In this episode, I’ll discuss whether ICU patients benefit from daily QTc interval monitoring during antipsychotic use for delirium. Subscribe on iTunes, Android, or Stitcher QTc prolongation is a known side effect of antipsychotic use. While the QTc itself is only a number on a sheet of paper, a prolonged QTc is often used as […]

In this episode, I’ll discuss the effect of unnecessary long-term continuation of newly initiated stress ulcer prophylaxis in the ICU on morbidity and mortality after hospital discharge. Subscribe on iTunes, Android, or Stitcher ICU patients are routinely started on proton pump inhibitor therapy for the purpose of stress ulcer prophylaxis. However, PPI use often continues […]

In this episode, I’ll discuss why glucagon is not recommended in the calcium channel blocker poisoning guidelines. Subscribe on iTunes, Android, or Stitcher Critical Care Medicine has published in 2017 Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. These guidelines list the following first line therapies prioritized based on desired […]

In this episode, I’ll discuss how correction of hypokalemia in a hyponatremic patient makes inadvertent overcorrection of hyponatremia more likely. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Alex” for inspiring this episode! During the correction of hyponatremia, care is taken to not correct the serum sodium too quickly. This is because the […]

In this episode, I’ll discuss adding fludrocortisone to hydrocortisone to treat patients with septic shock. Subscribe on iTunes, Android, or Stitcher There is a discordance in steroid recommendations for patients with septic shock between the Surviving Sepsis Guidelines, which recommend giving hydrocortisone and the 2020 Japanese Clinical Practice Guidelines for Sepsis and Septic Shock which […]

In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation. Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. The only difference between infiltration and extravasation is that the […]

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 […]