t use the Naranjo algorithm in the setting of drug overdose. Subscribe on iTunes, Android, or Stitcher Shout out to “Toxicology Dave” on Twitter for highlighting this issue. The Naranjo Adverse Drug Reaction Probability Scale (commonly referred to as the Naranjo Scale) attempts to apply objective criteria to answer […]