Podcasts about Acute

Prehospital blood is one of the hottest debates in trauma resuscitation — and the evidence just got a lot more interesting. In this episode, Drs. Patrick Georgoff and Ayman Ali sit down with Dr. Ed Barnard, UK defense professor of emergency medicine and author of the landmark SWIFT trial, and Dr. Juan De Chesney, trauma surgeon and pioneer in prehospital blood programs, to break down what we actually know about getting blood to patients before they hit the doors. The SWIFT trial — the largest prehospital whole blood RCT to date — found no superiority of whole blood over component therapy, but the story is far more nuanced than a negative headline suggests. From the logistics of carrying blood on a helicopter to the stark reality that only 1.8% of US ground EMS carries any blood products at all, this conversation exposes both the progress and the enormous gaps that remain. Hosts: Ayman Ali, MD: Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital.  Patrick Georgoff, MD @georgoff: Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content. Juan Duchesne, MD: Juan Duchesne is a trauma surgeon and Professor of Surgery serving as the Trauma Medical Director and Division Chief at the University of Mississippi Medical Center. His pioneering contributions to the field—particularly in whole blood and balanced resuscitation practices—have been honored with numerous accolades.  Ed Barnard, PhD FRCEM FIMC RCSEd, @edbarn @DefProfEM: Ed Barnard is an emergency physician and UK Defence Professor of Emergency Medicine, RCEM/NIHR Associate Professor, and Affiliated Assistant Professor at the University of Cambridge. He has sub-specialty training in pre-hospital and academic emergency medicine and possesses extensive experience in trauma, anaesthesia, and critical care across both civilian and military settings. His contributions to the field have been honored with five national research awards and a PhD - undertaken with the US Army in San Antonio, TX. This episode was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Date: June 12, 2026 Guest Skeptic: Mr. Ross Fisher. Ross is a paediatric surgeon, presentation guru (P-Cubed), and long-time friend of the SGEM.  Reference: Talan et al. Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review. Ann Emerg Med. June 2026 Case: A 29-year-old healthy man presents to the emergency department […] The post SGEM#512: When you go your way, and I Go Mine – Surgery or Antibiotics for Acute Appendicitis. first appeared on The Skeptics Guide to Emergency Medicine.

Frustrated with attempts to manage rehab patients with soft tissue injuries? Overwhelmed at the amount of evidence regarding modalities for these injuries? Imagine being able to spend one hour and gain an understanding of the current evidence for treatment of sprains/strains and soft tissue injuries. This podcast is a concise look at the evidence for management of soft tissue injuries and includes a deep dive into modalities which are used to help the rehab process.   To view accreditation information and access completion requirements to receive a certificate for completing this course, please click here.   The content of this Summit podcast is provided only for educational and training purposes for licensed physical therapists and occupational therapists. This content should not be used as medical advice to treat any medical condition in either yourself or others.

The following article of the Entrepreneurs industry is: 'The Invisible Equation of Talent and Customer Loyalty' by Matías Fernández, Chairman & CEO, Acute Talent. 

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring

Un nouvel épisode du Pharmascope est disponible! Dans ce 178e épisode, Nicolas, Olivier et Amélie tentent de pondre des réponses un tant soi peu intelligentes à vos excellentes questions. Nous discutons d'ajustement de lévothyroxine, du suivi des IECA/ARA, du rôle de la cariprazine et de l'impact des inhibiteurs du SGLT-2 sur le magnésium.   Les objectifs pour cet épisode sont les suivants: Discuter des modalités d'ajustement de la lévothyroxine et de la déprescription potentielle de celle-ci Discuter des suivis de laboratoire suivant l'initiation d'un ARA ou d'un IECA Discuter des évidences portant sur l'utilisation de la cariprazine Discuter de l'impact des  inhibiteurs du SGLT-2 sur le magnésium Ressources pertinentes en lien avec l'épisode Jonklaas J, et coll; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014 Dec;24(12):1670-751. Van Uytfanghe K, et coll. Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status. Thyroid. 2023 Sep;33(9):1013-1028. Ravensberg J, et coll. Discontinuation of Levothyroxine in Adults Aged 60 Years or Older. JAMA. 2026 Apr 6;335(17):1491–8. RPE de néphrologie de l'APES. Place des IECA et des ARA dans le traitement de la maladie rénale chronique. Septembre 2025. Bhandari S, et coll; STOP ACEi Trial Investigators. Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease. N Engl J Med. 2022 Dec 1;387(22):2021-2032. Clase CM, et coll. Acute change in glomerular filtration rate with inhibition of the renin-angiotensin system does not predict subsequent renal and cardiovascular outcomes. Kidney Int 2017;91:683-90. Garlo KG, et coll. Association of changes in creatinine and potassium levels after initiation of renin angiotensin aldosterone system inhibitors with emergency department visits, hospitalizations, and mortality in individuals with chronic kidney disease. JAMA Netw Open 2018;1:e183874. Monographie de produit, Abbvie. VRAYLAR (cariprazine). Canada, 6 mars 2024. Barabassy A, et coll. Transdiagnostic Efficacy of Cariprazine: A Systematic Review and Meta-Analysis of Efficacy Across Ten Symptom Domains. Pharmaceuticals (Basel). 2025 Jul 2;18(7):995. Németh G, et coll. Cariprazine versus risperidone monotherapy for treatment of predominant negative symptoms in patients with schizophrenia: a randomised, double-blind, controlled trial. Lancet. 2017 Mar 18;389(10074):1103-1113. Fava M, et coll. Efficacy of adjunctive low-dose cariprazine in major depressive disorder: a randomized, double-blind, placebo-controlled trial. Int Clin Psychopharmacol. 2018 Nov;33(6):312-321. Durgam S, et coll. Efficacy and safety of adjunctive cariprazine in inadequate responders to antidepressants: a randomized, double-blind, placebo-controlled study in adult patients with major depressive disorder. J Clin Psychiatry. 2016 Mar;77(3):371-8. Barabassy A, Csehi R, Dombi ZB, Szatmári B, Brevig T, Németh G. Transdiagnostic Efficacy of Cariprazine: A Systematic Review and Meta-Analysis of Efficacy Across Ten Symptom Domains. Pharmaceuticals (Basel). 2025 Jul 2;18(7):995. Zhang J, et coll. Comparative Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Serum Electrolyte Levels in Patients with Type 2 Diabetes: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials. Kidney360. 2022 Jan 19;3(3):477-487. Toto RD, et coll. Correction of hypomagnesemia by dapagliflozin in patients with type 2 diabetes: A post hoc analysis of 10 randomized, placebo-controlled trials. J Diabetes Complications. 2019 Oct;33(10):107402.

Welcome to the Daily Disciple Podcast. As daily disciples, we seek to adore and follow Jesus, our teacher, into the abundant life that he offers. Because we find Jesus irresistible, fascinating, and incredibly practical, we want to be students of his scripture. Today's episode is found in Luke 17 "Acute Observations."

Dr. Drew Carey interviews Dr. Avner Hostovsky on his study evaluating the diagnostic yield of a structured systemic workup in patients presenting with acute visual symptoms who were diagnosed with isolated paracentral acute middle maculopathy (PAMM). From his Ophthalmology article, "High Yield of Systemic Workup in Patients with Acute Isolated Paracentral Acute Middle Maculopathy." Hostovsky A, Peled I, Katz G, et al. High Yield of Systemic Workup in Patients with Acute Isolated Paracentral Acute Middle Maculopathy. Ophthalmology, 2025; 133, 499-505.

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

In this episode, Tracey Davidoff, MD, Joe Toscano, MD, and Evan Nelson, MD, discuss the May 2026 Evidence-Based Urgent Care article, Urgent Care Evaluation and Management of Acute Bronchitis.0:08 Introduction1:08 Topic & guest introduction2:14 Differential diagnosis4:03 Respiratory virus testing6:42 Positive viral diagnosis & antibiotic prescribing8:00 Duration of cough & post-infectious cough9:41 Antibiotic stewardship12:07 Cough & cold medicines14:44 Narcotics & corticosteroids16:05 Steroid stewardship17:24 Radiologic stewardship & chest X-rays20:46 Sputum color21:53 Albuterol24:21 Special populations25:37 Take-home points & patient education27:08 Wrap-up and outroSubscribes, take the CME test here!Not a subscriber? Join here!

Hosts: Ed Jones (Owner of Nutrition World) & Clint Powell A variety of topics all related to living a healthy life Presented by: Nutrition World www.nutritionw.com Broadcasting from the Nooga Dentistry Studio www.noogadentistry.com Production of: Whitfield Media Group www.vitalhealthradio.com Title: Impact of Tennessee Hemp Bill, Discussion of Polypharmacy & Deprescribing  with Dr. Curt Dearing [0:00:00] Ed's Media & Product Updates Preview of main topics: Upcoming Tennessee hemp bill and its negative impact on people using hemp for anxiety, pain, and insomnia. Dr. Curt Deering will discuss polypharmacy and deprescribing. Ed's recent appearances on multiple TV outlets (Fox Phoenix & LA, Be Well NY, CBS Detroit). Discussion of testing the AquaTru water filtration system at home as a potential recommendation (microplastics, partial fluoride removal). Mention that peptides are a growing topic; reference to Noel Lawson as go‑to for prescribed peptides [0:10:42]  Tennessee Hemp Bill & Hemp Industry Impact Introduces guest: Dwayne Madden, owner of Hemp House, as a respected local expert. As of July 1 in Tennessee: All Delta‑8 products will no longer be available for in‑state sale. Many THCA products and all vape products will be gone from shops. CBD and Delta‑9 edibles will have caps: Max 15 mg per serving. Max 300 mg per package. Dwayne notes: Heavy users (e.g., serious pain/conditions) will need to consume many servings to reach effective doses. Law doesn't limit how many packages a person can buy, so total milligrams aren't truly stopped—just made inconvenient. Dwayne explains regulatory control moved: From Tennessee Department of Agriculture (2017–2023) To the ABC (Alcoholic Beverage Commission) Board. Key impacts: All products must now go through distributors, similar to alcohol. Distributors collect taxes and sit between producers and retailers. Small operators like Dwayne cannot qualify for distributor licenses , so he must pay a distributor to move product from his own lab to his own stores. Ed frames this as “follow the money trail” and a way to crush competition. In Tennessee after July 1: No in‑state online hemp sales. Banned products (Delta‑8, etc.) not criminalized for possession or use, only for sale. Potential Workaround: Consumers can order from out‑of‑state websites (e.g., North Carolina), receive products in Tennessee Money leaves the local economy, hurting Tennessee businesses. Ed and Dwayne suggest alcohol industry is likely threatened because many people are reducing alcohol use by using hemp products instead  Dwayne notes: Alcohol sales have declined while hemp sales rose. Regulators appear to be protecting alcohol interests via hemp restrictions. [0:17:41] Federal Regulations & State Opt‑Outs Upcoming federal regulations in November: Expected to be similarly “ugly and nasty” for hemp nationwide. States will have an option to opt out of these federal hemp rules. Tennessee's stance: Governor has stated Tennessee will NOT opt out, so federal restrictions will apply here. Other states (e.g., North Carolina) might opt out, keeping their markets more open. Industry response: Advocacy groups Tennessee Growers Coalition and Hemp Law Group monitor legislation and organize pushback. Some supportive legislators exist, but political drive to reverse current law is limited. Dwayne and Ed distinguish: Reasonable regulation (ID checks, lab tests, dosage clarity, education) vs. A “wipeout/control/takeover” by shifting to ABC and forcing distributor reliance. Dwayne: Says credible local shops (Hemp House, Chattanooga peers like BeeGrity, Snapdragon, etc.) already follow high standards. States this law is not about safety but about control and revenue capture, and will hurt small farmers and businesses. [0:25:55] What Consumers Should Do Before Deadline Practical advice: Stock up now on products that will disappear: Delta‑8 gummies (popular for sleep, anxiety, pain). Other higher‑milligram THC/CBD edibles. Flower and vapes. Hemp House is running clearance sales to move remaining inventory. Dosing notes: Many people do well with ½ Delta‑8 gummy for sleep/anxiety/pain. Some need more or less; staff helps tailor doses for goals. Hemp House will close its North Shore/Tremont Street flagship store by July 1 due to expected sales hit. Remaining Hemp House locations: Ringgold Road (East Ridge) near Spring Creek. Ooltewah by Food City on Lee Highway. Hixson Pike near Workout Anytime and Publix. Broader impact: Other Chattanooga hemp businesses have large staffs (some near 100 employees) and will be heavily affected. The industry is described as grassroots, farmer‑driven, and passionately quality‑focused. [0:33:20] Polypharmacy & Deprescribing with Dr. Curt Dearing Ed introduces Dr. Curt Dearing, clinical pharmacist at Nutrition World (30+ years experience). Curt's background: Formerly fully conventional pharmacist; later “veil lifted” as he discovered green pharmacy (nutritional & botanical alternatives). Current mission: Community outreach to medical schools and residency programs Teach about nutritional and natural alternatives not covered in standard curriculums. Traditional training provides almost zero meaningful nutrition or green pharmacy education. Polypharmacy: use of 5 or more prescription medications. Curt notes: Majority of Americans 65+ meet this definition. Average American receives ~17 prescriptions per year (not all concurrent). Consequences: Increased ER visits due to drug side effects. Estimated ~250,000 deaths/year from drug‑induced causes. Curt's role: Specializes in deprescribing: safely reducing or eliminating unnecessary pharmaceuticals and replacing them with effective natural options when possible.  How Curt Works with Patients & Their Doctors Curt provides coaching, not independent prescribing. Creates detailed packets (10–18+ pages) explaining: Why certain drugs may no longer be needed. Evidence for natural alternatives (e.g., supplements, lifestyle changes). Encourages clients to take the packet to their doctor and have an informed discussion. Patients often fear how their doctors will react to attempts to deprescribe. Green Pharmacy Approach (as described by Dr. Curt Dearing) Using nutritional, botanical, and lifestyle-based therapies either instead of or alongside pharmaceuticals. Focusing on root causes and supporting the body's own healing mechanisms, not just pushing lab numbers in a certain direction. Why polypharmacy is a problem: Increases side effects, drug–drug interactions, and emergency room visits. Contributes to cognitive decline, gut problems, and overall worse health. Often leads to the “prescribing cascade”: Drug A causes side effects → a new drug is added for those side effects → more side effects → more drugs, and so on. How Dr. Curt Dearing uses green pharmacy to reduce polypharmacy: Curt creates a comprehensive list of all medications and supplements. Asks: “Why was this started?” and “Is it still needed?” Looks for: Drugs with no clear current indication. Drugs where a natural option can give similar or better benefit with fewer risks. Drugs that can be safely tapered or sometimes stopped outright (always in coordination with the prescriber). Identifies which meds are likely causing the most harm or least benefit. Some drugs require slow, structured tapering (e.g., sleep meds, acid blockers). Others may be candidates for direct discontinuation after medical agreement. Replacing or supporting with natural alternatives ( please note this is not medical advice, this is a discussion of personal examples in collaboration with medical oversight) Cholesterol: Instead of (or in place of some) statin use, Curt uses berberine and bergamot (Berbercol). In Ed's brother's case, his cholesterol numbers improved on green-pharmacy options, matching or exceeding statin outcomes without the same side‑effect burden. Pain & inflammation: Uses curcumin (for most people), and Boswellia when curcumin isn't enough. Gut/acid issues: Long-term proton pump inhibitor (PPI) use (e.g., omeprazole, lansoprazole) is flagged as harmful to gut microbiome and nutrient absorption. Curt builds step-down plans (tapering PPIs) while supporting the gut with natural measures instead of leaving people on a PPI for 30 years. Focus on side benefits, not side effects. Green pharmacy interventions are chosen because they: Address root causes (e.g., metabolic health, inflammation, gut integrity). Often have multiple positive effects (e.g., berberine helping blood sugar and lipids; curcumin helping joints and systemic inflammation). The aim is fewer total drugs, fewer side effects, better overall function. Clients are encouraged to work with their doctor, so deprescribing is: Planned, Monitored, and Integrated with their existing care. Curt and Ed both acknowledge there are situations where “rescue medicine” is necessary: Severe pain where an opioid is appropriate. Acute crises where drugs are needed as a bandage. The green pharmacy view: Use those drugs as short‑term tools, Then remove or reduce them once the immediate crisis passes, While implementing natural strategies to decrease the need for long‑term prescriptions. [0:56:26] Final Segment  At‑home HPV testing for cervical cancer Ed explains HPV is a major driver of cervical cancer Historically, women had to schedule an in‑office visit for cervical screening, which creates barriers (cost, fear, time, discomfort, lack of insurance). He notes there is now an option for at‑home HPV testing for cervical screening. Intended to increase access for women who aren't getting regular screening. Ed strongly approves of this as a valuable preventive tool and encourages women who haven't been tested to consider it. Ed cites new data showing: Microplastics are found in 100% of human stool samples tested in one study. Higher levels of microplastics are now being linked to gallstones. Broader concerns: Everyday plastic exposure (especially with food and drink) means these particles can: Interact with cells, Drive inflammation, Contribute to premature cellular aging and reduced energy. Practical countermeasures he recommends: Avoid heating food in plastic or placing hot food into plastic containers/wrap (e.g., Saran wrap, plastic take‑out containers). Filter drinking water to remove microplastics (he's trialing the AquaTru system at home, which he says removes 100% of microplastics and much of the fluoride). Improve indoor air quality to reduce airborne microplastic exposure. Ed highlights a serious, long‑term job opening at Nutrition World: Not a summer or short‑term job. Best for someone philosophically aligned with healthy eating and the “green pharmacy” approach. Interested candidates should: Go into the store and speak with Scott, Elisha, or Matt and complete an application.  The post Radio Show / Podcast – May 31, 2026 first appeared on Vital Health Radio.

Send us Fan MailIn this episode, we discuss how to identify and manage the acute complications of sickle cell disease. Written by Dr. Yi Hui Luo (Internal Medicine Resident). Reviewed by Dr. Véronique Naessens (Hematologist) and Dr. Sanabelle Zaabat (General Internist). Support the show

T-cell-engaging bispecific antibodies represent a major therapeutic and scientific advancement in the treatment of several types of cancer. However, they carry a risk of some unique acute toxicities, such as cytokine release syndrome and neurologic toxicity. This podcast reviews this emerging drug class and strategies for recognition and management of their unique adverse events. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

In this episode, we are joined by Dr Ina Schmidt, Consultant Anaesthetist, Intensivist, Flight Physician, and President of ICARUS e.V., to examine what truly changes when critical care leaves the ground. Drawing on extensive experience at the intersection of intensive care and aviation medicine, Dr Schmidt discusses why aeromedical medicine should be regarded as a distinct speciality rather than simply “EMS in the sky.”Together, we explore the unique physiological and operational challenges of patient care at altitude, from hypobaric hypoxia and environmental stressors to the complexities of monitoring critically ill patients in confined, high-noise environments. We also examine the future of in-flight critical care, including the broader evolution toward continuous, wireless, non-invasive haemodynamic monitoring and how emerging technologies may reshape the delivery of intensive care in the air.ICARUS (International Community for Aeromedical Research and Universal Standards) is an international professional association dedicated to advancing aeromedical transport medicine through research, education, quality improvement, and the development of evidence-based standards. Based in Germany, the organisation brings together clinicians, researchers, educators, and industry leaders to improve patient safety and outcomes during air medical transport. ICARUS promotes a patient-centred approach to critical care transport and retrieval medicine, supports collaborative research and audits, develops educational programmes and certifications, and advocates for the recognition of aeromedical transport medicine as a specialised medical discipline. Through its global network, webinars, conferences, committees, and academic partnerships, ICARUS aims to establish universal standards that enhance the quality and safety of aeromedical operations worldwide. More can be found here: https://icarus-aeromedical.org/VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital CareVitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you're not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.BHA Medical's VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net.Today on the emDOCs cast with Brit Long (@long_brit), we cover how to evaluate and manage acute limb ischemia. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play Send us Fan Mail

In this episode, we review the high-yield topic of ⁠ Acute Abdomen from the Gastrointestinal section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

In this episode, Andrew breaks down the concept of the Acute:Chronic Workload Ratio (ACWR) in a practical and easy-to-understand way for athletes, coaches, parents, and practitioners. Rather than getting lost in complicated formulas or sports science jargon, this discussion focuses on the bigger coaching and performance lesson behind ACWR — why sudden spikes in workload can become problematic when athletes are not properly prepared for the demands being placed on their bodies.Andrew explains how workload management is not about avoiding hard training, but instead about progressively building an athlete's capacity to tolerate sprinting, jumping, conditioning, lifting, and sport-specific demands over time. He also discusses why undertraining and underexposure can sometimes be just as risky as overtraining, especially when competition intensity suddenly exceeds what an athlete has been consistently prepared for.Throughout the episode, Andrew shares practical examples and coaching insights to help listeners better understand how intelligent progression, preparation, and monitoring can improve resilience, reduce breakdown, and optimize long-term athletic performance. Whether you are an athlete, coach, clinician, or parent, this episode provides valuable perspective on balancing performance development with athlete preparedness. Enjoy the episode!

Divorce can feel like it happens in an instant: an argument, a cold sentence, papers on the counter, and your world flips upside down. We slow that moment down and look at the data that challenges the “knee-jerk decision” story, including research suggesting many people who file have been contemplating divorce for a year or more, often much longer. That timeline matters because it creates a brutal asymmetry: one spouse finishes grieving and planning while the other starts at ground zero.We also dig into what tends to happen during that hidden runway. Think financial intelligence gathering, attorney consults, custody calendar strategy, and even filing timing around school schedules and holidays. Then we connect it to what happens inside your body when you get blindsided. Acute stress is not just a feeling; it changes cognition. If your working memory and executive function drop under pressure, the worst time to negotiate is the exact time the system pushes you toward temporary orders, quick compromises, and “just keep the peace” decisions that can define the next 10 to 20 years.From there, we shift into a practical survival playbook for dads: a 24-hour buffer rule before you agree to anything, bridging the lawyer gap by taking command of day-to-day boundaries, moving communication into a documented parenting app, building dense objective records, and mastering calm emotional regulation in high-conflict environments where bias and subjectivity can shape outcomes. If you want a clearer starting line and a smarter next step, subscribe, share this with a dad who needs it, and leave a review telling us what hit home most. Being unprepared is how great fathers become weekend visitors. Most ground is lost quietly through "drift" and decisions made under pressure. Stop the drift today at TheDivorcedDadvocate.com.Access your tactical tools:Risk Assessment: Identify your "quiet loss" exposure in 10 minutes.Protection Session: Book a private triage to ensure mistakes don't become permanent.Your kids are counting on you. Support the show

Interview with Caitlin Farruggio, DPT

In this episode, Yoga Medicine founder Tiffany Cruikshank and Katja Bartsch take a deep dive into the latest stretching research and what it means for yoga teachers, athletes, and movement professionals. Together, they unpack the latest recommendations around stretching for flexibility, stiffness, strength, hypertrophy, vascular health, recovery, and injury prevention while exploring the limitations of stretching as a standalone tool. Tiffany and Katja discuss why prolonged static stretching before explosive activity may impair athletic performance, how longer-held yin-style stretches may influence tissue stiffness, and why emerging vascular research around stretching is generating so much interest. They also explore why yoga recovery likely involves far more than just stretching mechanics, including nervous system regulation, breathwork, and relaxation. "We do not overestimate or underestimate what stretching can do." — Katja Bartsch. — What You'll Learn: What the new 2025 stretching consensus paper reveals about flexibility research [02:57] • Definitions of static, dynamic, and PNF stretching in both research and yoga practice [06:00] • Acute vs. chronic stretching effects on range of motion and mobility [13:54] • Recommendations for improving long-term flexibility and maintaining mobility with age [20:09] • The "Goldilocks" principle of tissue stiffness and athletic performance [27:24] • Why longer yin-style holds may influence connective tissue adaptation [32:12] • How stretching impacts strength, explosive performance, and warm-ups [34:32] • Research on stretching for strength gains and muscle hypertrophy [37:36] • Emerging evidence around stretching and vascular health [42:01] • Breathwork, nervous system regulation, and yoga's broader therapeutic effects [51:24] • Why stretching alone may not improve recovery or prevent soreness [54:07] • The limitations of flexibility-only approaches for injury prevention [1:00:13] • Why individualized mobility, stability, and strength work matter in yoga practice [1:01:40] • Final takeaways on stretching frequency, recovery, and long-term mobility [1:04:32] — Links Mentioned: Watch this episode on YouTube Warneke K, Thomas E, Blazevich AJ, Afonso J, Behm DG, Marchetti PH, Trajano GS, Nakamura M, Ayala F, Longo S, Babault N, Freitas SR, Costa PB, Konrad A, Nordez A, Nelson A, Zech A, Kay AD, Donti O, Wilke J. Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts. J Sport Health Sci. 2025 Dec;14:101067. doi: 10.1016/j.jshs.2025.101067. Epub 2025 Jun 11. PMID: 40513717; PMCID: PMC12305623. — Learn More: Find the full show notes at YogaMedicine.com/podcast-167. Learn more about insider tips, online classes or information on our teacher trainings at YogaMedicine.com. To support our work, please leave us a 5 star review with your feedback on iTunes/Apple Podcasts or wherever you listen to podcasts. 

LBCT: Interleukin-6 Inhibition in Acute Myocardial Infarction at Risk of Cardiogenic Shock: A Randomized Controlled Trial

Retreat from New Orleans! Professor Torbjörn Törnqvist from University of Tulane finds its inevitable and start now. Carbon dioxide is cooling the Stratosphere. Lamont-Dorherty scientist Sean Cohen explains. Much of America in frightening drought, going into hot El Nino year. And new science  …

Krissy Dilger of SRNA moderated an open Q&A on acute disseminated encephalomyelitis (ADEM) with pediatric neurologist Dr. Linda Nguyen of the University of Texas Southwestern Medical Center. Dr. Nguyen discussed how widespread MOG antibody testing has shifted many cases previously labeled ADEM to MOG antibody-associated disease, recommended MOG testing at onset, and reviewed relapse risk, mimics, and follow-up imaging [00:05:07]. Questions from the community covered acute treatments, recovery, guidance on pseudo-relapse, rehabilitation, and transition from pediatric to adult care [00:14:41].Dr. Linda Nguyen completed her MD, PhD training at West Virginia University in 2017, and then pediatric neurology residency at the University of California, San Diego in 2022. She then completed a combined pediatric and adult neuroimmunology fellowship at the University of Texas Southwestern in 2024, where she now serves as an Assistant Professor in the Department of Pediatrics. Dr. Nguyen currently sees patients in the Demyelinating Disease Clinic at Children's Medical Center Dallas.00:00 Welcome and Guest Intro01:08 What Is ADEM01:51 Causes and Who Receives This Diagnosis02:55 Early Signs and Onset04:20 Diagnosis and MRI Criteria05:07 MOG Antibodies and ADEM07:21 Testing and Relapse Risk09:06 Recurrent ADEM and Labels12:34 Mimics and Differential Diagnosis14:41 Acute Treatment Options15:38 Recovery Timeline and Rehab17:47 Long Term Effects and Seizures21:23 Family Support and Accommodations24:47 Follow Up Imaging and Relapse Signs27:25 Managing Fatigue and Headaches29:31 Supplements, Vaccines, and Genetics33:40 Pseudo Relapse and Exercise Balance37:41 Research and Predicting Outcomes43:14 Transition to Adult Care45:36 Weakness Sleep Issues and Final Thoughts

Acute respiratory distress syndrome (ARDS) induced by COVID-19 was a leading cause of severe illness and death during the pandemic, driven by an intense innate immune response, hyperinflammation, and a decrease in lymphocytes. Mesenchymal stromal cells (MSCs) represent a potential therapeutic option for ARDS due to their ability to modulate the immune system and inflammation. Our guests report results from a Health Canada–regulated Phase I and Phase II trials evaluating freshly cultured umbilical cord–derived MSCs in patients with COVID-19-related ARDS, including assessments of safety, maximum feasible tolerated dose, and preliminary efficacy. Their work explores a therapeutic strategy to improve ARDS outcomes using MSCs, which will be important for optimizing and targeting future cellular therapies.GuestDuncan Stewart, MD, Ottawa Hospital Research Institute and University of Ottawa, CanadaElmira Safaie Qamsari, Ottawa Hospital Research Institute, CanadaHostJanet Rossant, Editor-in-Chief, Stem Cell Reports and The Gairdner FoundationSupporting DocumentsPaper link: Cellular immunotherapy for COVID-19-induced acute respiratory distress syndrome: Results of the CIRCA-19 phase 1 safety and phase 2 randomized controlled trials About Stem Cell ReportsStem Cell Reports is the open access, peer-reviewed journal of the International Society for Stem Cell Research (ISSCR) for communicating basic discoveries in stem cell research, in addition to translational and clinical studies. Stem Cell Reports focuses on original research with conceptual or practical advances that are of broad interest to stem cell biologists and clinicians. X: @StemCellReportsAbout ISSCRAcross more than 80 countries, the International Society for Stem Cell Research (@ISSCR) is the preeminent global, cross-disciplinary, science-based organization dedicated to advancing stem cell research and its translation to medicine.ISSCR StaffKeith Alm, Shuangshuang Du, Kym Kilbourne, Megan Koch, Jack Mosher, and Hunter Reed

Send us Fan MailOn this week's episode , we visit an unusual situation, but yet one most of have had if you've been practicing for more than a just a few years.  The topic of this episode is the New patient that reaches out to you and your office, needs to be seen “ asap” and is in horrible pain. On previous episodes we've discussed the regular and routine new patient procedure, and the subsequent home instruction and leading into the great report of findings. While all of that is incredibly important, and is by far the most common way a new patients enter our offices, on occasion we get the new patient calling or even “walking in” that is in 10/10 on the pain scale. In a cased like that, what you do , and don't do can mean the difference between relief for the patient and a great reputation being built for you OR little to no relief for them with them telling everyone forever how you failed them and so they got relief someplace else.  I hope you enjoy this discussion of care for the super acute new patient. 

Chronic inflammation explained—if you're dealing with fatigue, brain fog, or ongoing health issues, this episode uncovers the real root causes and how advanced lab testing can help you finally heal. In this powerful conversation, Dr. Greg Jones sits down with Dr. Clement Lee, a licensed Naturopathic Medical Doctor (NMD), to break down why so many people feel unwell despite “normal” lab results.In this episode, you'll learn how chronic inflammation impacts aging, energy, and cognitive function—and why it's often missed in standard healthcare. Dr. Lee also explains the importance of comprehensive lab testing, including deeper biomarkers and tools like the Metabolic Vulnerability Index (MVX), to assess long-term health risks and optimize recovery.We also explore cutting-edge therapies such as peptide therapy, ozone therapy, and regenerative injections, along with foundational strategies like sleep, hydration, and nutrition that are critical for reducing inflammation and restoring health.If you've been searching for answers to unresolved health issues, this episode provides a clear, science-backed roadmap to understanding chronic inflammation and taking actionable steps toward healing.

Acute rescue medications are critical in time-sensitive emergencies, and pharmacists play an essential role in ensuring patients and caregivers are prepared to use them correctly. This course discusses the roles of glucagon, naloxone, and epinephrine, including recent updates on novel formulations and device innovations that are reshaping emergency response in community settings. You will gain practical insights to strengthen counseling, improve readiness, and support optimal outcomes when seconds matter most. HOST Rachel Maynard, PharmD GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTWendy Mobley-Bukstein, PharmD, BCACP, CDCES, CHWC, NASM-CPTProfessor of Pharmacy PracticeDrake University CPHS Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by enrolling in the course. Click here to enroll!CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe the mechanisms of action and primary indications for glucagon, naloxone, and epinephrine as acute rescue medications.2. Summarize recent updates for glucagon, naloxone, and epinephrine that impact pharmacist counseling and patient access.Rachel Maynard has no relevant financial relationships with ineligible companies to disclose. Wendy Mobley-Bukstein is a Diabetes Care Speaker for Abbott. All relevant financial relationships have been mitigated.  0.05 CEU/0.5 HrUAN: 0107-0000-26-131-H01-P Initial release date: 5/18/2026Expiration date: 5/18/2027Additional CPE details can be found here.

Acute rescue medications are critical in time-sensitive emergencies, and pharmacists play an essential role in ensuring patients and caregivers are prepared to use them correctly. This course discusses the roles of glucagon, naloxone, and epinephrine, including recent updates on novel formulations and device innovations that are reshaping emergency response in community settings. You will gain practical insights to strengthen counseling, improve readiness, and support optimal outcomes when seconds matter most.HOSTRachel Maynard, PharmD GameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTWendy Mobley-Bukstein, PharmD, BCACP, CDCES, CHWC, NASM-CPTProfessor of Pharmacy PracticeDrake University CPHSGET CE FOR LISTENING!Stay Compliant. Grow Clinically. Practice with Confidence. Pharmacist CE Subscription: All your CE in one convenient subscription.All episodes, CE, and Practice Resources for the GameChangers Clinical Update is included with your Pharmacist CE Subscription. But wait…there's even more!The Pharmacist CE Subscription includes: -  Compliance and licensure CE -  GameChangers Clinical Updates-  Practical continuing education across patient care topics *The subscription does not include microcredentials or certificates, which are available separately for pharmacists seeking specialized service training. Purchase Now!PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by purchasing the Pharmacist CE Subscription.CPE REDEMPTIONThis course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation to claim credit:If you are already enrolled in this course, click here to redeem your credit. To purchase the Pharmacist CE Subscription and claim your CPE credit, click here or to purchase this course individually, click here.  CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe the mechanisms of action and primary indications for glucagon, naloxone, and epinephrine as acute rescue medications.2. Summarize recent updates for glucagon, naloxone, and epinephrine that impact pharmacist counseling and patient access.Rachel Maynard has no relevant financial relationships with ineligible companies to disclose. Wendy Mobley-Bukstein is a Diabetes Care Speaker for Abbott. All relevant financial relationships have been mitigated.  0.05 CEU/0.5 HrUAN: 0107-0000-26-131-H01-P Initial release date: 5/18/2026Expiration date: 5/18/2027Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

UnBecoming Part 3 - The Hallway. (May 14, 2026)You look over at the light streaming in through your bedroom window. It's not the soft light of the moon; it's artificial light. Street lights. You're not home, you're back home. In the same twin bed you slept in during high school, watching the same trees dance in the wind, the same shadows play on the same hardwood floors you played on, talked on the phone in circles on, those floors have witnessed you.And now you kneel on them. You pray on them, whispering down toward them, you walk in tight circles on them, not on a call, but as a form of meditation, feeling God's Love in every step. Calling His Name with every step. Asking to be shown, to be provided the next step- whether to divorce or not. Whether to move or not? To the beach, perhaps.You're conflicted. But the floor is not. The room is not. It's bare. It's clean. It's small, but tidy. You can hear yourself think here, even as you are trying to get out to that place beyond thoughts, where the real answers come from. The Peace you feel as you listen past your thoughts and look over their shoulders, brings about sleep.Just as you drift, you are startled awake. Was that a crash? Did something fall? Did someone fall? You listen… for the children. For your parents. Acute. Aware. It was nothing. You soften back into the mattress, resting on your back, not yet asleep again,CRASH.Definitely something that time. Definitely someone. Your heart rate rises faster than you can. You jump up, grabbing your phone with shaky hands, instinctively yelling, 'DAD!' the one you worry about the most. The one you've called on the most. The one who understands. Before you can even enter the hall, you see his feet sticking out of his door. God. >>>> UNBECOMING.https://www.curlynikki.com/unbecoming.html

Can an algorithm actually give you your life back? A recent Stanford paper revealed that using large language models at home yields massive efficiency gains—up to 176%. For busy surgeons drowning in clinical duties and administrative bloat, every reclaimed second is priceless.In this episode of Behind the Knife, Ayman and Patrick sit down with Christian Péan—an orthopedic trauma surgeon, Duke's Executive Director of AI and IT Innovation, and the Founder/CEO of RevelAi Health. He's also a Core faculty member at the Duke-Margolis Institute for Health Policy. Dr. Péan breaks down how naturally skeptical surgeons can adopt AI to save time, shares his granular daily workflow, and discusses his mission to cure physician burnout through tech. Whether you are a tech enthusiast or a total skeptic, this episode gives you the practical playbook for integrating AI into your surgical career today.Hosts:- Ayman Ali, MDAyman Ali is a PGY-4 at Duke Hospital and current Behind the Knife fellow.- Patrick Georgoff, MD @georgoffPatrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.- Christian Péan, MD @DrChristianPeanChristian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine where he serves as Executive Director of AI and IT Innovation. He is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value-based care in musculoskeletal health with conversational AI. He is also author of the popular substack Techy Surgeon.  https://www.revelaihealth.com/https://techysurgeon.substack.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

The episode explains that inflammation is a necessary survival mechanism, with acute inflammation supporting healing, while chronic inflammation drives chronic disease. It outlines major contributors to chronic inflammation including visceral fat (with fasting insulin as a proxy for insulin resistance), poor sleep and sleep apnea, ultra-processed foods, sedentary behavior, overtraining, chronic psychological stress, poor oral health, gut dysbiosis/barrier issues, smoking, alcohol, pollution, autoimmune disease, and chronic infection. The host reviews biomarkers to discuss with a physician such as high-sensitivity CRP, ESR, ferritin, WBC and neutrophil-to-lymphocyte ratio, fasting insulin, ApoB, omega-3 index/omega-6:omega-3 ratio, and homocysteine. Chronic inflammation is linked to cardiovascular disease, depression/anhedonia, brain fog, autoimmune disease risk, cancer mechanisms, skin aging, erectile dysfunction, and chronic pain. Treatment focuses on lifestyle (notably treating sleep apnea, sleep optimization, fat loss, exercise, oral health, omega-3 intake, sauna, stress regulation, circadian rhythm), selected supplements (vitamin D if deficient, curcumin, boswellia, ginger, garlic, olive oil polyphenols, sulforaphane, magnesium/glycine, taurine, NAC, quercetin, probiotics, creatine), and brief discussion of drugs including GLP-1 agonists, colchicine, NSAIDs, corticosteroids, and biologics.   Chronic inflammation https://www.ncbi.nlm.nih.gov/books/NBK493173/ C-reactive protein test https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/ ESR blood test https://medlineplus.gov/lab-tests/erythrocyte-sedimentation-rate-esr/ Ferritin blood test https://medlineplus.gov/lab-tests/ferritin-blood-test/ Homocysteine test https://medlineplus.gov/lab-tests/homocysteine-test/ ApoB test https://my.clevelandclinic.org/health/diagnostics/24992-apolipoprotein-b-test Insulin resistance https://www.ncbi.nlm.nih.gov/books/NBK507839/ Obstructive sleep apnea https://medlineplus.gov/ency/article/000811.htm CPAP therapy https://medlineplus.gov/ency/article/001916.htm Sleep hygiene https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html Physical activity guidelines https://www.cdc.gov/physical-activity-basics/guidelines/adults.html Ultra-processed foods https://pmc.ncbi.nlm.nih.gov/articles/PMC10831891/ Gum disease https://www.cdc.gov/oral-health/about/gum-periodontal-disease.html Gut microbiome https://www.nccih.nih.gov/health/gut-microbiome-what-you-need-to-know Fiber https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/ Autoimmune diseases https://medlineplus.gov/autoimmunediseases.html Inflammation and heart disease https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/inflammation-and-heart-disease Inflammation and depression https://pmc.ncbi.nlm.nih.gov/articles/PMC4566946/ Cancer and chronic inflammation https://www.cancer.gov/about-cancer/causes-prevention/risk/chronic-inflammation Omega-3 supplements https://www.nccih.nih.gov/health/omega3-supplements-what-you-need-to-know   Show Notes 00:00 Welcome to the Hart2Heart Podcast 00:58 Inflammation Basics 01:24 Acute Versus Chronic 03:29 Chronic Disease Link 03:52 Visceral Fat Driver 06:06 Sleep And Apnea 12:33 Food And Movement 16:02 Stress And Oral Health 18:17 Gut And Fiber 21:17 Toxins Autoimmune Infection 26:05 Inflammation Biomarkers 27:13 Inflammation Blood Markers 28:37 Ferritin Iron Balance 30:07 Metabolic Cardio Labs 32:08 Omega 3 Index Insights 34:07 Homocysteine Risks 34:58 Why Inflammation Matters 41:07 Lifestyle Fixes 46:24 Supplement Options 54:36 Medication Overview 57:36 Final Takeaways   The Hart2Heart podcast is hosted by family physician Dr. Michael Hart, who is dedicated to cutting through the noise and uncovering the most effective strategies for optimizing health, longevity, and peak performance. This podcast dives deep into evidence-based approaches to hormone balance, peptides, sleep optimization, nutrition, psychedelics, supplements, exercise protocols, leveraging sunlight, and de-prescribing pharmaceuticals — using medications only when absolutely necessary. Beyond health science, we explore the intersection of public health and politics, exposing how policy decisions shape our health landscape and what actionable steps people can take to reclaim control over their well-being. Guests range from out-of-the-box thinking physicians such as Dr. Casey Means (author of "Good Energy") and Dr. Roger Sehult (Medcram lectures) to public health experts such as Dr. Jay Bhattacharya (Director of the National Institutes of Health (NIH) and Dr. Marty Mckary  (Commissioner of the Food and Drug Administration (FDA) and high-profile names such as  Zuby and Mark Sisson (Primal Blueprint and Primal Kitchen). If you're ready to take control of your health and performance, this podcast is for you.We cut through the jargon and deliver practical, no-BS advice that you can implement in your daily life, empowering you to make positive changes for your well-being. Connect with Dr. Mike Hart Instagram: @drmikehart Twitter: @drmikehart Facebook: @drmikehart

Airway management remains one of the most critical and technically demanding aspects of pre-hospital care. In this special Pre-Hospital Airway Compilation, we bring together leading voices in airway management to explore the fundamentals, controversies, and high-stakes realities of managing the airway outside the hospital environment.Across these conversations, we move from airway assessment and respiratory evaluation through to advanced interventions including rapid sequence induction, Suction Assisted Laryngoscopy and Airway Decontamination (SALAD), and Front of Neck Access (FONA). We examine the challenges unique to the pre-hospital environment, discuss practical approaches to decision-making under pressure, and explore where clinicians fit into a stepwise airway management strategy—from optimisation and monitoring all the way through to invasive surgical techniques.Joining us first is John Chatterjee. John is a Consultant Anaesthetist with interests in pre-hospital care, difficult airway management, thoracic anaesthesia, and high-risk anaesthesia. Alongside John, we are joined by Cliff Reid, a retrieval physician with more than two decades of experience across air ambulance and critical care transport services. This episode aims to provide practical insights into one of pre-hospital medicine's most challenging and consequential interventions.This episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at ⁠https://www.pax-bags.com/en/⁠VitalStream from BHA Medical sponsors this podcast: Closing the Haemodynamic Blind Spots in Acute and Pre-Hospital CareVitalStream is a wireless, wearable, non-invasive haemodynamic monitoring platform designed to deliver continuous, real-time physiological data, so you're not relying purely on intermittent cuff readings when patients are unstable, moving, or in non-traditional care environments.BHA Medical's VitalStream solution focuses on integrating this level of monitoring into acute care workflows, streaming real-time data to a centralised platform, supporting earlier recognition of deterioration and more informed clinical decision-making.In corridor medicine, where patients are often managed outside traditional monitored spaces, the challenge is missed deterioration between spot checks. Continuous trending helps reduce those “blind spots,” enabling earlier identification of haemodynamic decline and better prioritisation when systems are under pressure.And in pre-hospital care, the value is in maintaining a clear physiological narrative from first patient contact through to hospital handover. VitalStream is designed for rapid deployment, applied, calibrated, and delivers data within around 90 seconds, using a low-pressure finger sensor that allows teams to follow trends in real time, rather than relying on isolated snapshots.For more information, visit: https://www.bha-medical.com/vitalstream-patient-monitoring

In this video, Dr. Ruscio discusses 8 benefits of taking butyrate, a fat molecule with gut and systemic healing properties. Butyrate is produced by gut bacteria, but it is often low in different chronic health conditions. Supplementation has been shown to improve a variety of gut conditions, including IBS, IBD, and SIBO, as well as chronic inflammation and brain health. Doctor Ruscio also discusses some simple dietary strategies to increase butyrate production naturally.    ✅ Start healing with us! Learn more about our virtual clinic:  https://drruscio.com/virtual-clinic/  

In this edition of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, CA, USA, speaks with expert guest Jan Headley, Principal at Consultants in Acute and Critical Care. They explore the use of functional hemodynamics in the postoperative management of cardiothoracic surgical patients. Chapters  00:00 Intro  01:26 Case Study  04:28 Fluid Responsiveness, Dynamic Parameters  07:37 Variability Within Normal Limits  09:34 Determining Responsiveness Efficiently  12:45 No PA-Catheter Patients  15:35 Reassessing Values  17:22 First Step  19:20 No-Fluid Patient  20:27 Stroke Volume Trends  21:13 Key Takeaways  The discussion includes a case study illustrating how functional hemodynamics can guide clinical decisions in this context. They delve into the concepts of fluid management and fluid responsiveness, comparing dynamic parameters and static parameters, and the importance of increasing stroke volume. Key topics also include pulse pressure variation, stroke volume variation, variability, and delta stroke volume. The conversation further covers techniques such as the passive leg raise maneuver and the pulmonary occlusive maneuver. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don't miss next month's episode! Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Dr. John Lewis joins the show today to discuss how to create a healthier brain and body at any age. He is the Founder and President of Dr. Lewis Nutrition and has spent years “educating others about the importance of nutrition, dietary supplementation and exercise for health”.Listeners will discover the importance of polysaccharides for brain health and immune function; how to use key dietary supplements to improve your immune system function and understanding how poor nutrition is linked to chronic diseases.Dr. John Lewis can be reached for consultation via the following links:DrLewisNutrition.com DailyBrainCare.com

Progressive Overload for Runners Over 40Build strength, mileage, and speed—without breaking downProgressive overload isn't about doing more—it's about doing just enough to create adaptation.In this episode, we break down how to train smarter as a runner over 40 by working with your body (not against it). We cover the stress → recovery → adaptation cycle and why recovery becomes even more important with age, hormones, and life stress.You'll learn how to use the 3 key training dials:VolumeIntensityFrequency…and why adjusting one at a time is the key to staying consistent and injury-free.We also dive into:5 ways to progress your strength training (without just adding weight)How to build mileage safely (without overloading your long run)Smarter speed progression, starting with stridesWhy your nervous system plays a bigger role than you thinkPlus: Join our FREE live masterclass on May 12

On this episode we were joined by special guest sports dietician Brett Singer from Memorial Hermann! Acute effects of nutritional and physical recovery strategies on exercise performance, muscle damage, and fatigue in elite basketball players: a pilot randomized crossover trial Marín-Galindo A, Perez-Bey A, Escudier-Vázquez JM, et al. Life. 2026;16(2):275. doi:10.3390/life16020275 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest VALD MoveHealth - https://movehealth.me/ Learn more about/purchase our courses: The Science PT | Dungeons & Dynamometers Support us on the Patreons! Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux  

Dr. Alan Micco, Neurotology at Northwestern Medicine, joins Lisa Dent to talk about Benign Paroxysmal Positional Vertigo (BPPV). He details how people get it, who’s at risk, and what people can expect.

https://www.patreon.com/highyieldfamilymedicineIntro (0:35),Acute pharyngitis (1:44),Infectious mononucleosis (3:52),Gonococcal pharyngitis (5:59),Diphtheria (7:31),Peritonsillar abscess (8:53),Retropharyngeal abscess (10:05),Epiglottits (11:23),Croup (12:49),Ludwig's angina (13:51),Anaphylaxis (14:44),Foreign body aspiration (15:41),Laryngitis (16:28),Vocal cord nodules (17:19),Laryngeal cancer (18:23),Dysphagia (19:30),Thyroglossal duct cyst (23:38),Branchial cleft cyst (24:28),Subacute thyroiditis (25:20),Cervical lymphadenopathy (26:37),Practice questions (28:20)

Want to check out my online academy? Click the link belowhttps://www.skool.com/stokke-doubles-academy/aboutWant to attend a future doubles camp?https://stokketenniscoaching.comClick here for 10% off your next ADV baghttps://www.advtennis.pro/JONATHAN70538We talk:1:21 Acute vs. chronic injuries4:15 Being consistent with your routines7:12 Lower cross syndrome11:40 Structural problems vs. functional problems13:23 Improving how you sit15:05 Hydration19:27 Best food during a match22:05 3 action steps you can take

In this must-listen episode, Dennis sits down with Dr. Jon Andrews—former 5th and 20th Group Special Forces medic turned Duke-trained anesthesiologist (pediatric & cardiac fellowships)—to tackle one of the biggest headaches in austere medicine: you have a tiny box of opioids and ketamine, a long mission, and a patient who needs to stay alive AND comfortable.They break down exactly how to stretch every milligram using real OR strategies adapted for prolonged field care: patient-specific planning, smart titration, multimodal synergy, regional blocks, ketamine myths, and when (and how) to layer non-narcotics without crashing your patient or your supply.Why this episode matters: Acute pain becomes chronic pain. Chronic pain leads to opioid dependence, PTSD, and worse outcomes. In the field, your choices today shape your patient's tomorrow—and whether you still have meds left when the next casualty shows up.Key TakeawaysStart low, titrate smart. Cut your first dose in half on sick or unstable patients. You can always give more—never the other way around.Multimodal is mission-critical. Hit pain from every angle (blocks + ketamine + acetaminophen + judicious NSAIDs) to dramatically reduce opioid requirements and prevent chronic pain pathways.Ketamine IS an analgesic. It's not just dissociation—it's an NMDA antagonist that blunts central sensitization and has proven opioid-sparing effects.Schedule your non-opioids. Acetaminophen (1 g IV/PO/PR q6h) and longer-acting adjuncts form your baseline; use fentanyl or morphine only for breakthrough.Blocks beat everything—if you can do them. Pre-emptive regional anesthesia (when feasible) is the single highest-yield move before surgical stimulus hits.Monitor like your life depends on it. Heart rate, blood pressure, and respiratory rate are your best pain score when the patient can't talk.Plan for worst-case evacuation. Bring more than you think you'll need and dose for the opioid-naïve or opioid-tolerant reality in front of you.Why treating hypertension in the OR (or field) almost always starts with fixing pain firstThe “start low, see response, add more” mantra every austere provider needsWhy Tylenol often performs as well as morphine in blinded ED studies (and why your patients still doubt it)Real talk on ultrasound-guided blocks in 2011 vs. today—and why proficiency still mattersThe dangerous synergy of opioids + benzos + ketamine on respiratory driveWhy you must get comfortable decreasing doses, not just ramping them upChapters01:55 – The austere reality: limited narcotics and why your favorite med won't last forever03:37 – OR planning vs. field reality: opioid-naïve vs. chronic users05:57 – Multimodal analgesia explained (blocks, ketamine, Tylenol, NSAIDs, dexmedetomidine)08:28 – Patient & mission factors that should drive your loadout12:23 – Golden rule: start low, titrate to effect, monitor vitals15:05 – Sick-patient hack: cut your mental dose in half16:01 – Is ketamine actually an analgesic? (NMDA, opioid-sparing, PTSD data)19:12 – Extending your supply: bolus vs. infusion, redosing strategy24:27 – First-line multimodal choices in the field27:43 – Juggling multiple agents: timing, scheduling, and longer-acting blocks30:15 – Regional anesthesia timing—pre-emptive is king (post-injury limitations)32:48 – Ultrasound & blocks in the current PFC world35:08 – Safety considerations for adjuncts (liver, kidneys, bleeding, alcohol)36:59 – Bang-for-buck data on Tylenol vs. morphine38:55 – Practical integration: layering Tylenol/ketamine with fentanyl titration41:54 – Getting comfortable titrating down (and why pain scores can lie)42:53 – Final wisdom: use everything you're comfortable with.For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

T.J. has acute laryngitis so we are keeping things short and sweet this week so he can rest his voice. If you want more of the podcast, we have extra episodes for members every week and when you become a member you get access to all of them, ad free! Join here - walkinlove.supercast.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long (@long_brit), we cover EBM updates concerning the imaging and management of adult appendicitis.  See part 1 for history and exam findings, laboratory testing, and risk diagnostic scores. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle PlaySend us Fan Mail

CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams.  The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP

Program notes:0:30 Controlling HTN after intracerebral hemorrhage1:30 Triple pill or placebo2:30 Only effective treatment is lowering blood pressure3:32 Serum creatinine levels4:15 Is there a role for Paxlovid?5:15 Did not reduce hospitalization or death6:10 Fast antimicrobial susceptibility test for gram negative7:10 Desirability of outcome ranking or DOOR8:10 Median time to effective therapy reduced9:10 Was not superior10:07 Acute sinusitis treatment11:15 Secondary effects higher with augmentin12:21 End

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from April 18-24, 2026.

This episode includes two full, sample vascular scenarios pulled directly from our Vascular Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."Sample Scenarios Included in This Episode: Case 22: Aortoenteric Fistula (AEF). A 78-year-old woman presents to the ER with a massive upper GI bleed and a history of an open AAA repair 10 years ago. We walk you through the immediate stabilization, CTA evaluation, and the definitive operative management—including axillobifemoral bypass, aortic stump closure, and duodenal repair. Case 27: Acute Mesenteric Ischemia. A 79-year-old woman with a history of atrial fibrillation presents with abdominal pain out of proportion to her physical exam. Test your decision-making on systemic heparinization, SMA embolectomy versus stenting (ROMS), and how to appropriately evaluate bowel viability with a second-look laparotomy. About our Vascular Surgery Oral Board Review Course: 72 High-Yield Scenarios: Covering everything from carotid stump syndrome to a AAA with a horseshoe kidney. Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the same scenario packed with expert tips, tricks, and commentary). Free Simulator Access: Every purchase of the course includes access to our new AI-powered Oral Board Simulator, allowing you to practice your verbal responses under pressure. Resources: Vascular Surgery Oral Board Review Course: https://app.behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator Download the BTK App on iOS and Android for on-the-go studying. DOMINATE THE DAY!

Show Notes Inflammation is one of the body's most important defense mechanisms—but when it doesn't shut off, it can quietly contribute to serious health problems. In this episode of Health Matters, host Courtney Allison speaks with Dr. Charis Meng, a rheumatologist at NewYork‑Presbyterian and Weill Cornell Medicine, about how inflammation works and why chronic inflammation can put the body at risk. Dr. Meng explains the difference between short‑term, helpful inflammation and long‑term inflammation that lingers for months or years, affecting everything from joints to the heart, brain, and immune system. The conversation explores autoimmune conditions like rheumatoid arthritis, what causes inflammation, and how lifestyle factors such as diet, sleep, stress, and physical activity can impact inflammation. Dr. Meng also discusses treatment options ranging from targeted immune therapies to lifestyle changes, acupuncture, and emerging research on GLP‑1 medications. This episode offers clear, science‑based guidance to help listeners understand inflammation—and what they can do to help keep it in check. Chapters 00:00 – What Is Inflammation, and When Is It Helpful? How inflammation works as the body's natural defense system 03:45 – Acute vs. Chronic Inflammation Why inflammation sometimes doesn't shut off—and how it can cause harm 07:30 – Inflammation and Disease Risk Autoimmune conditions, heart disease, diabetes, and cancer 09:45 – How to Reduce Chronic Inflammation Medical treatments, diet, exercise, sleep, and emerging research   Key Topics Covered Inflammation and the immune system Acute vs. chronic inflammation Autoimmune diseases and rheumatoid arthritis Heart disease, diabetes, and cancer risk Anti‑inflammatory lifestyle habits Mediterranean diet and inflammation Exercise, sleep, and immune balance Acupuncture and integrative care GLP‑1 medications and inflammation research   Takeaway Message Inflammation is the body's natural healing response, but when it becomes chronic and doesn't turn off, it can contribute to serious conditions like heart disease, diabetes, and cancer. While some chronic inflammation is driven by autoimmune disease or factors beyond our control, healthy habits like diet, exercise, and sleep can still help support the body and reduce long-term health risks.   Doctor Bio Dr. Charis Meng is an assistant attending rheumatologist at NewYork-Presbyterian/Weill Cornell Medical Center and an assistant professor of clinical medicine at Weill Cornell Medicine, who is also certified in acupuncture. Her practice is in general rheumatology, and her special interests are in treating older patients with chronic pain, low back pain and inflammatory arthritis.

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized controlled trial evaluated treatment of intermediate risk PE patients Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone The primary outcome evaluated changes in right ventricular enlargement at 48 hours A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions Low clinical significance The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments Treatment for intermediate risk PE patient remains controversial The same study will have second follow-up at 90 days to see if there are other benefits References Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/