The Elective Rotation: A Critical Care Hospital Pharmacy Podcast

Show notes at pharmacyjoe.com/episode100. In this episode I ll: 1. Discuss a new guideline on Acute kidney injury in ICU patients. 2. Answer the drug information question What do you think about IV push antibiotics in sepsis?” 3. Share a resource for creating workflow diagrams.

Show notes at pharmacyjoe.com/episode100

In this episode I’ll discuss my ICU workflow as a critical care pharmacist. I'll also share how I orient PGY-1 pharmacy residents to my critical care pharmacy rotation.

Workflow

There is a basic workflow to the critical care pharmacy rotation, and I’ve captured it in a diagram using the tool draw.io.

Other than assigned projects, the tasks performed by students and residents on rotation come down to:

Show notes at pharmacyjoe.com/episode99. In this episode I ll: 1. Discuss a new guideline on Acute kidney injury in ICU patients. 2. Answer the drug information question What do you think about IV push antibiotics in sepsis?” 3. Share a resource for creating workflow diagrams.

Show notes at pharmacyjoe.com/episode99

In this episode I’ll:

1. Discuss a new guideline on Acute kidney injury in ICU patients.

2. Answer the drug information question “What do you think about IV push antibiotics in sepsis?"

3. Share a resource for creating workflow diagrams.

Article

Acute kidney injury in the perioperative period and in intensive care units (excluding renal replacement therapies)

Lead author: Carole Ichai

Published April 2016 in Anaesthesia Critical Care & Pain Medicine

French critical care and nephrology societies have published recommendations for acute kidney injury in the perioperative period and in intensive care units. These guidelines use the GRADE method to rate the strength of the recommendations.

I’ve selected the recommendations that involve medications for discussion in this episode.

Show notes at pharmacyjoe.com/episode98. In this episode I’ll discuss whether there is a pro-ketamine bias in the FOAMed community.

Show notes at pharmacyjoe.com/episode98

In this episode I'll discuss whether there is a pro-ketamine bias in the #FOAMed community.

Click here if you'd like to help me pick the title for my new book about inpatient medical emergencies for pharmacists.

Ketamine is a uniquely useful drug. I discussed the use of ketamine in critical care in episode 16.

Ketamine checks a lot of boxes and fills a lot of niches. Analgesia? Check. Sedation? Check. Respiratory drive maintained? Check. Neutral to positive cardiovascular effect? Check.

Ketamine is a very popular subject within the #FOAMed world on twitter.

When I asked on twitter whether ketamine in inpatient critical care was under utilized or overrated, I got a lopsided result:

Show notes at pharmacyjoe.com/episode97. In this episode I’ll: 1. Discuss an article about sedation choice and infection risk. 2. Answer the drug information question “Is phentolamine superior to terbutaline for treatment of extravasation?” 3. Share a resource for crowd-sourced medical lecture notes.

Show notes at pharmacyjoe.com/episode97

In this episode I'll:

1. Discuss an article about sedation choice and infection risk.

2. Answer the drug information question "Is phentolamine superior to terbutaline for treatment of extravasation?"

3. Share a resource for crowd-sourced medical lecture notes.

Article

The Relationship Between Sedatives, Sedative Strategy, and Healthcare-Associated Infection: A Systematic Review

Lead Author: Daniel A. Caroff

Published early online in Infection Control & Hospital Epidemiology

Background

There is a good deal of research on the link to sedative regimens with complications like delirium, but not on other complications like infection. A recent topic of conversation in the Pharmacy Nation Slack group was

Show notes at pharmacyjoe.com/episode96. In this episode I ll discuss the use of magnesium sulfate in critical care.

Show notes at pharmacyjoe.com/episode96

In this episode I’ll discuss the use of magnesium sulfate in critical care.

Shout out to listener “Pharmacy Alex” for suggesting this topic!

When I think of magnesium in critical care, 3 uses come to mind:

1. Prevention of recurrent eclamptic seizures

2. Adjunctive therapy in life-threatening asthma exacerbations

3. Treatment of torsades / polymorphic ventricular tachycardia

Prevention of recurrent eclamptic seizures

Magnesium sulfate IV is the drug of choice for prevention of recurrent eclamptic seizures. Efficacy of magnesium for this indication was established by The Eclampsia Trial Collaborative Group. 1687 women with eclampsia were recruited into an international multicentre randomized trial comparing magnesium vs phenytoin and magnesium vs diazepam. Women allocated magnesium sulphate had a 52% lower risk of recurrent convulsions than those allocated diazepam. Women allocated magnesium sulphate had a 67% lower risk of recurrent convulsions than those allocated phenytoin.

Mechanism

The specific mechanism by which magnesium prevents recurrent eclamptic seizures is