In this episode, I’ll discuss whether a pacemaker or implanted cardiac defibrillator (ICD) protects from medication-induced torsades. Subscribe on iTunes, Android, or Stitcher I’ve heard clinicians make this argument several times in my career – that because a patient has a pacemaker or ICD, a QTc prolonging drug interaction has little or no risk compared […]

In this episode, I’ll discuss oral sedation strategies for young patients presenting to the ED with acute severe behavioral disturbance. Subscribe on iTunes, Android, or Stitcher When treating children and adolescents who present to the ED with acute behavioral disturbances, the American Association for Emergency Psychiatry states: There is consensus that PO administration should be […]

In this episode, I’ll discuss 3 types of ICU patients and why they matter for making patient-focused risk:benefit assessments. Subscribe on iTunes, Android, or Stitcher I find that I make better patient focused risk:benefit assessments when I start off by figuring out the answer to the following question: Why is my patient in the ICU? […]

In this episode, I’ll discuss some possible negative effects of using low-dose ketamine to achieve an opioid-sparing effect in critically ill patients. Subscribe on iTunes, Android, or Stitcher Using a low-dose ketamine infusion has been recommended by recent sedation guidelines for the purpose of reducing opioid consumption. This is however a surrogate outcome that may […]

In this episode, I’ll discuss the impact of compounded oral vancomycin liquid on hospital readmission for C diff infection. Subscribe on iTunes, Android, or Stitcher The drug acquisition cost for oral vancomycin capsules is several orders of magnitude larger than for liquid vancomycin prepared from the IV formulation and given via the oral route. This […]

In this episode, I’ll discuss time to positivity as a predictor of catheter-related bacteremia and mortality in adults with Pseudomonas aeruginosa bloodstream infection. Subscribe on iTunes, Android, or Stitcher Two metrics are emerging as predictors of catheter-related infection with Pseudomonas as well as mortality risk: 1. Time to positivity, which is the time from when […]

In this episode, I’ll discuss whether delayed broad-spectrum antibiotics have an impact on clinical outcomes. Subscribe on iTunes, Android, or Stitcher From my experience with antimicrobial stewardship efforts, the biggest reason for overly broad antibiotic coverage is what I call the “what if” factor. What if it really is Pseudomonas even though risk factors might […]

In this episode, I’ll discuss why the NKF says its OK to use race-free eGFR to make renal dose adjustments. Subscribe on iTunes, Android, or Stitcher A Consensus workgroup of the National Kidney Foundation has just published in the American Journal of Health-System Pharmacy a consensus document title Moving forward from Cockcroft-Gault creatinine clearance to […]

In this episode, I’ll discuss the use of methylene blue for the treatment of refractory anaphylaxis without hypotension. Subscribe on iTunes, Android, or Stitcher Methylene blue has some unique uses such as in the treatment of acquired methemoglobinemia and vasoplegia after cardiac surgery.  It also appears to have a role in treating patients experiencing anaphylaxis […]

In this episode, I’ll discuss whether the Tisdale Risk Score can be used to identify ICU patients at risk of QTc prolongation. Subscribe on iTunes, Android, or Stitcher The Tisdale Risk Score (TRS) was first published in 2013 as a way to identify hospitalized patients at risk for QT interval prolongation. The scoring system assigns […]

In this episode, I’ll discuss when dialysis is recommended to be used to treat ethylene glycol poisoning. Subscribe on iTunes, Android, or Stitcher The metabolites of ethylene glycol (glycolate and oxalate) are responsible for the development of metabolic acidosis, neurotoxicity, acute kidney injury, and mortality. Fomepizole effectively blocks the development of these toxic metabolites and […]

In this episode, I’ll discuss when octreotide can be discontinued in patients with variceal bleeding. Subscribe on iTunes, Android, or Stitcher When given to patients with variceal bleeding, octreotide helps achieve hemostasis and prevent rebleeding. While it is a relatively inexpensive intervention at between $50 and $100 per day, octreotide does carry a high incidence […]