In this episode, I’ll discuss why vaccines shouldn’t be given in the 14 days immediately post-splenectomy. Subscribe on iTunes, Android, or Stitcher This recommendation is based on a small study of 59 splenectomy patients where vaccine response at 1, 7, and 14 days post-splenectomy were compared. Better functional antibody responses against the serogroup and serotypes […]

In this episode, I’ll discuss 6 ways to develop a clinical pharmacist’s mindset. Subscribe on iTunes, Android, or Stitcher When it comes to having a positive impact on patient care, how a pharmacist thinks can be as important as their knowledge base. This episode is a collection of 6 mindset techniques that I have found […]

In this episode, I’ll discuss the use of alteplase for suspected Impella device thrombosis Subscribe on iTunes, Android, or Stitcher An Impella device provides mechanical circulatory support, and device thrombosis is a potential complication. The purge solution for an Impella device is heparinized but despite this, thrombosis may still occur. A combination of low purge […]

In this episode, I’ll discuss persistent MRSA bacteremia after vancomycin therapy. Subscribe on iTunes, Android, or Stitcher The usual course of treatment for MRSA bacteremia is a minimum of 14 days, and the median time to bacterial clearance is about 7 days. For this reason, IDSA guidelines recommend an assessment to determine whether a change […]

In this episode, I’ll discuss whether levetiracetam, fosphenytoin, or valproate is better for status epilepticus unresponsive to benzodiazepines. Subscribe on iTunes, Android, or Stitcher A recent randomized, blinded, adaptive trial was published in New England Journal of Medicine comparing levetiracetam, fosphenytoin, or valproate in pediatric and adult patients for status epilepticus unresponsive to benzodiazepines. The […]

In this episode, I’ll discuss an article about using thrombolysis during resuscitation for out-of-hospital cardiac arrest caused by pulmonary embolism. Subscribe on iTunes, Android, or Stitcher   Article Thrombolysis During Resuscitation for Out-of-Hospital Cardiac Arrest Caused by Pulmonary Embolism Increases 30-Day Survival Lead author: François Javaudin Published in the journal CHEST December 2019 Background Pulmonary […]

In this episode, I’ll discuss why beta-blockers should be tapered before clonidine. Subscribe on iTunes, Android, or Stitcher For patients taking concomitant beta-blocker and clonidine therapy who require tapering, the recommendation is to taper the beta-blocker first, followed by the clonidine.  The concern if this taper order is not followed is the development of severe […]

In this episode, I’ll discuss cefazolin and ertapenem combination therapy for refractory MSSA bacteremia. Subscribe on iTunes, Android, or Stitcher A recent case series published in Clinical Infectious Diseases describes the successful treatment of 11 patients with persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The authors had an index case where they discovered apparent synergy against […]

In this episode, I’ll discuss why IV phenytoin cannot be diluted lower than 5 mg/mL. Subscribe on iTunes, Android, or Stitcher When it comes time to convincing a clinician to do or not do something, the “why” often becomes very important. This is for good reason, as there are many examples of unnecessary information placed […]

In this episode, I’ll discuss whether adult critically ill patients benefit from inline filters. Subscribe on iTunes, Android, or Stitcher Several studies (1,2,3&4) in pediatric patients have suggested that reducing particles in IV infusions results in positive patient outcomes. Although not all studies have found a benefit, those that have signal a reduction in ICU […]

In this episode, I’ll discuss adjunctive cholestyramine therapy for thyroid storm. Subscribe on iTunes, Android, or Stitcher Both thyroxine (T4) and triiodothyronine (T3) undergo enterohepatic recycling. Cholestyramine is known to bind many medications in the lumen of the GI tract that undergo enterohepatic recycling. Studies of thyrotoxicosis and Grave’s hyperthyroidism have evaluated the effect of […]

In this episode, I’ll discuss whether results from trials that were stopped early are trustworthy. Subscribe on iTunes, Android, or Stitcher The short answer to this question is: It depends on why the trial was stopped early. Perhaps the biggest pitfall is in using evidence from a trial stopped early for benefit. It has been […]