In this episode, I’ll discuss the use of phenobarbital in severe alcohol withdrawal. Subscribe on iTunes, Android, or Stitcher Severe alcohol withdrawal is a result of both the lack of GABA activity AND overstimulation of glutamate receptors. While benzodiazepines are considered the first-line treatment option, phenobarbital is used as an adjunct and, in recent years, […]

In this episode, I’ll discuss the pharmacist’s role if malignant hyperthermia is suspected outside of the operating room. Subscribe on iTunes, Android, or Stitcher Malignant hyperthermia is a rare event, occurring in about 1 out of 100,000 administrations of anesthesia. While MH is usually thought of as occurring in the operating room, it can occur […]

In this episode, I’ll discuss high-dose IV vitamin C to mitigate brain injury and organ dysfunction after out-of-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher After initial excitement on the promise of improving outcomes in sepsis with high-dose IV vitamin C, research ended up settling on the idea that vitamin C either did nothing […]

In this episode, I’ll discuss the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients. Subscribe on iTunes, Android, or Stitcher The standard urine output threshold to identify acute kidney injury (AKI) in critically ill patients is 0.5 ml/kg/hr. However, this threshold may be too high. A group of researchers […]

In this episode, I’ll discuss how getting the depth of sedation correct in the ED might reduce mortality rates by half. Subscribe on iTunes, Android, or Stitcher A group of researchers from Washington University School of Medicine in St. Louis published a prospective before-after pilot and feasibility trial of an educational initiative aimed at instituting […]

In this episode, I’ll discuss the impact of pharmacist involvement on hospital sepsis response teams. Subscribe on iTunes, Android, or Stitcher While it makes sense that having someone who focuses on medications on a sepsis response team would lead to faster antibiotic administration times, data supporting this was sparse. That is until a group of […]

In this episode, I’ll discuss using clinical decision support to minimize sedation gaps in patients receiving rocuronium for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis in ED patients who receive the long-acting paralytic rocuronium during rapid sequence intubation but have a delay in receiving adequate sedation is a continuing area […]

In this episode, I’ll discuss anaphylaxis to sugammadex. Subscribe on iTunes, Android, or Stitcher The rate of anaphylactic reaction to the use of sugammadex has historically been put at somewhere between 1 in 2000 and 1 in 4000 patients; however, one article that used population statistics suggests it is more like 1 in 25,000 patients. This […]

In this episode, I’ll discuss using actual vs ideal body weight for dosing of sedatives in critically ill patients. Subscribe on iTunes, Android, or Stitcher The majority of sedative medications used in critically ill patients to allow them to tolerate mechanical ventilation and other aspects of ICU care are lipophilic.  As such, the medications have […]

In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates. Subscribe on iTunes, Android, or Stitcher Surviving Sepsis Guidelines do not list dopamine as one of the vasopressors to use for the treatment of septic shock, and other types of shock are usually treated with non-dopamine vasopressors as well due […]

In this episode, I’ll discuss cefazolin for methicillin-susceptible staphylococcus aureus bacteremia. Subscribe on iTunes, Android, or Stitcher Until recently, the strongest data on what to use to treat MSSA bacteremia has always been for the penicillinase-resistant penicillins like nafcillin and cloxacillin. But these antibiotics have high rates of adverse events. Cefazolin has a much more […]