In this episode, I’ll discuss predicting the chance of successful sedation and the development of hypotension with dexmedetomidine. Subscribe on iTunes, Android, or Stitcher Have you ever noticed that dexmedetomidine seems to be a “hit or a miss” type of sedative? It seems to me to work great for some patients and poorly for others, […]

In this episode, I’ll discuss the most effective and safest therapies for nausea/emesis in adult patients presenting to the emergency department (ED). Subscribe on iTunes, Android, or Stitcher In the Annals of Emergency Medicine a group of authors have published a systematic review and meta-analysis to identify the best medications to use for nausea and […]

In this episode, I’ll discuss a pharmacy-driven rapid bacteremia response program. Subscribe on iTunes, Android, or Stitcher While rapid diagnosis of bacteremia infections is wonderful, nothing matters until the patient actually receives effective antibiotic treatment. However the lag time between laboratory notification, physician order selection, pharmacy verification and dispensing, and nurse administration can be significant […]

In this episode, I’ll discuss tranexamic acid’s effects on mortality for trauma patients based on time given post-injury. Subscribe on iTunes, Android, or Stitcher Trauma guidelines have incorporated giving tranexamic acid within 3 hours of injury, citing the CRASH-2 study as rationale for this recommendation. But the idea that time from injury to treatment matters […]

In this episode, I’ll discuss conditional reflex urine culturing for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Overtreatment of urinary tract infections is a common problem that antimicrobial stewardship teams face. One of the major reasons for this is the overdiagnosis of UTIs. The overdiagnosis leads to overtreatment because providers worry about the rare […]

In this episode, I’ll discuss how often opioid overdose patients also have a benzodiazepine co-exposure. Subscribe on iTunes, Android, or Stitcher When patients who overdose on opioids also have a benzodiazepine co-exposure, they are more likely to experience respiratory failure and less likely to be responsive to naloxone. But how common is co-exposure to benzodiazepines […]

In this episode, I’ll discuss a case report of enoxaparin overdose. Subscribe on iTunes, Android, or Stitcher A group of authors recently published their experience treating an overdose of 900 mg enoxaparin with a protamine bolus and infusion in the American Journal of Health System Pharmacy. There is little data available on managing large enoxaparin […]

In this episode, I’ll discuss the association of long-term proton pump inhibitor use with adverse events in patients with chronic kidney disease. Subscribe on iTunes, Android, or Stitcher Proton pump inhibitors have many important indications, but they are also notorious for sticking around on a patient’s medication regimen long after their indication for use has […]

In this episode, I’ll discuss possible design flaws in a recent study that suggested cefepime has a mortality benefit over piperacillin-tazobactam. Subscribe on iTunes, Android, or Stitcher In a recent issue of JAMA Internal Medicine, a group of authors used instrumental variable (IV) analysis to conclude that the use of cefepime was associated with a […]

In this episode, I’ll discuss converting inpatients from insulin glargine 300 units/mL to insulin detemir 100 units/mL without causing hypoglycemia. Subscribe on iTunes, Android, or Stitcher A 3-month study comparing insulin glargine 300 units/mL (glargine300) to insulin detemir 100 units/mL (detemir100) found that to achieve similar glucose control, with glargine300 needing a roughly 0.07 units […]

In this episode, I’ll discuss the risk factors for not attaining target beta-lactam levels in ICU patients. Subscribe on iTunes, Android, or Stitcher For beta-lactam antibiotics, an adequate time above the MIC is essential to achieve clinical success. However, critically ill patients undergo physiologic changes that may make achieving adequate time above MIC difficult. This […]

In this episode, I’ll discuss early vs delayed norepinephrine use in patients with septic shock. Subscribe on iTunes, Android, or Stitcher The optimal timing of when to start a vasopressor in patients with septic shock is unknown. While early norepinephrine makes intuitive sense, there are many reasons why a clinician may wish to see if […]