Status Epilepticus Treatment Approach

When a cardiac arrest or trauma activation is called, most people think of physicians, nurses, and respiratory therapists. But what role does the emergency medicine pharmacist play when every second counts? In this episode, we explore the growing evidence behind pharmacists on resuscitation teams, from improving ACLS guideline adherence and reducing medication errors to helping deliver life-saving therapies more quickly. We also discuss what happens behind the scenes during a Code Blue, the specialized training that prepares pharmacists for these high-stakes situations, and the challenges that continue to limit their integration into emergency departments. Whether you're an emergency clinician, pharmacist, learner, or simply curious about how resuscitation teams work, this episode offers an evidence-based look at why pharmacists are becoming an increasingly important part of emergency care. As an emergency medicine pharmacist, this is a topic that is especially meaningful to me and I'm excited to share both the evidence and the real-world perspective behind it.

Restarting blood thinners after an intracranial hemorrhage is one of the most challenging decisions in neurology and stroke care. Restart too early and the risk of recurrent bleeding rises. Wait too long and patients may be left vulnerable to stroke or other thromboembolic complications. In this episode, we break down the latest evidence on when to resume antiplatelet and anticoagulant therapy, why recommendations differ for conditions such as mechanical heart valves and atrial fibrillation, and how factors like hemorrhage location and cerebral amyloid angiopathy shape decision making. We also explore how imaging findings and validated risk assessment tools can help individualize treatment for each patient. Whether you're a neurologist, emergency physician, internist, pharmacist, or trainee, you'll leave with practical, evidence-based strategies to navigate one of the most complex dilemmas in modern neurovascular care.

Your patient has a pulse again, but will your vasopressor choice determine whether they keep it? In this episode, we tackle one of the most common yet underappreciated decisions in post-cardiac arrest care: epinephrine or norepinephrine for post-ROSC hypotension. We break down the physiology of the stunned myocardium, explore why epinephrine may increase the risk of recurrent cardiac arrest, and examine the landmark trials and latest meta-analysis that are reshaping clinical practice. Most importantly, we translate the evidence into practical bedside recommendations you can apply on your very next shift. If you care for critically ill patients in the emergency department, ICU, or anywhere along the resuscitation continuum, this is an episode you won't want to miss.

Sepsis demands timely, effective antimicrobial therapy, but does how we administer beta-lactam antibiotics matter? In this episode, we take a deeper dive into the growing evidence behind prolonged beta-lactam infusion strategies and explore why recent guidelines now recommend extended or continuous infusions for many patients with sepsis and septic shock. We unpack the pharmacokinetic and pharmacodynamic principles, review key clinical trials and meta-analyses demonstrating improved outcomes, and discuss the critical role of an appropriate loading dose. We also examine which patient populations may benefit the most, including those with augmented renal clearance or altered physiology and when therapeutic drug monitoring should be considered. Finally, we tackle the practical challenges of implementing prolonged infusions in clinical practice, from drug stability and IV compatibility to the unanswered questions surrounding antimicrobial resistance.

Ketamine is best known for its roles in analgesia, sedation, and depression, but could it also help patients navigate the most challenging phase of opioid agonist therapy initiation in the fentanyl era? In this episode, we explore the emerging science behind ketamine as an adjunctive treatment for opioid withdrawal and OAT initiation, including its potential effects on NMDA receptors, opioid tolerance, and receptor signaling. We review the latest clinical evidence, from case reports of refractory withdrawal to early studies suggesting improved retention in treatment through rapid relief of depression and withdrawal distress. We'll also unpack the fascinating biology of beta-arrestin, receptor internalization, and whether ketamine may help improve opioid responsiveness by rebalancing some of the neurobiological changes associated with chronic fentanyl exposure. Join us as we separate promise from proof and discuss where ketamine may fit and where it may not in the future of addiction care.