In this episode, I’ll discuss how well a negative nasal MRSA screen rules out infection with MRSA. Subscribe on iTunes, Android, or Stitcher Many hospitalized patients are treated empirically with anti-MRSA antibiotics only to have cultures come back negative for MRSA after several days of anti-MRSA therapy. This represents an antibiotic stewardship opportunity if the […]

In this episode, I’ll discuss whether N-acetylcysteine can be used in non-acetaminophen-induced acute liver failure. Subscribe on iTunes, Android, or Stitcher A prospective study of 80 patients of Kashmiri ethnicity with non-acetaminophen-induced acute liver failure was published in 2017 where half of the patients received a 72-hour infusion of IV N-acetylcysteine (NAC )and half served […]

In this episode, I’ll discuss an article about desmopressin effectiveness and safety in patients with antiplatelet-associated intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher Article Retrospective Assessment of Desmopressin Effectiveness and Safety in Patients With Antiplatelet-Associated Intracranial Hemorrhage Lead author: Elizabeth Feldman Published ahead of print in Critical Care Medicine Background Back in episode 51 […]

In this episode, I’ll discuss what dose of steroids can prevent post-extubation stridor. Subscribe on iTunes, Android, or Stitcher Corticosteroid administration before elective extubation has been used to prevent post-extubation stridor and reintubation. Multiple steroid regimens have been studied to prevent post-extubation stridor and re-intubation. No one regimen has been proven superior. Three example regimens […]

In this episode, I’ll discuss whether recent laxative use should preclude testing for C diff. Subscribe on iTunes, Android, or Stitcher The recently updated IDSA C Diff guidelines make the following recommendation: Patients with unexplained and new-onset ≥3 unformed stools in 24 hours are the preferred target population for testing for CDI (weak recommendation, very […]

In this episode, I’ll discuss a tip to predict pharmacotherapy needs in rapid response or emergent situations. Subscribe on iTunes, Android, or Stitcher At the beginning of any rapid response or emergent procedure such as rapid sequence intubation, make a note of your patient’s starting heart rate, rhythm, oxygen saturation, and blood pressure. Any significant […]

In this episode, I’ll discuss the intraosseous route in critically ill adults. Subscribe on iTunes, Android, or Stitcher When a critically ill adult patient needs IV access, but it cannot be obtained, the intraosseous route of administration is a potentially life-saving alternative. The IO route has been well established for use in pediatrics and over […]

In this episode, I’ll discuss the most common triggers for a rapid response call. Subscribe on iTunes, Android, or Stitcher A retrospective multisite cohort study published in Critical Care Medicine October 2019 examined this issue. The article is titled Characteristics of Rapid Response Calls in the United States: An Analysis of the First 402,023 Adult […]

In this episode, I’ll discuss whether DOACs ever require bridging. Subscribe on iTunes, Android, or Stitcher When the only oral anticoagulant available was warfarin, patients who experienced a thromboembolic event required a bridging period with unfractionated or low molecular weight heparin when starting warfarin therapy. The reasons for this bridging are two-fold: 1. In the […]

In this episode, I’ll discuss whether oral vancomycin use for C diff increases the risk of VRE. Subscribe on iTunes, Android, or Stitcher Recent changes to the C diff guidelines moved vancomycin up to first line treatment for C diff infection, regardless of the level of disease severity. Such a large increase in vancomycin use […]

In this episode, I’ll discuss an article about rebound hypertension from dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Article Incidence of Rebound Hypertension after Discontinuation of Dexmedetomidine Lead author: Lauren A. Flieller Published in the journal Pharmacotherapy August 2019 Background Because the sedative dexmedetomidine shares receptor targets with the antihypertensive clonidine, a warning was placed […]

In this episode, I’ll discuss what antibiotic to use in a patient with severe appendicitis and severe penicillin allergy. Subscribe on iTunes, Android, or Stitcher In severe appendicitis, antibiotic coverage is typically broadened to cover: Pseudomonas aeruginosa Enterobacteriaceae Enteric streptococci Anaerobes A carbapenem such as meropenem is the usual choice of therapy to cover all […]