IBCC Episode 101 - Stress Hyperglycemia in the ICU
23 min

In this episode we cover the often overlooked topic of glycemic control in the ICU. What blood sugar should we be targeting? Is that hyperglycaemia a stress response? Insulin resistance? Iatrogenic? All of the above. Come listen to our discussion, and Josh's attempt at clearing up a confused evidence base.

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
Freely Filtered, a NephJC Podcast
Freely Filtered, a NephJC Podcast
NephJC Team
Freely Filtered 026: Interventional Nephrology meet NephJC, NephJC meet Interventional Nephrology
The Filtrate: Swapnil Hiremath Samira Farouk Matt Sparks Joel Topf And two special guests: Vandana Dua Niyyar, Professor of Medicine at Emory University and the president elect of American Society of Diagnostic and Interventional Nephrology. Wears lead. Sophia Ambruso, assistant professor and nephrologist at the University of Colorado. Show Notes: Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous Fistulas The NephJC summary The article in the NEJM The Haskal study, Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts in the NEJM from 2010 Accuracy of physical examination in the detection of arteriovenous fistula stenosis The Big Three was a trio of Major League Baseball starting pitchers for the Atlanta Braves from 1993-2002 which consisted of Greg Maddux, Tom Glavine, and John Smoltz. The Big Three combined to win seven National League Cy Young Awards in the 1990s and helped lead the Atlanta Braves to a 1995 World Series win. Each member of the Big Three has had their jersey retired by the Atlanta Braves and has been inducted into the Baseball Hall of Fame. (From Wikipedia) The Trerotola study, Drug Coated Balloon Angioplasty in Failing AV Fistulae Scathing anti-interventional nephrologist editorial by Trerotola Rebuttal though data by Beathard, Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists And then a walk back and update by Tretola…What is the current and future status of interventional nephrology? Paclitaxel mechanism of action video with awesome music The role of fungus in the paclitaxel story Twitter comment on the half life of balloon delivered paclitaxel The meta analysis of peripheral revasculaization having a mortality signal with paclitaxel: Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials FDA warning about paclitaxel balloons: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality The NephJC primer on non-inferiority trials: Understanding the vortex of non-inferiority trials ASN Distinguished Clinical Service Award 2020 goes to Vandana Dua Niyyar! (and Derek Fine, who is also a great guy) ASN Kidney Week Sessions: Samira: Embracing Technology: Nephrology 2.0 Swapnil: Hard-to-Control Hypertension: What to Do Next? Vandana: A Look Inside: Noninvasive Imaging of Kidney Diseases
1 hr 6 min
Stimulus.
Stimulus.
Rob Orman, MD
30. COVID-19: Why a negative test doesn't clear you to see Grandma, Vax updates
We review the false negative rates of different COVID tests (PCR and rapid antigen), the known knowns and known unknowns of the Moderna vaccine. Listen on: * iTunes * Spotify * Stitcher We discuss: * Why the lack of a legitimate gold standard is a challenge when comparing different tests for COVID-19 [01:45]; * RT-PCR: why we shouldn't be reassured by a negative test result [03:45]; * How your pretest probability of disease affects your interpretation of test results [07:00]; * The COVID antigen test: faster and more widely available, but less accurate [08:10]; * A NYT report of a rapid antigen test study showing suboptimal test sensitivity when applied to asymptomatic people [10:15]; * Why you can’t rely on a negative test to make your decision to travel or spend time with family/friends for the holidays [12:05]; * Whether you need to quarantine if you’ve been in close contact with someone who themselves was exposed to a known COVID patient [13:30]; * The Moderna vaccine which has a reported efficacy of 94.5% [14:00]; * 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
18 min
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