Podcasts about auscultate

Hoc in episodio, Timotheus et Catherina flores vicinorum clam sumunt, et in animalia mutantur. Auscultate, si audetis- episodium valde ridiculum est!

Hoc in episodio, Timotheus et Catherina de libis fartis mexicanis, seu de cuneis mexicanis, garriunt. Quid soletis addere ad cuneos mexicanos vestros? Mavultis carnem suillam an carnem gallopavonaceam? Auscultate et fruimini!

Inviaci la tua testimonianza elica a mosche.radio@gmail.com Iscriviti al nostro canale Telegram t.me/radiomoschepodcast Iscriviti al nostro canale con chat https://t.me/+F7qXNTmDwK1jMjY0 Torna Radio Mosche con la Quinta Stagione: si riparte con il botto! In questa puntata parliamo dei recenti concerti teatrali, impressioni e risate di un un ritorno tutt'altro che sgradito! Auscultate bene l'episodio perché ci sono tantissime sorprese, buon ausculto con Radio Mosche!

Hoc in episodio, et de benificiis et de incommodis culinarum alienarum loquimur. Hoc etiam notandum est: beati sumus (et auscultatores beati sunt) quia amicus noster carissimus Iason nos comitatur in hoc episodio! Auscultate et fruimini!

Hoc in episodio optimo, cum Irene Regini, conditrix clarissima acroamatis nomine "Satura Lanx", laetissimi loquimur! Auscultate et fruamini!

Hoc in episodio, Timotheus et Catherina de cultellis loquuntur. Suntne cultri vestri acuti an hebetes? Quotiens soletis cultros acuminare? Auscultate et fruimini!

Andrea Kovalsky uses Twitter a lot as an Athletic Trainer. Why do you use social media for sports medicine? I was professionally socialized by Boomer ATs, so I'm a bit old school. But working on a relatively nontraditional DAT, I've learned that we have to embrace change and make it work for us before we get left behind. If social media is how future generations consume information and interact with the world, then it has to be a part of how we advocate and move the profession forward. Otherwise, we're losing out on engaging with a huge audience.   There is just so much information out there, it's impossible to read & digest everything coming out of sports medicine today. I like the short snippets that social media provides so that I can decide whether I want to read the whole article/study later Journal subscriptions are expensive! I'm completing a DAT at FIU right now, but I joke that I'm only there for access to the university's library databases (PS: If we want preceptors to encourage clinical students to practice EBP, we must give preceptors access to the university library databases as a form of payment for the work they do!) What have you taken from Social Media? Like the disclosure slide that no one pays attention to in CEU presentations: my opinions may not be those of my employer, and use this information with caution!  Take everything with a grain of salt: Who is the speaker? What's their background? What's their motivation for posting this? Are they blowing off steam, subtweeting someone, or looking for genuine engagement? If they are looking to engage, are they open to learning, or will any discourse make them dig in further? Know when to disengage. We have such a diverse community on #ATtwitter. There are a lot of positives as well as some challenges. It's also helpful to bring those connections to the real world, though. The life we present online is often much rosier than real life, but real life is where things get done. Advocating on social media and living it are two different things. I try to be the same person online as off. How has it helped? Probably wouldn't have survived lockdown without finding AT friends online Learning new clinical techniques, hearing about research before it's published Another avenue to get questions answered & reach people in power Got our new practice act language passed! Helps me survive as a solo AT: venting, troubleshooting, connecting with others who get my jokes Has it been harmful or negative for you at all? There will always be trolls and misinterpretation of context, which is how messages get blown out of proportion Probably mildly addicted, but who isn't? (It's also kinda my job to be on socials, so I use that excuse) How do you manage Twitter? Tweetdeck is a lifesaver, but there are dozens of paid and free social media managing apps out there Add relevant images as much as possible, it boosts your visibility Use a link-shortener like bit.ly when you reach a character limit Don't just post a link to other content, post a quote or short explanation Ask a question, and state something poignant if you want people to engage Best engagements happen when you post in the morning My NATM is often not the theme: 2022 was #ATgratitude, and 2023 was #auscultATe.  IATA's 2022 was #FlatAT (had so much fun with that!) I do use ATCAnonymous, but only when I need to reach a wider audience than what I have, with a legitimate question. Not a fan of anonymous accounts. Why? Listen to Kutz & Konin's Leadercast episode 15: Anonymity & leadership Socrates said: “Is it true? Is it kind? Is it necessary?” There's enough shit in the world. Be kind. Eleanor Roosevelt said: “Great minds discuss ideas; average minds discuss events; small minds discuss people.” Which platforms do you use and why? Fewer and fewer nowadays! The real world is too busy (FT job, FT doctoral student,

Hoc in episodio, Timotheus et Catherina garriunt de isiciis hamburgensibus. Estne panis fartus? Qualis caseus nobis placet in isiciis hamburgensibus? Quid aliud addendum est ad isicium hamburgense? Auscultate et fruimini!

Hoc in episodio, de pitta loquimur. Unde venit? Suntne fabulae antiquae quae spectant ad pittam? Quomodo sapit pitta cum ananate et carne porcina? Auscultate et, si placet, scribite roganda et responsa vestra de pitta ad nos!

Hoc in episodio, garrimus de methodis quibus ova coquantur, et de thermopoliis francogallicis. Etiam de duobus methodis quibus brassicae pompeianae coquantur. Auscultate, et fruamini!

Hoc in episodio, cum carissima sodale nostra, Iessica, garrimus. Immo, nugamur, quia de nuce (hahae!) nomine "amygdalum" loquimur. Auscultate et fruamini!

Auscultate le nostre opinioni su TUTTI i giochi che abbiamo provato nella 1° e 2° in questo esplosivo finale di stagione.

Hoc in episodio, Catherina et Timotheus Plinium Maiorem recitant. Qualia sunt beneficia asparagi, sententia Plinii? Auscultate et discite!

Hoc in episodio, garrimus de cenis nostris hodiernis- Catherina iusculum lentis parabit; etiam bis coctos casei plenos assabit. Timotheus etiam salmonem fumatum coquet; etiam ferculum nomine 'paella' sub divis parabit. Auscultate et fruamini!

Hoc in episodio, Timotheus et Catherina garriunt de consuetudinibus suis, mane, die Solis. Quid solet Timotheus legere, et edere, die Solis? Quid de Catherina? Auscultate et fruimini, sodales!

Today's episode is dedicated to the approach to thyroid storm. It's the first in our Mini-Case series. Show Highlights: Our case, symptoms, and diagnosis: A 12-year-old female presents to the PICU with chest discomfort. She was noted to be anxious by her parents over the past few days. They felt she was a bit "off," as she would constantly drop items and have a tremor. A few weeks prior to these symptoms, she was noted to have rhinorrhea, congestion, and progressive neck swelling. Her parents became increasingly concerned this morning as her temperature was 104F. Per her parents, she was agitated throughout the night and became increasingly somnolent in the early morning.  To summarize key elements from this case, this patient has: Chest pain likely due to a cardiac etiology or musculoskeletal cause. Tremor likely due to a primary neurologic cause or increased metabolic drive. Neck swelling with fever after a prodrome of URI symptoms which could be concerning for lymphadenitis or thyroid goiter. Synthesizing these symptoms together, this patient likely has a systemic etiology such as hyperthyroidism, with the most severe manifestation being thyroid storm, a toxidrome, or a pheochromocytoma. Given the fever and altered mental status, considering sepsis is key. Key history features in this child with tachycardia and signs of hyperthyroidism: High fevers up to 104F Altered mental status Neck swelling  Red flag symptoms and physical exam components in a patient with severe hyperthyroidism include: Airway Check for dyspnea or stridor when the patient is supine. Do a Mallampati assessment. Auscultate for a bruit in the neck.  Cardiovascular system Concerns include congestive heart failure and cardiac dysrhythmias. Widened pulse pressure is common  The American Thyroid Association has advocated for the Burch-Wartofsky Point Scale (BWPS) for severe thyrotoxicosis. A score of 45 or higher indicates thyroid storm. A case-control study published in 2015 in the Journal of Endocrinology noted that the BWPS may overdiagnose up to 20% of patients. Clinical criteria on the BWPS include the following: Thermoregulatory dysfunction Central nervous system effects Gastrointestinal-hepatic dysfunction Cardiovascular dysfunction Congestive heart failure Presence or absence of a precipitant history of URI or underlying thyroid condition Back to our specific case, the patient's labs are consistent with low TSH and elevated free T4, indicating primary hyperthyroidism, positive for TSH-receptor antibodies, and the diagnosis of thyroid storm was confirmed. Other lab findings included elevated WBC, high ALT and AST, elevated glucose, and elevated cortisol. Her cardiac evaluation was notable for sinus tachycardia with occasional PACs. Other important labs include a coagulation panel, BNP and lactate, CRP, procalcitonin, blood cultures, and basic blood chemistries. Let's quiz ourselves with a multiple choice question: A patient with thyroid storm is admitted to the PICU. He is started on thyroid modulating therapy. Which of the following mechanisms of action does this medication likely work by?  A. Activate Thyroid Peroxidase  B. Inhibit Thyroid Peroxidase  C. Inhibit Iodine Uptake within the Thyroid  D. Increase conversion from T4 to T3    The correct answer is B. The most likely medication which is used in thyroid storm is methimazole or propylthiouracil. Both of these medications block thyroid peroxidase.  In terms of differential in our case, you want to think about other causes of fever, tachycardia, and CNS dysfunction, including, but not limited to sepsis, serotonin syndrome, neuroleptic malignant syndrome, heatstroke, and drug intoxication.  The diagnostic approach for our patient should focus on her history and physical examination. Be sure to include thyroid function tests, cardiac evaluation via EKG or Echo, chest x-ray, blood culture, urine...

Hoc in episodio, sodalis nostra Elea de iusculo mirabili (et de altero cibo mirabili) loquitur. Timotheus et Catherina etiam de vere (et de genere ostrearum mirabilium) loquuntur. Auscultate et fruamini!

Quidnam rerum inest in scuto Vitellii, secundum Suetonium? Cerebella avium!? Linguae phoenicopterorum?!?! Lac murenae ?!?!?!? Auscultate, et fruamini hunc lectionem mirabilem.

Operae pretium est sermonem de primo christiano scriptore edere qui Romae florens verba latina litteris, quae supersunt, primus consignavit. Auscultate, fratres!

Hoc nono acroamate incredibilem feminam vobis ostendo quae nata saeculo secundo p.C.n universos christianos non solum mirabili suae vitae et mortis exemplo verum etiam scripto carissimo illustravit. Auscultate et cognoscite Divam Vibiam Perpetuam, invictam Christi martyrem.

Guglo quaerite "Credo quia absurdum" et multos hoc effatum Tertulliano imputantes reperietis. Attamen, (mehercle!) Tertullianus hoc haud dixit! Auscultate ut et originem et sortem huius locutionis intellegatis.

Num Divus Hieronymus totius sacrae scripturae vere est interpres? Fama verum traditur, annon? Auscultate et comperietis!

Binos libros scribit Tertullianus ad suam uxorem. Quam vero rem tractat? Auscultate!

Qui duas septimanas in Polonia versatur ad latine et graece loquendum (#scholaposnaniensis2019 et https://scholaaestivaposnaniensis.wordpress.com necesse est eum aliquando subdelirare. Auscultate igitur fabulam meam aliquantae gravitatis!

Carmen iterum legimus, quod est Martialis epigramma 78 e libro quinto. Amicum cenatum invitat poeta: quidnam ei praebebit edendum? Auscultate ut sciatis!

Loquor de nonnullis rebus palaeographicis atque carminibus pertinentibus ad novum annum, necnon de propositis meis huius novi anni. Auscultate usque ad finem ut cognoscatis primum hospitem meum apud Discite Mecum!!! Lapsus est annus: https://www.youtube.com/watch?v=skGIFjEz2Co&t=2s Sequimini me apud Youtube: http://www.youtube.com/c/AprilisAlbuquerquensis

Chief Complaint Pt comes in with a heart rate of 170-200. Complains of palpitations/sob/chest pain/dizziness/or nothing.  Is this SVT or A-Fib? Hint! Today we are talking about SVT. Bedside Checklist Take off clothing waist up. Put on a hospital gown. Immediately place pulse ox, leads, and bp cuff - in that order. If oxygenation is poor with good waveform - address this first. Start with a nasal cannula, if that doesn't give your pt relief. Apply NRM, while you set up BIPAP. Find out if they have COPD or emphysema or a chronic smoker - oxygen saturation requirements are less for this population. High flow nasal cannula may be an option. Keep hob elevated to min. 30 degrees. 45-90 better. Watch the position that your patient is sitting. If they are leaning forward or sitting up straight - Put the hob at 90 degeees and ask them, is it easier for you to breathe sitting up. Obese patients may prefer to have legs over the side of the stretcher due to abdominal girth. Get an EKG stat. After you get the 12 lead - keep the EKG leads on pt Is this an atrial or ventricular rhythm? Today it’s an atrial rhythm. It’s so fast, we don’t know if it’s SVT or A Fib! Get 1-2 iv access. Preferably 2. Labs now or later? This is controversial. If the pt looks like they are a hard stick, I get labs so I can at least run a venous panel to get a baseline pCO2 level. If the pt goes on BIPAP or high flow nasal cannula - you can trend this along with other values to direct the oxygen needs. Look at your pt. If they are talking to you and appear somewhat calm - you have the time to get labs off that first iv line. If the pt looks really bad, just get the iv access and you can get the labs later. Ideally you have a 2nd nurse who is putting in the IV line while the EKG is in progress so you can get the labs right away. While you are doing this - examine your patient: Mental status - hello sir! Can you tell me your name? Do you know where you are? What day is it? If you know the pt has dementia, what year or who's the president seems to work better. Work of breath - are they gasping for air? What is the respiratory rate? Do they look tired? - worried about losing compensatory drive? Auscultate the lungs. Wheezing - inspiratory or expiratory or both? Upper or throughout the lungs? Crackles? Decreased air movement? Trick question - are they coming in with multiple problems? Yes, sometimes that happens. Get the story as the above is happening: What happened? When did this happen? Were you sitting, walking, lying down? SOB/Chest pain/Palpitations/Dizziness or Lightheadedness/Nausea/Vomiting/LOC? If BIBEMS, Ask EMS how did they find the patient and where, what interventions (oxygen, iv line, meds), do they look better now? Has this ever happened to you before? Any fevers or recent illness? Do you have a pacemaker or defibrillator? What medications are you on? Do you have any allergies to medications? SVT Treatment First line of treatment: Vagal Maneuvers. Ice to face Carotid massage Tell the pt to bear down Modified Valsalva Maneuver Technique Second line of treatment: Adenosine In 2015 the Lancet published the REVERT trial and the findings were pretty impressive. The REVERT trial created another vagal maneuver that actually works!  It’s called a Modified Valsalva Maneuver Technique.  I’ve tried this out myself and it works pretty well. You just have to make sure your technique is good and you have 2 people at the bedside. Modified Valsalva Maneuver Technique: Have the pt sit down on the stretcher with HOB elevated at 45 degrees (semi-recumbent) or the pt can just sit up straight. Use a 10mL syringe (pressure of 40mmHg) and have them blow into it for 15 seconds (creating the Valsalva strain) Immediately afterwards, place the pt in a supine position and passive leg raise 45-90 degrees for 45 seconds. (Increases the relaxation phase of venous return and vagal stimulation). This is the modification.