In this episode, I’ll discuss an article about hypotension from ketamine for rapid sequence intubation. Subscribe on iTunes, Android, or Stitcher Hypotension is an undesirable effect of rapid sequence intubation, and can occur from the medications used to facilitate intubation or from decreased venous return due to positive pressure ventilation. Because ketamine has a side effect profile […]

In this episode, I’ll discuss an article about TOF monitoring vs clinical assessment only in ARDS patients on NMBAs. Subscribe on iTunes, Android, or Stitcher The SCCM Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patients give a weak recommendation that peripheral nerve stimulators with train-of-four monitoring may be a useful tool for monitoring […]

In this episode, I’ll discuss the optimal sedation strategy in patients with ARDS who receive NMBAs. Subscribe on iTunes, Android, or Stitcher The two large trials regarding neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS) (ACURASYS and ROSE) produced ambiguous results regarding the utility of NMBAs in these patients. One possibility […]

In this episode, I’ll discuss whether the sugammadex-contraceptive interaction is being adequately considered in practice. Subscribe on iTunes, Android, or Stitcher Sugammadex is a γ-cyclodextrin that was designed to bind rocuronium and vecuronium for the purpose of reversing paralysis from these neuromuscular blocking medications. The prescribing information includes information that sugammadex may interfere with the […]

In this episode, I’ll discuss whether diuretics are safe to reduce fluid balance in critically ill patients. Subscribe on iTunes, Android, or Stitcher Interest in fluid balance and the associated adverse effects in ICU patients has grown considerably over the last decade. The general practice of reducing fluid balance, sometimes referred to as deresuscitation, is […]

In this episode, I’ll discuss 5 steps an ED or ICU pharmacist can take to prevent awareness with paralysis. Subscribe on iTunes, Android, or Stitcher Awareness with paralysis occurs when a patient receives a paralytic for rapid sequence intubation but does not receive ongoing sedation before the induction agent wears off. In the context of […]

In this episode, I’ll discuss recent expert recommendations regarding the use of dialysis to treat isoniazid poisoning. Subscribe on iTunes, Android, or Stitcher When taken in excess, isoniazid can cause severe toxicity, primarily in the form of seizure. Isoniazid inhibits pyridoxine metabolism and conversion of glutamate to GABA. This creates two problems that lead to […]

In this episode, I’ll play an excerpt from one of my Hospital Pharmacy Academy trainings on using the Seagull Sign to identify a patient at risk of clinical deterioration. Subscribe on iTunes, Android, or Stitcher . You can get access to the full-length training as well as more than 150 other practical hospital pharmacy trainings, […]

In this episode, I’ll discuss the latest trial on vitamin C, thiamine, and hydrocortisone for sepsis. Subscribe on iTunes, Android, or Stitcher Using vitamin C, thiamine, and hydrocortisone to treat septic shock was heralded as a cure to sepsis by authors of a 2016 retrospective article. I reviewed this article back in episode 177. Unfortunately, subsequent […]

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, […]