In this episode, I’ll discuss bacterial density as a therapeutic indicator for ventilator-associated tracheobronchitis due to pseudomonas. Subscribe on iTunes, Android, or Stitcher Bacterial density refers to how many colony-forming units of bacteria are found in a given culture and is reported as log10 CFU/mL. The bacterial density of Pseudomonas relates to its pathogenicity. Authors in […]

In this episode, I’ll discuss the effects of haloperidol and clonidine on the resolution of delirium in critically ill patients. Subscribe on iTunes, Android, or Stitcher My practice when treating patients with delirium has been to avoid using any medications unless they are necessary for the safety of either the patient or staff members. This has […]

In this episode, I’ll discuss the CDC Recommendations if a patient develops COVID-19 before receiving the 2nd vaccine dose. Subscribe on iTunes, Android, or Stitcher As with most clinical decisions during the current pandemic, CDC recommendations on what to do if a patient gets COVID-19 before receiving their 2nd vaccine dose is based on expert opinion, […]

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

In this episode, I’ll discuss whether a nasal MRSA screen is useful for choosing antibiotics in critically ill patients with an intraabdominal infection. Subscribe on iTunes, Android, or Stitcher A recent multicenter, retrospective, cohort study looking at the performance of a nasal MRSA screen in predicting intraabdominal infection with MRSA was published in the journal Pharmacotherapy. […]

In this episode, I’ll discuss the first update to the Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU. Subscribe on iTunes, Android, or Stitcher Published recently in the journal Critical Care Medicine is the first update to the Surviving Sepsis Campaign Guidelines on the Management of Adults With […]

In this episode, I’ll discuss why hypokalemia can result from digoxin immune fab fragment administration. Please note, in the recording, I call this “episode 588” however it is in fact episode 582. Subscribe on iTunes, Android, or Stitcher In the setting of digoxin toxicity, the sodium-potassium ATPase pump is impaired and potassium shifts from the intracellular […]

In this episode, I’ll discuss a case of antidepressant discontinuation syndrome in the ICU. Subscribe on iTunes, Android, or Stitcher Antidepressant discontinuation syndrome has a significant potential to occur in ICU patients. This could be from unrecognized withdrawal from the antidepressant when home medications are stopped during the initial treatment of critical illness or from […]

In this episode, I’ll discuss awareness with paralysis in the ICU. Subscribe on iTunes, Android, or Stitcher In episode 578 I discussed the ED-AWARENESS study, a single-center, prospective, observational cohort study on 383 mechanically ventilated ED patients that found a 2.6% incidence of awareness with paralysis in ED patients. Recently in Critical Care Medicine a meta-analysis […]

In this episode, I’ll discuss 3 Alternative routes of administration for dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine is an alpha2 adrenergic agonist sedative agent commonly used in the ICU as a continuous IV infusion. However, alternative routes of administration for dexmedetomidine have been studied. In a study of 8 healthy volunteers, dexmedetomidine 1 […]

In this episode, I’ll discuss the frequency of awareness with paralysis in the ED. Subscribe on iTunes, Android, or Stitcher Rapid sequence intubation is a common procedure in the ED. After this procedure where a paralytic such as succinylcholine or rocuronium has been used along with a short-acting sedative such as propofol, ketamine, or etomidate, […]

In this episode, I’ll compare succinylcholine vs rocuronium with magnesium pretreatment. Subscribe on iTunes, Android, or Stitcher Succinylcholine and rocuronium are the two main neuromuscular blockers that are used in rapid sequence intubation. Many clinicians have a strong preference for one or the other based on how they value the small differences between them. Succinylcholine […]