In this episode, I’ll discuss an article comparing half-dose to full-dose alteplase for pulmonary embolism. Subscribe on iTunes, Android, or Stitcher The risk of hemorrhage is the major drawback to therapy with alteplase for any indication. When used for pulmonary embolism, a long-standing research question has been whether 50 mg of alteplase can treat PE […]

In this episode, I’ll discuss how to guarantee you pick a great article for the journal club. Subscribe on iTunes, Android, or Stitcher There are two important criteria that are essential to fulfill when presenting an article to a journal club: 1. The article should be of high quality 2. The article should be relevant […]

In this episode, I’ll discuss which beta-blockers should be dialyzed to treat toxicity. Subscribe on iTunes, Android, or Stitcher   Beta-blocker toxicity is often severe, causing bradycardia, hypotension, and cardiogenic shock.  Beta blockers are responsible for a sizeable portion of fatal poisonings in the US. Supportive therapy is the mainstay of care.  Treatments like high-dose insulin […]

In this episode, I’ll discuss how fluid overload affects the pharmacokinetics of extended infusion meropenem in critically ill patients with sepsis. Subscribe on iTunes, Android, or Stitcher Therapeutic monitoring of beta-lactams has not yet reached everyday practice in most hospitals, owing both to a lack of data and a lack of in-house test results that […]

In this episode, I’ll discuss a pre-planned analysis of long term outcomes of haloperidol use in the Agents Intervening against Delirium in the ICU Trial. Subscribe on iTunes, Android, or Stitcher Back in episode 762 I discussed the AID-ICU trial which was a placebo-controlled randomized blinded trial of 1000 patients with ICU delirium published in NEJM.  Patients […]

In this episode, I’ll discuss the ACEP clinical policy on adult patients presenting to the ED with severe agitation. Subscribe on iTunes, Android, or Stitcher The issue of an extremely agitated patient in an emergency department has significant consequences for all present in the ED. The agitated patient is usually at risk of harming themselves […]

In this episode, I’ll discuss whether it is ever appropriate for a patient to be on oral and IV vancomycin. Subscribe on iTunes, Android, or Stitcher While IV vancomycin is indicated to treat a variety of infectious diseases, oral vancomycin is primarily used to treat C diff infection (CDI). Unlike IV metronidazole, which achieves therapeutic […]

In this episode, I’ll discuss whether the reversal of anticoagulants is necessary for neurologically intact patients with traumatic intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher While intracranial hemorrhage (ICH) has the potential to lead to a catastrophic outcome in patients with traumatic injury who are also taking oral anticoagulants, the reversal of anticoagulation is […]

In this episode, I’ll discuss what phenotype of patients are most affected by delays in antibiotic therapy. Subscribe on iTunes, Android, or Stitcher For patients with sepsis, the link between a delay in antibiotic therapy and increased risk of mortality is well-established. However, it is possible that not all patients are affected the same way […]

In this episode, I’ll discuss the change in serum potassium after supplementation. Subscribe on iTunes, Android, or Stitcher A common estimate for the increase in serum potassium levels is 0.1 mEq/L per 10 mEq of potassium administered. However, there is little data that can support this conversion formula. Therefore a group of authors sought to […]

In this episode, I’ll discuss the unwarranted continuation of antipsychotics after ICU and hospital discharge. Subscribe on iTunes, Android, or Stitcher Although the use of antipsychotics to treat ICU delirium does not have robust patient-focused outcomes data, they are frequently used. Usually antipsychotics are started when a patient with ICU delirium becomes agitated to the […]

In this episode, I’ll discuss anti-Xa monitoring of enoxaparin in VTE prophylaxis. Subscribe on iTunes, Android, or Stitcher An advantage of using enoxaparin for VTE prophylaxis is that it has predictable pharmacokinetics and pharmacodyamics which allow for either fixed dosing of 40 mg subQ once daily or 0.5 mg/kg in the case of obese patients. […]