Episode 133: Human Dx Unknown with Arsalan & Case Western residents – Syncope
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Description: Gizem Reyhanoglu presents a Human Dx unknown to Arsalan, Dr. Tranchito, & Dr. Kramer

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Cardionerds: A Cardiology Podcast
Cardionerds: A Cardiology Podcast
CardioNerds
90. Case Report: Atrioesophageal Fistula (AEF) Formation after Pulmonary Vein Isolation – Thomas Jefferson University Hospital
CardioNerds (Amit Goyal) joins Thomas Jefferson cardiology fellows (Jay Kloo, Preya Simlote and Sean Dikdan - host of the Med Lit Review podcast) for some amazing craft beer from Independence Beer Garden in Philadelphia! They discuss a fascinating case of atrioesophageal fistula (AEF) formation after pulmonary vein isolation (PVI). Dr. Daniel Frisch provides the E-CPR and program director Dr. Gregary Marhefka provides a message for applicants. Johns Hopkins internal medicine resident Colin Blumenthal with mentorship from University of Maryland cardiology fellow Karan Desai.   Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A mid 60s male with relevant PMHx of paroxysmal atrial fibrillation presents to the ED with altered mental status after one week of mild chest pain. Given the long history of atrial fibrillation refractory to rate and rhythm control with diltiazem and flecainide, he underwent a pulmonary vein isolation 21 days prior to arrival. In the ED, T 39.4 and patient had a witnessed seizure requiring intubation for airway protection. Signs of hypoperfusion on labs, but white blood cell count not elevated. LP negative, but blood cultures positive for strep agalactiae. CT head with multiple tiny foci of intravascular air throughout the brain with MRI consistent with multiple areas of acute infarction. CTA of chest then obtained, which was notable for a small focus of air tracking along the esophagus. Taken together, findings most c/w atrial esophageal fistula causing sepsis and air emboli. Patient underwent surgical repair of left atrium and esophagus with a good outcome.  Case Media ABCDEFClick to Enlarge A. ECG: Normal sinus rhythm HR 105 bpmB. CXRC. CT head: Multiple tiny foci of air throughout bilateral cerebral hemispheres. Appearance is most suggestive of intravascular air, although it is unclear if it is venous, arterial or both.D. MRI: 1. Restricted diffusion in bilateral cortical watershed zones, as well as in the posterior medial left cerebellar hemisphere, most consistent with recent infarctions.E. CT Chest: A small focus of air tracking along the left mainstem bronchus anterior to the esophagus, may represent a small amount of pneumomediastinum versus air in an outpouching of the esophagus. No air tracking more cranially along the mediastinal soft tissues. No definite soft tissue defect in the esophagus.F. Surgical repair of LA & Esophagus Episode Schematics & Teaching Coming soon! The CardioNerds 5! – 5 major takeaways from the #CNCR case Coming soon! References Coming soon! CardioNerds Case Reports: Recruitment Edition Series Production Team Bibin Varghese,
1 hr 12 min
Emergency Medical Minute
Emergency Medical Minute
Emergency Medical Minute
Podcast 618: Treating Opiate Side Effects
Contributor: Don Stader, MD Educational Pearls: * Majority of patients experience side effects while taking opioids * Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose * Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol) * Itching from opiates isn’t histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren’t effective - oddly ondansetron may help with itching. * Constipation is best treated with promotility agents like Senna, rather than stool softeners References Rogers E, Mehta S, Shengelia R, Reid MC. Four Strategies for Managing Opioid-Induced Side Effects in Older Adults. Clin Geriatr. 2013 Apr;21(4): PMID: 25949094; PMCID: PMC4418642. Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R. Pathophysiology, diagnosis, and management of opioid-induced constipation. Lancet Gastroenterol Hepatol. 2018 Mar;3(3):203-212. doi: 10.1016/S2468-1253(18)30008-6. PMID: 29870734. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.
4 min
Stimulus.
Stimulus.
Rob Orman, MD
31. The Dalai Lama’s Doctor, Barry Kerzin MD
A discussion with His Holiness the Dalai Lama’s personal physician Barry Kerzin, MD on: how he came to his unique job, why compassion might be better than empathy in healthcare, simple ways to develop compassion towards both others and yourself, the cure for jealousy, lessening the impact of errors, and a prescription for longevity in medicine and life. Guest Bio: Barry Kerzin, MD is a US born and trained family physician who for the past several decades has resided a monk in Dharamshala, India -- home of the Tibetan community in exile. In addition to serving as H.H. the Dalai Lama’s personal physician, Dr. Kerzin is the founder of the Altruism in Medicine Institute, whose mission is to increase compassion and resilience among healthcare professionals and extended professional groups, such as police officers, first responders, teachers and leaders. Self described as “...a doctor, a monk, a teacher, a lazy man. All of these things, yet none of these things,” you can follow Dr. Kerzin on Facebook, Youtube, Instagram or learn more about his story here. Listen on: * iTunes * Spotify * Stitcher We discuss: * How Barry Kerzin got the job of being the Dalai Lama’s personal physician [07:15]; * Why allopathic medical providers shouldn’t discount traditional health care systems [18:20]; * Advice Dr. Kerzin would give to his younger self upon graduation from family medicine residency in the late 1980s [24:25]; * The dangers of too much empathy [27:00]; * Compassion, which is just about a half step back from empathy [29:15]; * Methods of teaching compassion on a curricular level [33:20]; * The Buddhist practice of unconditional compassion [39:45]; * The importance of mutual respect, even in the face of difference [43:35]; * Replacing jealousy with rejoicing [46:00]; * The pillars of self-compassion [49:48]; * Lessening the impact of an error [56:15]; * Bodhisattvas -- people who have universal compassion that excludes no one [56:15]; * What it’s like to live in Dharamshala and to be the Dalai Lama’s physician for the past 15 years [59:20]; * Dr. Kerzin’s prescription for longevity in medicine [01:07:45] * And more. For complete and detailed show notes, previous episodes, or to sign up for our newsletter: https://www.stimuluspodcast.com/ If you like what you hear on Stimulus and use Apple/iTunes as your podcatcher, please consider leaving a review of the show. I read all the reviews and, more importantly, so do potential guests. Thanks in advance! Interested in sponsoring this podcast? Connect with us here Follow Rob: Twitter: https://twitter.com/emergencypdx Facebook: https://www.facebook.com/stimuluswithrobormanmd Youtube: https://www.youtube.com/c/emergencypdx
1 hr 9 min
Freely Filtered, a NephJC Podcast
Freely Filtered, a NephJC Podcast
NephJC Team
Freely Filtered 027: Long and deep on the KDIGO Diabetes Guidelines
The Filtrate: Swapnil Hiremath Samira Farouk Matt Sparks Joel Topf Jennie Lin And two special guests: Katherine Tuttle Clinical Professor Division of Nephrology, Medical & Scientific Director, Providence Medical Research Center/Sacred Heart Center, Professor of Basic Medical Sciences, WWAMI Program Washington State Universityendocrinologist and nephrologist at the University of Washington Ian de Boer Professor in the Division of Nephrology, Adjunct Professor, Epidemiology and Associate Director, Kidney Research Institute Show Notes: The Guideline NephJC’s summary Accord study showing harm from tight glycemic control Advance Trial the other trial showing harm from tight glycemic control 2007 KDOQI diabetes guidelines 2012 KDOQI diabetes guidelines ADA guidelines Rob Nelson, diabetes legend Classic pathology of diabetic nephropathy Should all patients with diabetes have a kidney biopsy? Flow trial: A Research Study to See How Semaglutide Works Compared to Placebo in People With Type 2 Diabetes and Chronic Kidney Disease The Grading of Recommendations Assessment, Development and Evaluation (short GRADE) working group. Don’t you love it when the first word in an acronym is the acronym itself. Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease Continuous glucose monitoring and icodextrin. Keto diets have 1.2 to 1.7 g protein/kg Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events by the PURE investigators The Association Between Kidney Disease and Diabetes Remission in Bariatric Surgery Patients With Type 2 Diabetes Jordy Cohen and Bariatric surgery in CKD at Kidney Week Metformin knocking out of the park in UKPDS Kidneys at the Zoo: What Can We Learn from Comparative Renal Physiology? at Kidney Week
1 hr 33 min
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