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Episode 32: Why normal saline makes hyponatremia worse in SIADH
I’ve got to thank a critical care doc I work with – Pulmonology Tony – for taking the time to teach me about hyponatremia from SIADH several years ago.
In this episode I’ll share with you what he taught me and I’ll:
1. Review the pathophysiology of hyponatremia from SIADH
2. Explain how normal saline makes … -
Episode 31: Vanco dosing by AUC:MIC, heparin vs LMWH, and sleep hygiene resources
In this episode, I will:
Review an article about monitoring vancomycin by trough levels
Answer a drug information question: Why do some of my trauma patients get heparin and some enoxaparin for DVT prophylaxis?
Share sleep hygiene resources that I personally use.Article
Vancomycin Trough Concentration as a Predictor of Clinical Outcomes in Patients with Staphylococcus aureus Bacteremia: A Meta-analysis … -
Episode 30: Intravenous lipid emulsion for the treatment of drug toxicity
If you haven’t already joined the Pharmacy Nation slack group where pharmacists collaborate about patient care in real-time, sign up at pharmacynation.org. I hope you join me and the over 70 other Pharmacy Nation members there already!
In this episode I’ll
1. Discuss some cases of using IV lipid emulsion for drug toxicity
2. List which … -
Episode 29: Idarucizumab for dabigatran reversal, rivaroxaban for PE with active cancer, and an evidence based guideline resource
In this episode I will:
1. Review an article about idarucizumab for dabigatran reversal2. Answer a drug information question: “Can I use rivaroxaban to treat a pulmonary embolism (PE) in a patient with active cancer?”3. Share a resource I use that is a collection of evidence based critical care guidelines
Article
Idarucizumab for Dabigatran Reversal
Lead author: Charles V. Pollack
Published … -
Episode 28: Hospital pharmacist pain management tips
In this episode I’ll share how I approach a “Pharmacy Pain Consult” at my hospital. I’ll discuss how I titrate opioid doses when the patient has risk factors for respiratory depression. I’ll also share the 4 most common fixes to inadequate pain management.
I was talking with Andrew, one of our listeners in the free group I created … -
Episode 27: Choice of IV fluids, dexmedetomidine drug fever, and a great resource
In this episode I will:
1. Review an article about the choice of IV fluids in ICU patients 2. Answer a drug information question: “Have you seen dexmedetomidine drug fever?” 3. Share a free resource I use to stay updated with medical literature
Article
Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury (AKI) Among Patients in … -
Episode 26: 2015 Cardiopulmonary resuscitation guidelines update
The American Heart Association cardiopulmonary resuscitation guidelines have been updated for 2015! There are some interesting changes to the guidelines that pharmacists should know about, and I’ll summarize them for you in this episode. I strongly recommend that any pharmacist who is involved in responding to medical emergencies read sections 7, 8, …
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Episode 25: How to dose naloxone for opioid reversal
When it comes to direct antidotes for drug toxicity, there are only a handful. In this episode I’ll talk about how to dose naloxone (Narcan) including when to give a lot, and when to give just a little bit.
Naloxone is a pure opioid antagonist that competes with and displaces opioids at receptor sites. It … -
Episode 24: Mechanical ventilation tips for pharmacists
I’m excited to have my first guest here on The Elective Rotation Podcast. In this episode we’ll be talking with one of the most talented and patient focused respiratory therapists I know. He is also a tremendous advocate for bedside pharmacy services in emergency situations, and he spends a considerable amount of time helping …
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Episode 23: Sensitivity, specificity, and predictive values of medical tests
In this episode, I’ll give real world patient care examples of how to remember and apply the concepts of sensitivity, specificity and predictive value as they relate to medical tests.
I struggled with remembering these concepts for a long time. Then I learned about the mnemonics SpPINS and SnOUTS which really helped me. Here … -
Episode 22: Treatment of methemoglobinemia
Methemoglobinemia is a potentially life-threatening form of functional anemia.
There are two types of methemoglobinemia – congenital and acquired. In this episode I’ll discuss the recognition and treatment of acquired methemoglobinemia.
Background
Methemoglobin is formed when the ferrous irons of heme are oxidized to the ferric state. The ferric hemes of methemoglobin are unable to bind … -
Episode 21: How to participate and give pharmacy recommendations on ICU rounds
In episode 20, I discussed how I prepare for ICU rounds. In this episode I’ll be talking about how ICU rounds are structured and how I participate in ICU rounds, including when and how I present my recommendations.
For context, know that I am in a 20 bed community hospital open medical/surgical ICU. There … -
Episode 20: Preparation for ICU rounds on a critical care pharmacy rotation
Have you already joined the Pharmacy Nation slack group to collaborate and communicate with other pharmacists in real time? If not, request a free invite at pharmacynation.org!
Most of my pharmacy students are surprised that I look at medications last in my pre-rounding review of ICU patients.
I am constantly tweaking and improving my method for … -
Episode 19: When and how to write a pharmacy progress note
Have you already joined the Pharmacy Nation slack group to collaborate and communicate with other pharmacists in real time? If not, request a free invite at pharmacynation.org!
In this episode I’ll share the decision making process I use to decide when and how to write a pharmacy progress note.
When to write a pharmacy progress note?
Not … -
Episode 18: Sedation of the acutely agitated patient when intubation is prohibited
Have you already joined the Pharmacy Nation slack group to collaborate and communicate with other pharmacists in real time? If not, request a free invite at pharmacynation.org!
The methods I am going to discuss in this episode are not first line or even second line therapies for controlling acute agitation. I use them rarely – … -
Episode 17: When to IV push alteplase for massive PE
Have you already joined the Pharmacy Nation slack group to collaborate and communicate with other pharmacists in real time? If not, send yourself an invite at pharmacynation.org!
In this episode I’ll cover when, why, and how to give alteplase for massive pulmonary embolism (PE). I’ll also touch on bleeding risk and whether to stop or … -
Episode 16: How to use ketamine in the critical care setting
Pssst. There’s something special in the audio for today’s show…It’s right at the beginning, so if you are usually reading the blog but not listening to the podcast, be sure to listen to the start of today’s episode!
There is a lot of buzz around the use of ketamine in the critical care setting, … -
Episode 15: Pharmacist role and expectations during endotracheal intubation
If one of us is not already at the bedside, pharmacists at my institution are frequently called by critical care providers to assist with intubation procedures in critically ill patients.
This episode will provide a review of the pharmacists’ role and expectations during intubation of critically ill patients.
We’ll cover the following scenarios in this … -
Episode 14: Sux vs Roc AND Roc doesn’t rock unless a pharmacist is in the house
The debate For over a decade there has been a debate on whether it is better to use succinylcholine (Sux) or rocuronium (Roc) for rapid sequence intubation (RSI) in emergency settings. I’m surprised when reading these debates by the lack of attention given to the time it takes for the patient to receive sedation after …
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Episode 13: Antibiotic dosing in CRRT
In today’s episode we will discuss three topics regarding antibiotic dosing in CRRT (continuous renal replacement therapy).
1. Review CRRT antibiotic dosing rules
2. Review CRRT antibiotic dosing exceptions
3. Discuss the prevelance of antibiotic underdosing in CRRT
The CRRT variant this episode will refer to is CVVHDF, or continuous veno-venous hemodiafiltration as this is the only … -
Episode 12: How to evaluate QTc drug interactions
Evaluating QTc drug interactions
Prolonged QTc interval leading to torsades. It is the adverse medication event that keeps pharmacists awake at night. In this episode I will explain how, as a hospital-based pharmacist, I evaluate drug interactions that carry the risk of QT prolongation.
This is an area of my practice that I struggled … -
Episode 11: Making patient focused risk:benefit assessments
Why Is My Patient In the ICU and How Sick Are They?
The topic for today’s show is PharmacyJoe-ism #7: Making patient focused risk benefit assessments. My ability to do this greatly improved when I started to explicitly and on a basic level think about why a patient was in the ICU to … -
Episode 10: The pharmacist and the ECG should be friends
As the expert in drug therapy, you need to know how different drugs exert their effects on the electrical system of the heart.
Pharmacist review of the ECG is relatively straight forward compared to other professions. We should be able to identify the rhythm, look for signs of drug toxicity, and calculate a … -
Episode 9: How to talk like a physician and get a physician to listen like a pharmacist – verbal communication tips for hospital pharmacists
Today I’m going to pull the curtain back and show you how I trained myself to have successful verbal communications with physicians, and get my interventions accepted. We’ll go over:
Expected acceptance rates
First impressions of your conversation
Planning out your conversation
What to do when the physician comes to you with a questionHaving the right idea on how to …
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Episode 8: Empiric antibiotic selection in the adult medical ICU
So much of antibiotic selection has to do with local resistance patterns, and it cannot be protocolized or generalized without that knowledge.
That said I believe there are some principles of antibiotic selection in the ICU that are worth discussing in general terms. A big shout out to pharmacist Sokhak & physician Mary for suggesting this … -
Episode 7: 7 tips on how to stay current with medical literature
Here are my 7 tips for how to stay current with medical literature:
Pharmacist Letter / Subscriber’s Letter
Pubmed Alerts on saved searches
Electronic delivery of journal table of contents
Utilize your medical librarian
Listen to a podcast
Discuss new articles with other healthcare providers
Run a journal clubPharmacist’s Letter / Prescriber’s Letter
I’ve been a subscriber to Pharmacist letter for over 12 years. They … -
Episode 6: Alternatives to phentolamine for vasopressor extravasation
Update: Phentolamine is available again!
Another one bites the dust.Phentolamine is no longer manufactured
Phentolamine has now made ASHP’s list of drugs no longer available.
This information is critical to communicate to emergency medicine and critical care practitioners, as the risk:benefit of peripheral vasopressor therapy changes without the availability of this extravasation antidote.
This doesn’t change my any port in a … -
Episode 5: Vasopressors in shock – A review for PGY-1 pharmacy residents
Shock is the syndrome that results when the cardiovascular system fails to maintain adequate tissue perfusion.
The treatment goal is to maintain hemodynamics while the cause of shock can be addressed.
Fluids, vasopressors, and inotropes are the essential parts of the treatment of shock.
Today we’ll focus on the vasopressors norepinephrine, vasopressin, epinephrine, dopamine, and phenylephrine.
For more details, find … -
Episode 4: Push dose pressors: Use them once, shame on me. Use them twice, shame on you!
Push Dose Pressors, They’re Not Just For Anesthesia Anymore!
I like preventing the complications of profound hypotension as much as anyone. Really, I do.
It’s why I suggest you focus so much on anticipating patient and provider needs during an emergency situation.
It’s why I suggest you put a norepinephrine drip in your pocket whenever hypotension can reasonably … -
Episode 3: Pharmacists as members of the rapid response team
Welcome! Today we are talking about pharmacist participation on rapid response teams. According to the wikipedia definition (don’t tell my professors I referenced that site!):
A rapid response team (RRT) is a team of health care providers that responds to hospitalized patients with early signs of clinical deterioration on non-intensive care units to prevent respiratory or … -
Episode 2: Pharmacist response to code blue continued
In this episode we are continuing discussing pharmacist response to code blue calls.
We’ll wrap up a few things from episode 1 and review the ACLS cardiac arrest algorithm.
We ended episode one with the following:
At the start of the code open and assemble an epinephrine syringe Obtain 6 NS flushes and prepare them for immediate use … -
Episode 1: Patients will die less often if a pharmacist responds to code blue calls
Why should Pharmacy Nation respond to code blue calls?
It’s simple. Patients will die less often. To the tune of 12,880 reduced deaths in 2007, p=0.009 according to: Bond, C. A. and Raehl, C. L. (2007), Clinical Pharmacy Services, Pharmacy Staffing, and Hospital Mortality Rates. Pharmacotherapy, 27: 481–493. doi: 10.1592/phco.27.4.481 Even without any data I still think you should be there …