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Join Eric and Will Heuser, PharmD, discussing “The Influence of Low pH on Efficacy of Critical Care Pharmacology.” Changes in acid-base balance have a profound influence on many aspects of the action of drugs. This is illustrated by data on the absorption of drugs from the stomach and intestine, changes in the distribution of drugs…

Shock is the final common pathway before death. No matter what the etiology or insult to the human body, we all will enter into a state of shock that reduces oxygen delivery to the point that cells die, then tissues die, organs become dysfunctional, then organ systems fail, and finally the whole machinery of human…

Ketamine is a non-barbiturate dissociative anesthetic originally synthesized in the 1960s. In lower doses, ketamine acts as a potent analgesic, causing it to be adapted to manage pain during the Vietnam War.(1,2) Ketamine acts as an N-methyl-D-aspartate (NMDA) receptor antagonist. NMDA receptors are a type of glutamate receptor, which bind with glutamate, the principal excitatory…

This article is the first of a series of three articles about managing adult patients with diabetic ketoacidosis (DKA). This patient population can be quite challenging for even the most seasoned provider. Indeed, DKA is characterized by unique physiology that includes, amongst other things, severe fluid deficit and mild to severe metabolic acidosis. This patient…

Since its North American debut in 2018, TikTok has dominated the teenage social media market. In 2022, a survey reported that 67% of American teenagers have used TikTok and 16% report use multiple times a day.[1] With its 60 to 120 second videos, TikTok allows users to record and upload video clips on almost any…

On the surface, these are not bad triggers for airway management, but they do not engage clinicians to evaluate the situation in its entirety. The astute clinician can recognize that there are obviously more than 4 notable triggers and that these decisions are made along a spectrum of “forced to act” to “elective.” The decision…

Clinical Scenario: You respond as an ALS ambulance to a local dialysis center for a middle-aged male with altered mental status. Upon arrival, you find a conscious male being gently held in his dialysis chair by staff members. They report the patient was partially through his dialysis treatment when he developed acute delirium. Medical History…

Overview A 27-year-old woman arrived at the emergency room late at night, her face crumpled in pain. She reported feeling sick this morning and vomiting, but that didn’t strike her as unusual as her young children have had stomach flu the last few days. Since then, she has had severe and acute neck and head…