In this episode, I’ll discuss whether non-verbal ICU pain scales can indicate the severity of pain. Episode 941: Can non-verbal ICU pain scales indicate the severity of pain? Subscribe on iTunes, Android, or Stitcher The use of pain assessments for patients who are unable to verbally communicate are recommended in the SCCM Pain, Agitation & Delirium Guidelines. 2 examples of such assessments are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT). The Behavioral Pain Scale (BPS) examines 3 domains giving 1 to 4 points on each domain for a range in score ..read more

In this episode, I’ll discuss whether tranexamic acid has a role in the treatment of aneurysmal subarachnoid hemorrhage. Subscribe on iTunes, Android, or Stitcher Tranexamic acid is an antifibrinolytic agent that inhibits the conversion of plasminogen to plasmin. This results in the inhibition of fibrinolysis and should promote the stabilization of a clot that is forming in response to a bleed. Because this mechanism is not directly prothrombotic, tranexamic acid is generally considered to have less of a clotting risk than other strategies like the administration of clotting factors. While ear ..read more

In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity. Episode 939: Lipid Rescue Dosing for LAST vs Enteral Drug Toxicity Subscribe on iTunes, Android, or Stitcher Intravenous lipid emulsion (ILE) or “lipid rescue” therapy is used in local anesthetic systemic toxicity (LAST) and enteral drug toxicity. Anesthesia, toxicology, and ACLS guidelines recommend intravenous fat emulsion with various levels of evidence. Ever since the American College of Medical Toxicology published a position statement in 2016, the recommended dosing of lipid emulsion has b ..read more

In this episode, I’ll discuss the chance of cardiovascular toxicity from bupropion overdose. Episode 938: Can you predict the chance of cardiovascular event from bupropion overdose? Subscribe on iTunes, Android, or Stitcher Bupropion overdose carries a risk of cardiovascular toxicity however the onset is often delayed. This presents an additional risk to patients if they are incorrectly presumed to be of low cardiac toxicity risk and have reduced monitoring. Traditional factors for identifying patients with bupropion overdose who are at high risk of cardiac toxicity are standard predictors as ..read more

In this episode, I’ll discuss the suppression of antimicrobial susceptibility results. Episode 937: Is your micro lab hiding susceptibility data from you? Subscribe on iTunes, Android, or Stitcher When a hospital microbiology laboratory performs antimicrobial susceptibility testing using microdilution or disk diffusion methods, not all of the results are presented to clinicians in the medical record. Some of the data is ‘suppressed’ meaning the micro lab has the data but it is not forward-facing in the medical record. There are several reasons why this is routinely done for example: The antimi ..read more

In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation. Episode 936: Why does ketamine for RSI sometimes cause post-induction hemodynamic instability? Subscribe on iTunes, Android, or Stitcher While ketamine is often considered a hemodynamically neutral induction agent for rapid sequence intubation, there are reports of post-induction hypotension and hemodynamic collapse occurring occasionally with ketamine use. For example, in the study I referenced back in episode 672 comparing ketamine and etomidate ..read more

In this episode, I’ll discuss an article about which vasopressor is best in early traumatic brain injury patients. Episode 935: What vasopressor is best to use in traumatic brain injury? Subscribe on iTunes, Android, or Stitcher Patients who have severe traumatic brain injury and develop hypotension that requires vasopressor therapy are already at risk for mortality and poor long term outcomes. But could the choice of vasopressor affect these outcomes? Is the preferred vasopressor for septic and cardiogenic shock (norepinephrine) also good in early severe traumatic brain injury patients? A gro ..read more

In this episode, I’ll discuss an article about using fondaparinux in critically ill patients with severe renal dysfunction. Episode 934: Fondaparinux in critically ill patients with severe renal dysfunction Subscribe on iTunes, Android, or Stitcher   Evaluating options for venous thromboembolism (VTE) prophylaxis in critically ill patients is challenging and many issues can limit options including renal failure, bleeding risk, and thrombocytopenia. Fondaparinux use is often limited in critically ill patients due to its contraindication in severe renal dysfunction (SRD). The authors of a 2 ..read more

In this episode, I’ll discuss tenecteplase for stroke from 4.5 to 24 hours after the time last know well. Episode 933: Can tenecteplase be used for acute ischemic stroke beyond 4.5 hours from time last know well? Subscribe on iTunes, Android, or Stitcher While the use of thrombolytics for patients with acute ischemic stroke is usually done if the patient presents within 4.5 hours of the time last know well, data specifically with tenecteplase beyond the 4.5 hour window is sparse. A group of authors recently published a randomized controlled trial in New England Journal of Medicine involving ov ..read more

In this episode, I’ll discuss recent articles regarding stress ulcer prophylaxis. Episode 932: Major Developments in Stress Ulcer Prophylaxis Evidence Subscribe on iTunes, Android, or Stitcher The use of acid-suppressing agents to prevent the development of stress ulcers has been an area of intense research as the exact benefits and harms of this strategy in the context of modern ICU care is uncertain. Several articles have recently been published in New England Journal of Medicine to provide clarity on this topic. The first is a large randomized controlled multicenter trial of nearly 5000 cri ..read more