In this episode, I’ll discuss hemodynamic changes after using a dexmedetomidine loading dose in ED patients. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine has many properties that make it an ideal sedative, such as not causing respiratory depression, having an analgesic sparing effect, and having a reduced risk of delirium. One drawback, however, is the […]

In this episode, I’ll discuss a case report of seizures precipitated by esmolol in sterile water formulation. Subscribe on iTunes, Android, or Stitcher A case report recently published in American Journal of Health-System Pharmacy highlights the potential for a drug diluent to have significant adverse clinical consequences. The case is that of a 34-year-old male […]

In this episode, I’ll discuss aiming for high-normal potassium to reduce sustained ventricular tachycardia in patients with an ICD. Subscribe on iTunes, Android, or Stitcher Both hypokalemia and hyperkalemia are associated with ventricular arrhythmias and sudden death. This is sometimes referred to as a U-shaped association due to the graphical representation of mortality risk vs […]

In this episode, I’ll discuss the SCCM Rapid Sequence Intubation Guidelines. Subscribe on iTunes, Android, or Stitcher The SCCM recently published Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. While any pharmacist that works in a critical care setting should take the time to read these new guidelines, there are […]

In this episode, I’ll discuss recent guidelines about fluid removal in critically ill patients. Subscribe on iTunes, Android, or Stitcher The European Society of Intensive Care Medicine Clinical has published part 3 of its Practice Guideline on fluid therapy in adult critically ill patients, which addresses fluid removal during the de-escalation phase. The title chosen […]

In this episode, I’ll discuss two doses of ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher Low dose ketamine for analgesia is generally considered to be doses of 0.5 mg/kg IV or less. This dose is below the threshold that will cause dissociative anesthesia, and ketamine is considered to have a […]

In this episode, I’ll discuss the rapid administration of antiseizure medications. Subscribe on iTunes, Android, or Stitcher While the antiseizure medications lacosamide, levetiracetam, and valproate were initially labeled to be given via slow IV minibag infusion, evidence has continually been published supporting IV push administration over a few minutes for these medications. However, old habits […]

In this episode, I’ll discuss the effect of phenylephrine push prior to continuous infusion norepinephrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher Push dose vasopressors as a temporizing measure for profound hypotension in critically ill patients is frequently used in many institutions. However the extent of the data for this strategy […]

In this episode, I’ll discuss the optimal dosing regimen for meropenem and piperacillin/tazobactam in critically ill patients receiving continuous renal replacement therapy. Subscribe on iTunes, Android, or Stitcher Achieving adequate antibiotic concentrations over 100% of the dosing interval is particularly challenging for critically ill patients receiving continuous renal replacement therapy. A group of authors recently […]

In this episode, I’ll discuss predicting the chance of successful sedation and the development of hypotension with dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Have you ever noticed that dexmedetomidine seems to be a “hit or a miss” type of sedative? It seems to me to work great for some patients and poorly for others, […]

In this episode, I’ll discuss the most effective and safest therapies for nausea/emesis in adult patients presenting to the emergency department (ED). Subscribe on iTunes, Android, or Stitcher In the Annals of Emergency Medicine a group of authors have published a systematic review and meta-analysis to identify the best medications to use for nausea and […]

In this episode, I’ll discuss a pharmacy-driven rapid bacteremia response program. Subscribe on iTunes, Android, or Stitcher While rapid diagnosis of bacteremia infections is wonderful, nothing matters until the patient actually receives effective antibiotic treatment. However the lag time between laboratory notification, physician order selection, pharmacy verification and dispensing, and nurse administration can be significant […]