Managing anticoagulation in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is a complex clinical challenge. In this episode, we explore the delicate balance between preventing venous thromboembolism (VTE) and minimizing bleeding risks in this vulnerable population. We discuss the evolving role of direct oral anticoagulants (DOACs), including the limited and often controversial evidence supporting their use in ESRD, alongside the continued relevance of warfarin. Drawing on guideline recommendations, observational studies, and emerging research on novel agents such as Factor XI inhibitors, we highlight the nuances of decision-making and the importance of individualized therapy. Whether you’re a clinician, researcher, or learner, this episode provides a concise yet comprehensive look at where the field stands and where it’s headed.

What if treating diabetic ketoacidosis didn’t always require IV drips, ICU beds, or long hospital stays? In this episode, we explore the SQuID protocol, a cutting-edge approach that uses subcutaneous insulin for mild to moderate DKA. Evidence shows it can safely resolve DKA, speed up recovery, and free up critical hospital resources...all while keeping outcomes comparable to traditional treatment. We’ll also discuss the important limitations, safety considerations, and the steps needed before this approach can be widely adopted. Tune in to hear how SQuID could transform the way we manage DKA.

When every second counts, speed matters. But how fast is too fast when it comes to giving intravenous antiseizure medications? In this episode, we dive into the latest research on rapid administration of lacosamide, levetiracetam, and valproate. From intravenous push to piggyback infusions, we break down what the data says about safety, side effects, and real-world efficiency. Join us as we explore how faster medication delivery could reshape emergency seizure care and what hospitals need to consider before making the switch.

https://academic.oup.com/ajhp/advance-article-abstract/doi/10.1093/ajhp/zxaf214/8237247?redirectedFrom=fulltext&login=false

Dive into the world of pharmacology as we explore how warfarin interacts with antibiotics at a molecular level. This episode highlights the crucial role of CYP2C9 metabolism in regulating S-warfarin and explains why certain antibiotics, like metronidazole and fluconazole, can significantly impact INR levels. We also unpack the challenge of separating true drug-drug interactions from infection-driven effects, giving you a clear look at the science behind these complex interactions. Perfect for pharmacists, clinicians, and anyone fascinated by how drugs work in the body.

Tranexamic acid (TXA) has been hailed as a game-changer in bleeding management...but does the evidence really support its widespread use? In this episode, we dive into the research behind TXA across multiple clinical settings: trauma, surgery, postpartum hemorrhage, GI bleeds, intracranial hemorrhage, and more. We explore landmark trials like CRASH-2 and CRASH-3, discuss why small positive studies don’t always translate into meaningful patient outcomes, and unpack the nuances of timing, context, and risk. Join us as we separate hype from evidence and ask the big question...where does TXA truly belong in emergency medicine?

In this episode, we dive into a groundbreaking exploratory analysis from the Annals of Emergency Medicine examining the PATCH-Trauma trial. Researchers investigated the optimal timing for administering tranexamic acid (TXA) to patients with severe trauma, challenging the long-standing 3-hour window established by the CRASH-2 trial. The findings are striking...giving TXA within 90 minutes of injury significantly reduces 28-day mortality, while administration after 120 minutes may offer no benefit... Join us as we explore how these results could reshape trauma care guidelines and highlight the critical role of time-sensitive interventions in saving lives.

Ali A, Gruen RL, Bernard SA, Burns B, Forbes AB, Gantner DC, McArthur CJ, Maegele M, Mitra B; PATCH-Trauma trial investigators. Tranexamic Acid Timing and Mortality Impact After Trauma. Ann Emerg Med. 2025 Aug 1:S0196-0644(25)00989-8. doi: 10.1016/j.annemergmed.2025.06.609. Epub ahead of print. PMID: 40751727.

https://www.annemergmed.com/article/S0196-0644(25)00989-8/fulltext?rss=yes

BRASH syndrome is more than the sum of its parts. In this episode, we unpack this complex clinical entity defined by bradycardia, renal failure, AV node blocker use, shock, and hyperkalemia...and explore how these factors create a dangerous, self-perpetuating cycle. You’ll learn how to distinguish BRASH from isolated hyperkalemia or AV blocker toxicity, understand the synergistic physiology behind its rapid progression, and discover a multimodal treatment approach that targets every component at once. From volume management to bradycardia support and electrolyte correction, we’ll walk through practical strategies to break the cycle and improve patient outcomes. Whether you’re in emergency medicine, critical care, or just curious about complex pathophysiology, this episode delivers the knowledge you need to act fast and think comprehensively.

In this episode, we explore an innovative approach to managing congestive heart failure (CHF) in the Emergency Department: the use of a patient-directed, weight-based sliding scale furosemide plan. This strategy empowers patients to adjust their diuretic dose based on daily weight changes, aiming to improve self-management, reduce ED visits, and prevent hospital admissions. We also examine the role of a sliding scale furosemide plan in enabling patients to proactively and promptly adjust their dose, helping to address and offset the burden on an overstretched healthcare system, particularly in emergency settings.

What exactly qualifies as insomnia...and how does it differ from the occasional restless night? In this episode, we unpack the clinical definition of insomnia and demystify key sleep science terms like sleep latency, total sleep time, and sleep efficiency. We explore the far-reaching impacts of chronic insomnia on both physical and mental health, before guiding you through evidence-based treatment strategies. Tune in for a comprehensive look at pharmacologic options including Dual Orexin Receptor Antagonists (DORAs), Benzodiazepines, BRAs, melatonin agents, antidepressants, and antihistamines...along with their mechanisms, uses, and side effect profiles. Whether you're a clinician or a curious listener, this episode offers clear, concise insights into managing insomnia safely and effectively.

Patients with hepatic cirrhosis are uniquely at risk for both bleeding and clotting, making anticoagulation decisions complex. In this episode, we explore how cirrhosis alters coagulation, the pros and cons of LMWH, warfarin, and DOACs, and why INR isn’t a reliable guide. We also discuss the challenges of managing anticoagulation around procedures and how to individualize therapy in the face of limited evidence. Whether you're in training or practice, this is a must-listen for navigating one of medicine’s most nuanced dilemmas.