In this episode, I’ll discuss an article comparing IV acetaminophen with IV hydromorphone for acute pain in elderly ED patients. Subscribe on iTunes, Android, or Stitcher IV acetaminophen has been a tremendous disappointment when compared to opioids in terms of both efficacy and reducing opioid-related side effects. I have not yet seen a study demonstrating […]

In this episode I’ll, discuss an article about using buprenorphine as an antidote in methadone overdose. Subscribe on iTunes, Android, or Stitcher While naloxone is the standard treatment for opioid overdose, it does have two significant limitations when treating respiratory depression from methadone overdose. First, naloxone will precipitate opioid withdrawal in opioid-dependent patients and patients […]

In this episode, I’ll discuss nebulized tobramycin for bronchiectasis from pseuduomonas. Subscribe on iTunes, Android, or Stitcher Bronchiectasis is a chronic airway infection with exacerbations that can cause increases in sputum production/purulence, cough, hemoptysis, respiratory distress, and fatigue. The focus of treatment for an exacerbation is usually on the reduction of bacterial load which then […]

In this episode, I’ll discuss whether a quinolone is really superior to a macrolide for legionella pneumonia. Subscribe on iTunes, Android, or Stitcher In this episode, I’ll discuss macrolides vs. fluroquinolones for legionella pneumonia. Traditionally it is thought that a bacteriocidal antibiotic is preferable to a bacteriostatic one, especially in severe infections such as legionella […]

In this episode, I’ll discuss empiric vs pre-emptive antifungal therapy. Subscribe on iTunes, Android, or Stitcher The current standard of care for high-risk neutropenic patients with persistent fever is to start empiric antifungal therapy. This is done because the potential of missing a fungal infection in such patients can be catastrophic, so some unnecessary antifungal […]

In this episode, I’ll discuss a study about a restrictive fluid strategy for patients with sepsis presenting to the emergency department. Subscribe on iTunes, Android, or Stitcher For over 2 decades aggressive fluid resuscitation has been a mainstay of treatment recommendations for patients with sepsis. And while there is little debate that strict fluid restriction […]

In this episode, I’ll discuss whether the manner of tranexamic acid application changes the effectiveness for epistaxis. Subscribe on iTunes, Android, or Stitcher Epistaxis in ED patients is first treated with topical measures (usually a vasoconstrictor), and if it is unsuccessful, treatment progresses to anterior packing. Anterior packing has risks including toxic shock syndrome and the […]

In this episode, I’ll discuss how a pharmacist can ensure the best possible outcomes for status epilepticus. Subscribe on iTunes, Android, or Stitcher Whenever I encounter a hospital inpatient with an acute seizure, I make sure that I have IV lorazepam available. Most seizures stop after about 2 minutes. In reality, this means that by […]

In this episode, I’ll discuss an article that suggests the vancomycin – piperacillin-tazobactam AKI interaction is just pseudotoxicity. Subscribe on iTunes, Android, or Stitcher For many years there have been publications suggesting an association between the combination of vancomycin and piperacillin-tazobactam and the development of acute kidney injury. Studies that draw this conclusion typically compare […]

In this episode, I’ll discuss a company-sponsored indirect comparative study looking at andexanet alfa vs 4 factor prothrombin complex concentrate (4FPCC) for the reversal of apixaban- or rivaroxaban-associated intracranial hemorrhage. Subscribe on iTunes, Android, or Stitcher There are two methods used for reversing acute major bleeding from factor Xa inhibitors: 1. Prothrombin Complex Concentrate (PCC), […]

In this episode, I’ll discuss whether the bispectral index (BIS) correlates well to commonly used sedation scales. Subscribe on iTunes, Android, or Stitcher Bispectral index is commonly used by anesthesia providers as a tool to ensure adequate loss of consciousness in the operating room and lessen the chance of accidental awareness during anesthesia. The use […]

In this episode, I’ll discuss what works best for toxin-related status epilepticus. Subscribe on iTunes, Android, or Stitcher While benzodiazepines are first line treat for status epilepticus, they do not work in as many as one-third of patients. Early termination of convulsive status epilepticus is important because it lowers the chance of cardiac and respiratory […]