Lightnews — Scholar-powered news

LightNews

Austin Camp

@austincamp.bsky.social

860 followers 230 following 290 posts

Critical Care PharmD, BCCCP; Associate Professor of Pharmacy Practice; Surgical/Medical ICU

Posts Media Videos Starter Packs

Pinned

Austin Camp @austincamp.bsky.social · Nov 22

Attempting to make my first starter pack that includes both critical care and emergency medicine pharmacists! I have worked as both and think in a lot of ways we’re two sides of the same coin.

Please reply if you want to be added!

go.bsky.app/Hcx3iQ2

Austin Camp @austincamp.bsky.social · 1d

As a reminder, egg 🥚 and soy 🌱 allergies are NOT contraindications to propofol! (see previously shared pharmacy education board)

Thanks for reading and please share YOUR thoughts on BZD use in the ICU! 🙏

bsky.app/profile/aust...

Austin Camp @austincamp.bsky.social · May 6

Can you safely use propofol in patients with egg or soy allergies? See the answer below in my latest #PharmacyEducationBoard

Austin Camp @austincamp.bsky.social · 1d

What about when non-BZD sedatives are contraindicated?

While there are FEW contraindications to dexmedetomidine and propofol, in patients with proven (or at high risk of) intolerance due to bradycardia 💓 and hypotension 🩸 CONSIDER a BZD

Austin Camp @austincamp.bsky.social · 1d

What about patients with anxiety in the ICU?

Per the 2025 PADIS Update: There is insufficient evidence to make a recommendation on use of BZDs to treat anxiety 🤷‍♂️

HOWEVER if a patient takes BZDs for chronic anxiety, consider continuing these when appropriate to avoid withdrawal

Austin Camp @austincamp.bsky.social · 1d

CONSIDER the use of BZDs when a patient has a specific comorbidity where they may be preferred agents.

For example:
- Alcohol withdrawal 🥃
- Status epilepticus 🫨
- Overdose from a stimulant or sympathomimetic 🥵

(don't come at me phenobarbital truthers, I'm with you!)

Austin Camp @austincamp.bsky.social · 1d

We ALL know dexmedetomidine (Precedex) and propofol (Diprivan) are preferred over benzodiazepines in ICU patients requiring sedation (shoutout PADIS guidelines).

BUT (as there are exceptions to every rule) here are some situations to "consider" BZDs. 🧐

Keep reading below! 👇

Austin Camp @austincamp.bsky.social · 2d

Only 10 days until the 2025 ACCP Annual Meeting in Minneapolis! Who else is going to be there? 🙋‍♂️

Bonus points if you can share some touristy things to do/places to eat… 🙏

Austin Camp @austincamp.bsky.social · 11d

An ICU rounds convo…

Me: Can we reduce duration of ABX to 7 days?

Them: Isn’t 10-14 more appropriate for gram (-) bacteremia?

Me: Per the BALANCE trial, a 7-day course of ABX was non-inferior to 14 days.

Them: Is this in guidelines yet?

Me: …

What would YOUR response be??

Austin Camp @austincamp.bsky.social · 28d

Name that drug!

Austin Camp @austincamp.bsky.social · Sep 8

Whether a guideline recommends "50 mg q6h," "200 mg continuously," or "<400 mg/day" of hydrocortisone for septic shock, these all match the physiologic amount of cortisol the adrenal glands (are supposed to) release during stress.

Thanks for reading!

8/8

Austin Camp @austincamp.bsky.social · Sep 8

Therefore, hydrocortisone dosing (or equivalent) may be labeled as follows:

Low-dose: 25-200 mg/day
Stress-dose: 200-350 mg/day
Supra-physiologic dose: 351 to 1,000 mg/day
High-dose: >1,000 mg/day

7/8

Austin Camp @austincamp.bsky.social · Sep 8

The non-stressed daily production of cortisol (hydrocortisone) in adults is approximately 15-25 mg/day.

The maximal stressed daily production of cortisol (hydrocortisone) is approximately 200-350 mg/day.

6/8

Austin Camp @austincamp.bsky.social · Sep 8

The steroid doses recommended in septic shock are often referred to as stress doses.

A common mistake I see in learners is to equate “stress” doses and “high” doses.

Stress doses are meant to equal the human body’s normal physiologic response to stress/critical illness.

5/8

Austin Camp @austincamp.bsky.social · Sep 8

In the setting of septic shock, relative or absolute adrenal insufficiency is common.

Cortisol secretion and metabolism is impaired, resulting in a prolonged pro-inflammatory state that can further impact organ dysfunction, infection, and mortality.

4/8

Austin Camp @austincamp.bsky.social · Sep 8

Modern guidelines recommend the use of hydrocortisone in patients with septic shock.

However, recommendations on the optimal dosing, timing of initiation, and duration of use may vary depending on which guideline you look at.

3/8

Austin Camp @austincamp.bsky.social · Sep 8

First of all, cortisol is a steroid hormone. It is produced by the adrenal glands and has a variety of functions.

Hydrocortisone is a synthetic form of cortisol commonly used in the ICU. It has been studied for decades with the most common indication for use being sepsis.

2/8

Austin Camp @austincamp.bsky.social · Sep 8

How many of us working in the ICU use the term "stress dose steroids" daily but are unsure where the term comes from?

For me, I learned how to order hydrocortisone well before I understood “why” these doses were used.

Read below for a quick thread on stress dose steroids!

1/8

Austin Camp @austincamp.bsky.social · Sep 5

I’m with you but it is certainly a touchy subject! It feels like these types of parents are also the same ones who blame vaccines, etc for how their children are.

Austin Camp @austincamp.bsky.social · Sep 4

More money in selling your soul

Austin Camp @austincamp.bsky.social · Aug 28

Austin Camp @austincamp.bsky.social · Aug 25

Sorry albumin, ICU pharmacists ACTUALLY reduce mortality 🤓👏💊

journals.lww.com/ccmjournal/f...

Effect of Comprehensive Medication Management on Mortality... : Critical Care Medicine

ional, propensity-matched cohort study. Setting: Adult ICUs at the Oregon Health Sciences University. Patients: Consecutive adults admitted to an ICU greater than or equal to 24 hours between Ju...

journals.lww.com

Austin Camp @austincamp.bsky.social · Aug 17

“So, pharmacists can also work in hospitals.”

Austin Camp @austincamp.bsky.social · Aug 17

Anyone have a good article on natural versus vaccine-induced immunity? Thanks! 🙏

Austin Camp @austincamp.bsky.social · Aug 15

Technically an avocado is a berry! 🤓

But it TOTALLY counts in my book! 🥑🥑🥑

Austin Camp @austincamp.bsky.social · Aug 15

I agree with those as general “exceptions” to consider!

Of course every patient/scenario is unique but let’s face it, in the vast majority of hypotension/shock, norepinephrine is what we grab first

Austin Camp @austincamp.bsky.social · Aug 14

When is the answer to “which vasopressor should we use?” NOT norepinephrine? 🤔

Share your answers below! 👇