In this episode, I’ll discuss the incidence of hypotension for etomidate vs ketamine during 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 […]

In this episode, I’ll discuss Bayesian dosing. Subscribe on iTunes, Android, or Stitcher New vancomycin guidelines were published in March 2020. These guidelines have recommended that AUC/MIC be used to monitor vancomycin instead of trough values, and that Bayesian dosing software may be used to dose vancomycin and achieve the desired AUC/MIC. Bayesian dosing is […]

In this episode, I’ll discuss why the new vancomycin guidelines made the switch to AUC/MIC based dosing. Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Hany” for inspiring this episode. A trough is only a single point estimate of drug exposure at the end of the dosing interval, while AUC/MIC refers to the […]

In this episode, I’ll discuss alternatives to ampicillin for empiric listeria coverage. Subscribe on iTunes, Android, or Stitcher   Shout out to “Pharmacy Alex” for inspiring this episode. Bacterial meningitis treatment guidelines suggest adding ampicillin for empiric coverage against listeria in patients above age 50, and Swedish guidelines include this coverage for all adults. But […]

In this episode, I’ll discuss a case of drug-induced liver injury in a COVID-19 patient taking remdesivir and a PGP inhibitor. Subscribe on iTunes, Android, or Stitcher   A case report of apparent drug-induced liver injury from remdesivir and PGP inhibitors was published in the journal Clinical Infectious Diseases in June 2020. A 64-year old […]

In this episode, I’ll discuss whether immediate vs early antibiotic administration improves outcomes in severe sepsis. Subscribe on iTunes, Android, or Stitcher For patients with severe sepsis, it is logical to start antibiotic therapy as soon as possible. This concept is supported by studies that show increases in mortality for every hour that antibiotic therapy […]

In this episode, I’ll discuss new compatibility information for IV hydrocortisone infusions. Subscribe on iTunes, Android, or Stitcher Current Surviving Sepsis Campaign Guidelines recommend giving hydrocortisone 200 mg per day to patients with septic shock and inadequate response to vasopressor therapy. This is typically administered in one of two ways: 1. Intermittent bolus doses of […]

In this episode, I’ll discuss lactic acidosis from epinephrine. Subscribe on iTunes, Android, or Stitcher Epinephrine is a treatment for disease states that can cause elevated lactate such as anaphylaxis and sepsis, but epinephrine also has a known side effect of raising lactic acid levels. This leaves clinicians having to determine whether elevated lactate after […]

In this episode, I’ll discuss 10 tips for providing effective feedback to PGY-1 residents. Subscribe on iTunes, Android, or Stitcher When providing feedback, choose a location where both parties will be comfortable openly speaking.  This may be done on the unit as long as others are not actively listening, but be especially sensitive to giving […]

In this episode, I’ll discuss giving lactated ringer’s solution to a patient with elevated lactate. Subscribe on iTunes, Android, or Stitcher Lactated ringers is considered a suitable fluid for resuscitation in sepsis.  In fact, it is becoming more common to use it as a resuscitation fluid as it contains a more physiologic level of chloride […]

In this episode, I’ll discuss an article about IV push piperacillin-tazobactam. Subscribe on iTunes, Android, or Stitcher Article Safety and tolerability of i.v. push piperacillin/tazobactam within an emergency department Lead author: William Blake Hays Published in American Journal of Health-System Pharmacy May 2020 Background Piperacillin/tazobactam is typically administered via IV piggyback over 30 minutes or […]

In this episode, I’ll discuss mannitol extravasation. Subscribe on iTunes, Android, or Stitcher When given as a bolus, mannitol is an osmotic diuretic that does not cross the blood-brain barrier. Mannitol lowers intracranial pressure by osmotically drawing free water out of the brain and into circulation where it can be eliminated. If given as a continuous infusion, mannitol […]