The Elective Rotation: A Critical Care Hospital Pharmacy Podcast
The Elective Rotation is a podcast dedicated to critical care and hospital pharmacy practice, created for pharmacy students, residents, pharmacists, nurses, physicians, and critical care practitioners. Hosted by Pharmacy Joe, a Board Certified Pharmacotherapy Specialist, it delivers unbiased clinical content relevant to intensive care units and emergency departments. New episodes are published twice weekly, with show notes available on the official website.
Episodes
1158: Is there a benefit from switching to dexmedetomidine when sedation is started with midazolam?
Show notes at pharmacyjoe.com/episode1158 In this episode, I’ll discuss whether there is a benefit from switching to dexmedetomidine when sedation is started with midazolam.
1157: Sepsis and AFib heart rate differences with phenylephrine vs norepinephrine
Show notes at pharmacyjoe.com/episode1157 In this episode, I’ll discuss differences in heart rate in patients with sepsis and AFib between phenylephrine and norepineprhine.
1156: What is the effect of high-dose versus standard-dose influenza vaccines on hospitalization outcomes and mortality in older adults?
Show notes at pharmacyjoe.com/episode1156 In this episode, I’ll discuss the effect of high-dose versus standard-dose influenza vaccines on hospitalization outcomes and mortality in older adults.
1155: Have We Got the Mechanism of Phenobarbital in Alcohol Withdrawal Wrong?
Show notes at pharmacyjoe.com/episode1155 In this episode, I’ll discuss the use of phenobarbital in severe alcohol withdrawal.
1154: What a Pharmacist Can Do If Malignant Hyperthermia is Suspected Outside of the Operating Room
Show notes at pharmacyjoe.com/episode1154 In this episode, I’ll discuss the pharmacist’s role if malignant hyperthermia is suspected outside of the operating room.
1153: Don’t Use Vitamin C For This Either…
Show notes at pharmacyjoe.com/episode1153 In this episode, I’ll discuss high-dose IV vitamin C to mitigate brain injury and organ dysfunction after out-of-hospital cardiac arrest.
1152: A new urine output cutoff point to identify acute kidney injury in critically Ill patients?
Show notes at pharmacyjoe.com/episode1152 In this episode, I’ll discuss the optimal urine output cutoff point to identify acute kidney injury in critically Ill patients.
1151: The Importance of Light Sedation Starts in the ED
Show notes at pharmacyjoe.com/episode1151 In this episode, I’ll discuss how getting the depth of sedation correct in the ED might reduce mortality rates by half.
1150: Ortho Surgeons Are Going to Read This Study Different Than Pharmacists
Show notes at pharmacyjoe.com/episode1150 In this episode, I’ll discuss rivaroxaban, then aspirin vs aspirin alone for thromboprophylaxis after total knee or hip arthroplasty.
1149: Pharmacists Improve Sepsis Response Team Metrics for Antibiotic Timeliness
Show notes at pharmacyjoe.com/episode1149 In this episode, I’ll discuss the impact of pharmacist involvement on hospital sepsis response teams.
1148: Computer Decision Support to Avoid Awareness with Paralysis in the ED
Show notes at pharmacyjoe.com/episode1148 In this episode, I’ll discuss using clinical decision support to minimize sedation gaps in patients receiving rocuronium for rapid sequence intubation.
1147: If anaphylaxis to sugammadex is so rare, why bother thinking about it?
Show notes at pharmacyjoe.com/episode1147 In this episode, I’ll discuss anaphylaxis to sugammadex.
1146: Does using ABW vs IBW matter for ICU sedative doses?
Show notes at pharmacyjoe.com/episode1146 In this episode, I’ll discuss using actual vs ideal body weight for dosing of sedatives in critically ill patients.
1145: Exactly How Bad is it to Use Dopamine for Shock?
Show notes at pharmacyjoe.com/episode1145 In this episode, I’ll discuss how the use of dopamine for shock affects mortality rates.
1144: More Data That Supports Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia
Show notes at pharmacyjoe.com/episode1144 In this episode, I’ll discuss cefazolin for methicillin-susceptible staphylococcus aureus bacteremia.
1143: How to tell if your ICU patient is at risk for VTE
Show notes at pharmacyjoe.com/episode1143 In this episode, I’ll discuss the risk factors associated with the development of venous thromboembolism in ICU patients.
1142: Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock
Show notes at pharmacyjoe.com/episode1142 In this episode, I’ll discuss sodium bicarbonate for critically ill adult patients with metabolic acidosis and shock.
1141: Non-verbal ICU pain scales do not indicate the severity of pain
Show notes at pharmacyjoe.com/episode1141 In this episode, I’ll discuss whether non-verbal ICU pain scales can indicate the severity of pain.
1140: Get ready to use a lot more tranexamic acid…
Show notes at pharmacyjoe.com/episode1140 In this episode, I’ll discuss an article on the use of tranexamic acid to reduce transfusion in major noncardiac surgery.
1139: Lipid Dose Differs Depending on Drug Causing the Toxicity
Show notes at pharmacyjoe.com/episode1139 In this episode, I’ll discuss the dosing of lipid rescue therapy for LAST vs enteral drug toxicity.
1138: MRSA Nasal Swabs Work, But Only if You Use them…
Show notes at pharmacyjoe.com/episode1138 In this episode, I’ll discuss an article on using MRSA nasal swab testing to optimize pneumonia treatment with empiric vancomycin.
1137: More critical medications are going to be pushed into the prehospital setting
Show notes at pharmacyjoe.com/episode1137 In this episode, I’ll discuss using a heparin bolus in the prehospital setting for patients with STEMI.
1136: Why does ketamine occassionally cause post-induction hemodynamic collapse?
Show notes at pharmacyjoe.com/episode1136 In this episode, I’ll discuss why ketamine can sometimes cause post-induction hemodynamic instability when it is used for rapid sequence intubation.
1135: Norepinephrine vs phenylephrine in traumatic brain injury – which is best?
Show notes at pharmacyjoe.com/episode1135 In this episode, I’ll discuss an article about which vasopressor is best in early traumatic brain injury patients.
1134: IVP Cefepime Pharmacokinetics in Critically Ill Patients With Sepsis Are Highly Variable
Show notes at pharmacyjoe.com/episode1134 In this episode, I’ll discuss an article about the pharmacokinetic and pharmacodynamic properties of IV push cefepime in critically ill patients with sepsis.
1133: Can fondaparinux be useful in critically ill patients with severe renal dysfunction?
Show notes at pharmacyjoe.com/episode1133 In this episode, I’ll discuss an article about using fondaparinux in critically ill patients with severe renal dysfunction.
1132: Beware ketamine infusions in your transplant patients
Show notes at pharmacyjoe.com/episode1132 In this episode, I’ll discuss a case report of the effects of ketamine on the clearance of tacrolimus and sirolimus.
1131: Effects of obesity on SC and IM medication administration
Show notes at pharmacyjoe.com/episode1131 In this episode, I’ll discuss how obesity affects SC and IM medication administration.
1130: A study that proves what we’ve always felt about adenosine 6 vs 12mg for SVT
Show notes at pharmacyjoe.com/episode1130 In this episode, I’ll discuss the use of an initial 6 mg vs 12 mg dose of adenosine for supraventricular tachycardia.
1129: Do we need to worry about torsades from low-dose ondansetron in peri-operative patients?
Show notes at pharmacyjoe.com/episode1129 In this episode, I’ll discuss the incidence of torsades from low-dose ondansetron in perioperative patients.
1128: What is the best vasopressor to use in post-resuscitation shock?
Show notes at pharmacyjoe.com/episode1128 In this episode, I’ll discuss what vasopressor to use in post-resuscitation shock.
1127: Oxacillin seems safer than nafcillin (retrospective data)
Show notes at pharmacyjoe.com/episode1127 In this episode, I’ll discuss an article about the incidence of acute kidney injury with the use of nafcillin versus oxacillin.
1126: How well does nebulized ketamine work for pain compared with IV?
Show notes at pharmacyjoe.com/episode1126 In this episode, I’ll discuss an article about nebulized vs IV ketamine for analgesia in the ED.
1126: Does nebulized ketamine work for pain as well as IV?
Show notes at pharmacyjoe.com/episode1126 In this episode, I’ll discuss an article about nebulized vs IV ketamine for analgesia in the ED.
1125: What are the risk factors for serious and general opioid-related adverse drug events?
Show notes at pharmacyjoe.com/episode1125 In this episode, I’ll discuss an article about risk factors for serious and general opioid-related adverse drug events.
1124: Get ready for patients to come into the ED with vasopressors already infusing
Show notes at pharmacyjoe.com/episode1124 In this episode, I’ll discuss prehospital administration of epinephrine and norepinephrine infusions.
1123: What blood gas parameters indicate possible methemoglobinemia?
Show notes at pharmacyjoe.com/episode1123 In this episode, I’ll discuss what blood gas parameters can make you suspect methemoglobinemia.
1122: Well isn’t that convenient? (Sodium bicarb for severe hyponatremia)
Show notes at pharmacyjoe.com/episode1121 In this episode, I’ll discuss using sodium bicarbonate instead of hypertonic saline to treat severe hyponatremia.
1121: What if it is just the depth of sedation, not the choice of sedative that causes delirium?
Show notes at pharmacyjoe.com/episode1121 In this episode, I’ll discuss what if it is not the sedative class that causes delirium – just the depth of sedation?
1120: Here is something to prioritize for ED patients with Parkinson’s
Show notes at pharmacyjoe.com/episode1120 In this episode, I’ll discuss the importance of timely ordering and administration of antiparkinsonian medications for patients in the ED.
1119: The problem with hypo-osmolar solutions in neurological patients
Show notes at pharmacyjoe.com/episode1119 In this episode, I’ll discuss the problem with hypo-osmolar solutions in neurological patients.
1118: These two sepsis guideline updates will need hospital pharmacists to help implement
Show notes at pharmacyjoe.com/episode1118 In this episode, I’ll discuss the impact two new recommendations in the Surviving Sepsis guidelines on hospital pharmacy practice.
1117: What is the impact of achieving an aggressive PK/PD target for beta-lactams in critically ill patients?
Show notes at pharmacyjoe.com/episode1117 In this episode, I’ll discuss the impact of achieving an aggressive PK/PD target for beta-lactams in critically ill patients.
1116: If the lab can keep secrets from others, maybe the pharmacy should too?
Show notes at pharmacyjoe.com/episode1116 In this episode, I’ll discuss suppressing unnecessary allergy alerts for beta-lactams with dissimilar side chains.
1115: The extremely rare case when a very hypotonic solution may be indicated
Show notes at pharmacyjoe.com/episode1115 In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated.
1114: Saving $$$ With Oral Phosphate Replacement Instead of IV For Critically Ill Patients With Mild to Moderate Hypophosphatemia
Show notes at pharmacyjoe.com/episode1114 In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia.
1113: Ceftriaxone to Prevent Pneumonia After Out of Hospital Cardiac Arrest
Show notes at pharmacyjoe.com/episode1113 In this episode, I’ll discuss the impact of ceftriaxone on the development of pneumonia and noninfectious outcomes after out-of-hospital cardiac arrest.
1112: The Safety and Efficacy of Spraying Stuff Into the Lungs to Prevent Bleeding
Show notes at pharmacyjoe.com/episode1112 In this episode, I’ll discuss endobronchial instillation of epinephrine, cold saline, and saline to prevent bleeding in patients undergoing endobronchial biopsy.
1111: How to judge whether a journal is reputable?
Show notes at pharmacyjoe.com/episode1111 In this episode, I’ll discuss how to judge whether a journal is reputable.
1110: Is it time to rethink oral beta-lactams for some complicated UTI cases?
Show notes at pharmacyjoe.com/episode1110 In this episode, I’ll discuss oral beta-lactams for complicated UTIs.
1109: Is Days of Antibiotic Spectrum Coverage a Better metric for Antibiotic Stewardship?
Show notes at pharmacyjoe.com/episode1109 In this episode, I’ll discuss a novel metric for antibiotic stewardship.
1108: If Your Hospital Does Therapeutic Plasma Exchange, Keep In Mind This Interaction With Enoxaparin
Show notes at pharmacyjoe.com/episode1108 In this episode, I’ll discuss the effects of therapeutic plasma exchange on enoxaparin half-life.
1107: What Makes a Critical Care Pharmacist Take Action – Patient Acuity or Medication Regimen Complexity?
Show notes at pharmacyjoe.com/episode1107 In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity?
1106: New AHA Stroke Guideline Contraindications to Thrombolytics
Show notes at pharmacyjoe.com/episode1106 In this episode, I’ll discuss the 2026 AHA Stroke Guideline changes to how contraindications to thrombolytics are presented.
1105: Does it Matter if You Give Vancomycin Before the Beta-Lactam?
Show notes at pharmacyjoe.com/episode1105 In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin?
1104: Does Taking Beta-Blockers Mean Increased Doses of Epinephrine are Required for Anaphylaxis Treatment?
Show notes at pharmacyjoe.com/episode1104 In this episode, I’ll discuss whether patients taking beta-blockers require increased doses of epinephrine for anaphylaxis.
1103: These Antibiotics Are Really Getting Under My Skin! (Subcutaneous Antibiotics?!)
Show notes at pharmacyjoe.com/episode1103 In this episode, I’ll discuss the use of subcutaneous antibiotics.
1102a: At this single center, linezolid plus serotonergic agents was judged to be likely safe
Show notes at pharmacyjoe.com/episode1102 In this episode, I’ll discuss linezolid-associated serotonin toxicity in patients receiving linezolid and concomitant serotonergic agents.
1101: Inpatient Pharmacist Burnout: How many learners is too many?
Show notes at pharmacyjoe.com/episode1101 In this episode, I’ll discuss the association between number of learners trained per year and rates of burnout among inpatient pharmacists.
1100: Safety of Tenecteplase in Patients With Stroke Mimics
Show notes at pharmacyjoe.com/episode1100 In this episode, I’ll discuss the safety of tenecteplase in patients with stroke mimics.
1099: Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis. Here’s Why:
Show notes at pharmacyjoe.com/episode1099 In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis.
1098: Pharmacists Should Know When Electricity is Better Than Epinephrine
Show notes at pharmacyjoe.com/episode1098 In this episode, I’ll discuss the impact of giving epinephrine before defibrillation to in-hospital cardiac arrest (IHCA) patients with shockable rhythms.
1097: Do All ICU Patients Receiving Antipsychotics for Delirium Need QTc Monitoring?
Show notes at pharmacyjoe.com/episode1097 In this episode, I’ll discuss whether ICU patients benefit from daily QTc interval monitoring during antipsychotic use for delirium.
1096: Why is glucagon not given a strong recommendation to treat beta blocker or calcium channel blocker poisoning?
Show notes at pharmacyjoe.com/episode1096 In this episode, I’ll discuss why glucagon is not given a strong recommendation in the AHA guidelines for cardiopulmonary resuscitation.
1095: Does Routine Magnesium Supplementation in ICU Patients Reduce Tachyarrhythmias?
Show notes at pharmacyjoe.com/episode1095 In this episode, I’ll discuss whether routine magnesium supplementation of ICU patients reduces tachyarrhythmia incidence.
1094: Keep This Trick Up Your Sleeve For Intrathecal Baclofen Withdrawal
Show notes at pharmacyjoe.com/episode1094 In this episode, I’ll discuss a case report on the management of intrathecal baclofen withdrawal.
e1094: Keep This Trick Up Your Sleeve For Intrathecal Baclofen Withdrawal
Show notes at pharmacyjoe.com/episode1094 In this episode, I’ll discuss a case report on the management of intrathecal baclofen withdrawal.
1093: If You Like Half-Dose Alteplase for PE, Here is the Study You’ve Always Wanted
Show notes at pharmacyjoe.com/episode1093 In this episode, I’ll discuss an article comparing half-dose to full-dose alteplase for pulmonary embolism.
1092: Should hot or cold compresses be used to treat extravasation?
Show notes at pharmacyjoe.com/episode1092 In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation.
1091: What is iatrogenic hyperchloremia and what is so bad about it?
Show notes at pharmacyjoe.com/episode1091 In this episode, I’ll discuss iatrogenic hyperchloremia.
1090: Potential reasons for an unexpected positive urine barbituate screen
Show notes at pharmacyjoe.com/episode1090 In this episode, I’ll discuss potential reasons for an unexpected positive urine barbiturate screen.
1089: More support for the IDSA’s position on the CAP guidelines
Show notes at pharmacyjoe.com/episode1089 In this episode, I’ll discuss a study that addresses the controversy over giving patients with viral infections antibiotics in the Community Acquired Pneumonia guidelines.
1088: All My Antibiotics: The CAP Guideline Drama
Show notes at
1087: Make sure newbie hospital pharmacists (and students) know this about vancomycin by multiple routes of administration
Show notes at pharmacyjoe.com/episode1087. In this episode, I’ll discuss whether it is ever appropriate for a patient to be on vancomycin by more than one route of administration.
1086: Having trouble getting IV levetiracetam approved? Try this study…
Show notes at pharmacyjoe.com/episode1086. In this episode, I’ll discuss the efficacy of IV push levetiracetam over slow IV infusions.
1085: Do Neurologically Intact Patients With Traumatic ICH on Anticoagulants Need to be Reversed?
Show notes at pharmacyjoe.com/episode1085. In this episode, I’ll discuss whether the reversal of anticoagulants is necessary for neurologically intact patients with traumatic intracranial hemorrhage.
1084: What patient phenotypes are most affected by delays in antibiotic therapy?
Show notes at pharmacyjoe.com/episode1084. In this episode, I’ll discuss what phenotype of patients are most affected by delays in antibiotic therapy.
1083: Takeaways for the pharmacist on best practices in airway management in critically ill adults
Show notes at pharmacyjoe.com/episode1083. In this episode, I’ll discuss best practices in airway management in critically ill adults.
1082: Can the insulin dose for hyperkalemia be 5 units in overweight patients too?
Show notes at pharmacyjoe.com/episode1082. In this episode, I’ll discuss the dose of insulin to treat hyperkalemia.
1081: Just Because We Can Doesn’t Mean We Should: Anti-Xa Monitoring In VTE Prophylaxis
Show notes at pharmacyjoe.com/episode1081. In this episode, I’ll discuss anti-Xa monitoring of enoxaparin in VTE prophylaxis.
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