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.

In this episode, we dive into the clinical nuances of using gabapentin and pregabalin for chronic neuropathic pain. Join us as we unpack the evolving approach to gabapentinoid prescribing, including key pharmacologic differences, practical dose limitations, and when to consider switching therapies. Learn why doses of gabapentin above 1800 mg/day may not provide added benefit...and how pregabalin’s consistent absorption and greater binding affinity might offer an effective alternative, even with cost considerations. Whether you're a clinician or simply curious about pain management, this episode brings evidence-based insights to the forefront.

In this episode, we explore how a targeted approach to neurotransmitters such as serotonin, dopamine, and acetylcholine, can optimize antiemetic therapy. We break down key safety concerns for commonly used agents, including QT prolongation with ondansetron, extrapyramidal effects from metoclopramide and phenothiazines, and anticholinergic risks with diphenhydramine. Tune in for practical tips to balance efficacy and safety in managing nausea and vomiting across clinical settings.

In today’s episode, we explore the updated approach to managing status epilepticus. We walk through a practical, stepwise treatment strategy starting with benzodiazepines, followed by ketamine, and then anti-epileptics like levetiracetam and lacosamide. We also cover recommended intubation and general anesthetic choices for refractory cases, emphasizing the importance of early airway management. Stay tuned to sharpen your emergency care skills and improve outcomes for patients facing seizures.

In this episode, we dive into the PREVENT CLOT trial, which compared aspirin to low-molecular-weight heparin (LMWH) for thromboprophylaxis in orthopedic trauma. While the study found aspirin to be noninferior in preventing all-cause mortality, some clinicians raise concerns about its limited generalizability. We break down the findings, the controversy, and what it all means for real-world practice, especially in higher-risk patients. Tune in for a balanced look at evidence-based prophylaxis and the importance of individualized care.

In this episode, we dive into the evolving practice of administering intravenous (IV) push antibiotics, a method gaining traction across emergency departments and outpatient antimicrobial programs. Prompted in part by IV fluid shortages during natural disasters, healthcare providers have increasingly embraced IV push for its speed, efficiency, and potential to reduce hospital stays. We explore what the evidence says about safety, cost savings, and patient outcomes, and discuss the clinical considerations that guide when and when not to use this approach. From resource-strapped EDs to home-based care, IV push antibiotics are reshaping antimicrobial delivery. But is faster always better? Tune in as we unpack the data and practical implications.

In this episode, we explore a groundbreaking case report introducing a novel approach to buprenorphine induction for patients with Opioid Use Disorder, especially those using fentanyl. Learn how low-dose intravenous naloxone is used to safely trigger moderate withdrawal, allowing for immediate buprenorphine initiation and dramatically shortening the induction timeline. Tune in to hear how this protocol could change the way we manage OUD in acute care settings.

This episode covers practical, evidence-informed strategies for reversing anticoagulant and antiplatelet medications in critical bleeding scenarios, including intracerebral hemorrhage. We review reversal protocols for warfarin, dabigatran, and Factor Xa inhibitors, and discuss the roles of PCC, FFP, DDAVP, and tranexamic acid. Key pitfalls in reversal therapy are examined, along with guidance on tailoring interventions to individual patients.

In this episode, we break down how to assess liver injury and understand its impact on drug therapy. We explore the difference between liver enzymes and true liver function tests, why normal labs can be misleading in cirrhosis, and how impaired hepatic metabolism affects drug efficacy and toxicity. Tune in for practical insights on adjusting medications safely in patients with liver dysfunction.

This episode takes a deep dive into the fundamentals of medication overdose management in hospital and critical care settings. We explore the four key pillars of treatment: supportive care, antidotes, decontamination, and enhanced elimination...highlighting why supportive care often makes the greatest impact. You’ll also learn key clinical pearls and considerations to guide decision-making and navigate the limited landscape of antidotes. A must-listen for pharmacists and healthcare professionals facing toxicologic emergencies on the front lines.

This episode highlights the vital role of emergency pharmacists during high-stakes resuscitations such as cardiac arrests and trauma codes. We explore how their involvement improves patient outcomes by reducing medication errors, ensuring accurate dosing, and contributing to rapid clinical decision-making. Backed by research, we also discuss the importance of targeted training programs that go beyond standard life support, equipping pharmacists with the skills and confidence needed to excel in these fast-paced, high-pressure environments. From managing crash carts to anticipating medication needs, emergency pharmacists are a critical, but often overlooked, part of the code team. As an emergency medicine pharmacist, this topic is deeply personal...I’ve seen how timely medication support and clinical decision-making can make a life-saving difference during high-stakes resuscitations. Tune in to learn how empowering pharmacists can make a life-saving difference!

In this episode, we dive into the complex issue of diuretic resistance in congestive heart failure (CHF), focusing especially on loop diuretics. We break down how these medications work, why they sometimes stop working, and the physiological mechanisms behind resistance including post-diuretic sodium retention, the braking phenomenon, and cardiorenal syndrome. You'll also hear about evidence-based strategies to overcome resistance, from dietary interventions and dosing adjustments to combination diuretic therapy. Whether you're a clinician or a curious learner, this episode will help you understand why diuretics fail...and what to do about it.