The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has evolved into an emergent global pandemic. Coronavirus disease 2019 (COVID‐19) can manifest on a spectrum of illness from mild disease to severe respiratory failure requiring intensive care unit admission. As the incidence continues to rise at a rapid pace, critical care teams are faced with challenging treatment decisions. There is currently no widely accepted standard of care in the pharmacologic management of patients with COVID‐19. Urgent identification of potential treatment strategies is a priority. Therapies include novel agents available in clinical trials or through compassionate use, and other drugs, repurposed antiviral and immunomodulating therapies. Many have demonstrated in vitro or in vivo potential against other viruses that are similar to SARS‐CoV‐2. Critically ill patients with COVID‐19 have additional considerations related to adjustments for organ impairment and renal replacement therapies, complex lists of concurrent medications, limitations with drug administration and compatibility, and unique toxicities that should be evaluated when utilizing these therapies. The purpose of this review is to summarize practical considerations for pharmacotherapy in patients with COVID‐19, with the intent of serving as a resource for health care providers at the forefront of clinical care during this pandemic.

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Heparin‐induced thrombocytopenia (HIT) is a rare, potentially life‐threatening condition secondary to unfractionated heparin or low molecular weight heparin exposure. This immune‐mediated drug reaction manifests as thrombocytopenia with a paradoxical hypercoagulable state that can result in life‐threatening thrombosis. It is imperative to ensure cessation of heparin‐based products as soon as HIT is identified. Traditional treatment options include argatroban, bivalirudin, fondaparinux, and danaparoid with a transition to warfarin upon platelet recovery. These anticoagulants are notwithstanding limitations including parenteral administration and routine laboratory monitoring leading to prolonged hospitalizations, emphasizing the need for new therapies. Direct oral anticoagulants (DOACs) have been increasingly investigated for the management of HIT and may overcome the aforementioned challenges of current therapies. The objective of this narrative review is to summarize the current HIT guidelines, discuss limitations to contemporary treatment options, provide insight into the emerging evidence for the DOACs rivaroxaban, apixaban, and dabigatran, and conclude with a clinical summary for their use in this setting. The PubMed, Google Scholar, and MEDLINE databases were searched for peer‐reviewed literature from January 1, 2012, to June 31, 2018. Twenty‐seven articles met inclusion criteria for review: 1 prospective trial, 5 retrospective cohort studies, and 21 case reports totaling 104 patients treated with a DOAC for HIT. The DOACs prevented new and recurrent thrombosis in 98% (n=102) of cases, and bleeding complications occurred in 3% (n=3). While current literature remains limited, it is suggestive of a potential role of DOACs for HIT, which has led to their integration into the 2018 American Society Hematology Guidelines with a conditional recommendation.

Topic This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults. Clinical Relevance Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations. Purpose of Paper The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology. The nurse’s clinical and laboratory assessments of each patient help define the goals of fluid therapy, which will in turn be used to determine the optimal patient-specific selection and dose of fluid for administration. Nurses serve a vital role in monitoring the safety and efficacy of intravenous fluid therapy. Although this intervention can be lifesaving, inappropriate use of fluids has the potential to yield detrimental effects. Content Covered This article discusses fluid physiology and the goals of intravenous fluid therapy, compares the types of intravenous fluids (isotonic crystalloids, including 0.9% sodium chloride and balanced salt solutions; hypotonic and hypertonic crystalloids; and colloids) and their adverse effects and impact on hemodynamics, and describes the critical care nurse’s essential role in selecting and monitoring intravenous fluid therapy.

IntroductionInfographics, an abbreviated term for informational graphics, are visual representations of complex ideas or concepts. They have long played a role in the dissemination of ideas from various fields, such as business and arts. However, infographics have had an increasing role in the health care field and medical education, both for professionals and patients. To date, there is limited evidence on the use of infographics in the pharmacy profession. Conversely, the evidence is emerging for their use in other health care fields as an innovative strategy for education, dissemination of research, and public information.ObjectivesIn this narrative review, we aim to summarize the basic principles of infographic design, the role of infographics in education and research dissemination, and the role of amplifying audience reach through sharing infographics on social media.MethodsMedline and Google Scholar databases were searched for articles between 1969 and 2020 relating to infographics, healthcare, research and education then screened by all authors for their relevance to pharmacy practice.ResultsThis narrative review discussed the supportive literature for the role of infographics in patient education, higher‐level education, and research dissemination with a closing discussion on the intersection between social media, infographis and education.ConclusionThere is evolving evidence to support the use of infographics in patient education, research dissemination and higher‐level education. More research is needed to identify the role and impact of infographics in pharmacy education and clinical practice settings.