In this episode, I’ll discuss recommendations on the dose of cefazolin for a CNS infection. Subscribe on iTunes, Android, or Stitcher When a CNS infection such as meningitis, ventriculitis, or a brain abscess is due to methicillin susceptible staph aureus, an antistaphylococcal penicillin such as nafcillin has been considered the first-line therapy. With the long […]

In this episode, I’ll discuss a web-based program to estimate vancomycin AUC from a single trough value. Subscribe on iTunes, Android, or Stitcher Vancomycin guidelines published in March of 2020 have recommended AUC based monitoring over trough-based monitoring due to a reduction in AKI events when AUC based monitoring is used. However, methods to dose vancomycin […]

In this episode, I’ll discuss oral antihypertensive timing for hypertensive urgency. Subscribe on iTunes, Android, or Stitcher A hypertensive urgency is defined as a SBP reading of ≥180 mm Hg or DBP reading of ≥120 mm Hg without the presence of any end organ damage (such as but not limited to stroke, pulmonary edema, NSTEMI, […]

In this episode, I’ll discuss the therapeutic monitoring of cefepime to avoid neurotoxicity. Subscribe on iTunes, Android, or Stitcher Cefepime has the potential to cause severe neurotoxicity including seizures, myoclonus, or encephalopathy. The incidence of this neurotoxicity is variable however the risk is increased with excessive dosing or decreased clearance from renal impairment. Because high […]

In this episode, I’ll discuss the IV vs nebulized route for tranexamic acid to treat hemoptysis. Subscribe on iTunes, Android, or Stitcher In the treatment of hemoptysis, tranexamic acid has been given via the IV route and topically via nebulization. These two routes of administration were compared in a randomized controlled trial for the first […]

In this episode, I’ll discuss a scenario where phenylephrine may be a preferred vasopressor. Subscribe on iTunes, Android, or Stitcher Because of poor effects in patients with septic shock, phenylephrine is often thought of as a poor first-line vasopressor choice. However, not all causes of hypotension are equal and there may be circumstances where phenylephrine […]

In this episode, I’ll discuss what dose of norepinephrine is safe for patient mobilization. Subscribe on iTunes, Android, or Stitcher While patient mobilization is important to avoiding complications of an ICU stay, the use of vasopressors like norepinephrine is often perceived as a reason to not mobilize a patient since it indicates hemodynamic instability. A […]

In this episode, I’ll discuss alternatives to etomidate during the shortage. Subscribe on iTunes, Android, or Stitcher Despite there being multiple manufacturers, some institutions are unable to resupply etomidate stock due to shortages at nearly all manufacturers. The most common uses of etomidate are for sedation – either an anesthetic dose for rapid sequence intubation […]

In this episode, I’ll discuss how propofol appears to interfere with monitoring heparin using aPTT. Subscribe on iTunes, Android, or Stitcher Heparin and propofol have been used together in critically ill patients for decades, but is it possible that there has been a lab interference interaction between these two medications the whole time? A group […]

In this episode, I’ll discuss N-acetylcysteine in non-acetaminophen-induced acute liver failure. Subscribe on iTunes, Android, or Stitcher Treatment of acute liver failure with N-acetylcysteine is the first thing that comes to mind if the liver failure is due to acetaminophen. However acute liver failure from causes other than acetaminophen may also respond to treatment with […]

In this episode, I’ll discuss why vaccines aren’t given in the 14 days after non-elective splenectomy. Subscribe on iTunes, Android, or Stitcher This recommendation is based on a small study of 59 splenectomy patients where pneumococcal vaccine response at 1, 7, and 14 days post-splenectomy were compared. Better functional antibody responses against the serogroup and […]

In this episode, I’ll discuss amiodarone vs lidocaine for in-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher The ACLS guidelines suggest either amiodarone or lidocaine for in-hospital cardiac arrest that is due to ventricular tachycardia or ventricular fibrillation (VT/VF). However this recommendation has always been based on data from out-of-hospital cardiac arrest studies. A […]