In this episode, I’ll discuss the ceiling dose of ketorolac for renal colic in the ED. Subscribe on iTunes, Android, or Stitcher The analgesic ceiling dose of ketorolac is 10 mg, and this has been established in several articles going as far back as more than 30 years ago. In 1989, a study in the Journal […]

In this episode, I’ll discuss whether meropenem could theoretically work as an antidote for medications metabolized by UGT. Subscribe on iTunes, Android, or Stitcher One of my favorite antidote stories is octreotide as an antidote for sulfonylureas. Because of octreotide’s mechanism of action inhibiting insulin release from the pancreas, it was successfully applied as an […]

In this episode, I’ll discuss two doses of ketamine for analgesia in the ED. Subscribe on iTunes, Android, or Stitcher Low dose ketamine for analgesia is generally considered to be doses of 0.5 mg/kg IV or less. This dose is below the threshold that will cause dissociative anesthesia, and ketamine is considered to have a […]

In this episode, I’ll discuss the possibility of euglycemic DKA occurring after stopping canagliflozin. Subscribe on iTunes, Android, or Stitcher Shout-out to “Pharmacy Ashley” for inspiring this episode! Sodium-glucose cotransporter-2 (SGLT2) inhibitors are known to carry an increased risk of diabetic ketoacidosis (DKA) which may occur with lower than usual glucose levels, even with euglycemia. […]

In this episode, I’ll discuss the evidence for gastrointestinal cation exchangers other than sodium polystyrene sulfate in acute hyperkalemia. Subscribe on iTunes, Android, or Stitcher In the treatment of acute hyperkalemia, IV calcium provides immediate cardioprotection and allows time for insulin to move potassium into the intracellular space and away from the heart. This is […]

In this episode, I’ll discuss whether balanced crystalloid therapy could lead to faster resolution of DKA than normal saline. Subscribe on iTunes, Android, or Stitcher Fluid resuscitation with normal saline is known to cause more hyperchloremic metabolic acidosis when compared to balanced crystalloid fluids such as lactated ringers. It is physiologically plausible that this difference […]

In this episode, I’ll discuss the recent consensus statement published in CHEST on the Treatment of Community-Acquired Pneumonia in immunocompromised patients. Subscribe on iTunes, Android, or Stitcher Authors in the journal CHEST published a consensus statement on the Treatment of Community-Acquired Pneumonia in immunocompromised patients.  This patient population was left out of the updated IDSA […]

In this episode, I’ll discuss the effect of phenylephrine push prior to continuous infusion norepinephrine in patients with septic shock. Subscribe on iTunes, Android, or Stitcher Push dose vasopressors as a temporizing measure for profound hypotension in critically ill patients is frequently used in many institutions. However the extent of the data for this strategy […]

In this episode, I’ll discuss the available safety and efficacy data of Pfizer’s Covid-19 vaccine. Subscribe on iTunes, Android, or Stitcher On December 11, 2020 the FDA granted an emergency use authorization for Pfizer’s Covid-19 vaccine. A fact sheet for the vaccine is available from the FDA here. Data from the trial used to support […]

In this episode, I’ll discuss the danger of intubation in the setting of salicylate toxicity. Subscribe on iTunes, Android, or Stitcher During salicylate toxicity, the movement of salicylate into brain, liver, and other tissues is exacerbated by a low serum pH. This is because the more acidic the pH, the more salicylate becomes nonionized, and […]

In this episode, I’ll discuss how to predict hypotension from dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine is a popular sedative for use in critically ill patients. Hypotension is a common side effect that may limit the dose or even use of dexmedetomidine in critically ill patients.  Being able to predict hypotension in advance […]

In this episode, I’ll discuss how racemic epinephrine via nebulization is thought to help treat stridor. Subscribe on iTunes, Android, or Stitcher Stridor is an abnormal inspiratory sound and is a sign of airway obstruction that requires immediate attention. Stridor can be caused by a mass or foreign body in the upper airway, or by […]