Podcasts about CXR

Maddy, Youssef and Noah discuss a case presented by Andrew and share their approach to hypercarbia. CXR discussed in the episode:    Link to hypercarbia schema. To join us live on Virtual Morning Report (VMR), sign up HERE.  Download CPSolvers App here RLRCPSOLVERS

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we are joined by Dr Stephen Bradley, lead author of a new paper published in the BJGP looking at rates of CXR use in general practice and how this influences lung cancer stage at diagnosis and mortality. He discusses the findings of his research and how this might influence our practice. In other research, we look at a new paper in the BMJ on orthostatic HYPERtension - yes, you read that correctly - does treatment help, and does it really matter in the first place? And from the Lancet, research looking at the role of urodynamic studies in women with refractory overactive bladder - does it improve outcomes, or should it be stopped?ReferencesBMJ Orthostatic hypertension and BP treatmentBMJ OH editorialLancet Refractory overactive bladder & urodynamic studiesBJGP CXR in GP & lung cancer staging and mortalitywww.nbmedical.com/podcast

TWiP solves the case of the man with somnolence and something extra-erythrocytic, and presents a new puzzle for you to solve. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Letters read on TWiP 253 New Case 26-year-old female with no past medical history.  Patient is from Georgia in the US and is volunteering in Hérico, Guinea (town in the Lélouma Prefecture in the Labé Region of northern-central Guinea). She arrived in Guinea in December  2023.  She was taking doxycycline for malaria prophylaxis and says that she has not missed any doses On October  2024 she presented with fever and dry cough.  Lab work was done and follow up planned for the following day.  The patient slept poorly, was febrile to 104 and had ongoing cough.  The next day she went to the hospital and was evaluated in the ER for acute febrile illness of unclear etiology.   In the hospital, VS were 97.9F, BP 105/70, P 94 Oxy sat 98%, normal physical exam. She was started on Augmentin and Coartem. Pause here to think about the differential at this point and maybe some more history and what testing you might want WBC 14, Hb 13, HCT 40, PLT 285, Neut abs 8, Eos Abso0.80; BUN/creat  normal, AST normal; ALT 44, GGT 125 Stool parasite screen + for some sort of eggs, malaria smear negative, CXR with b/l infiltrates She was given a medication (vomited 30 min after dose received).  She then received a second dose of medication 5 hours after the first) and was discharged. The following day the patient returned to the ER, stating that she felt worse.  Her temperature had climbed to 104 overnight, and she developed watery diarrhea and nausea.  There were no additional episodes of vomiting.  She was given an additional dose of a medication, ibuprofen, and started on ceftriaxone 1 gm IV Q12 hrs.  During the day she continued to have low grade fevers and developed abdominal pain.  That night she was again febrile to 104 F.    She remained admitted for 5 days with ongoing symptoms of diarrhea, nighttime fevers and diffuse abdominal discomfort.  Three more malaria tests were negative (rapid test and slide review) Blood cultures collected – no growth She continued to have mild elevation of WBC and slight elevation of AST and ALT. The patient was transferred to a different hospital. They give her a different medication, and within 24 hours symptoms resolve.  What is the diagnosis and what happened here with management? Become a patron of TWiP  Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

CXR's Chris Hoyt (he/him), BASF's Claire Mason, and Cox Enterprise's Adam Glassman connect on their favorite takeaways from the Q4 Research on Strategic EB.

CXR's Chris Hoyt (he/him) and Bryan Adams of HappyDance will be sharing key findings from our latest Research Report: Establishing Employer Branding as a Strategic Business Driver. Key talking points include Employer Branding as a Strategic Differentiator, Evaluating and Refining Employer Branding, Aligning Employer Branding with Broader Corporate Strategies, and Employer Branding as a Leadership Priority.

Dermatology Snapshots is sponsored by a educational grant from Abbivie. Feedback always welcome. 1)    Patient satisfaction with Teledermatology; a systematic review and meta-analysis2)    Management of scabies in children under 15Kg and pregnant or breastfeeding women: recommendations supported by the Centre of Evidence of the French Society of Dermatology3)    Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema. Findings from the Danish Skin Cohort4)    Efficacy of colchicine treatment for aphthous ulcers in paediatric patients: a retrospective review5)    Assessing the efficacy of oral tranexamic acid as an adjuvant to Triple combination Topical Treatment in Melasma6)    How useful is CXR in addition to routine Quantiferon in the Detection of Latent TB prior to biologics?7)    Isla Galpin. Violin Sonata in G minor, 1st and 2nd movement by Eccles

Join Josh Secrest, former McDonald's Global Head of TA (and current Paradox VP) and CXR's Chris Hoyt to hear how innovative TA leaders are doing (a lot) more with (a lot) less - moving top line and bottom-line results along the way.

In this episode, CXR's Chris Hoyt and Leah Daniels of JobSync will dive into how 2025 will see an explosion of AI products and features, urging organizations to tackle their biggest challenges head-on. We'll explore the implications of auto-apply tools for job seekers, and the careful balance employers must strike to stay compliant. Plus, we'll discuss why effective governance is more critical than ever and how talent teams can thrive while doing more with less.

Welcoming longtime CXR friend and current CEO/Founder of Fora, Joe Essenfeld to the podcast this week. We'll be talking AI trends and how to best leverage AI.

La mobilització de rebuig, prevista aquest dimecres, comptarà amb representants de Junts, ERC, CUP, Òmnium, ANC i CxR.

We had the pleasure of being official sponsors of ESW BrawlFest and sat down with the new ESW Tag-Team Champions, Chael Conners and TJEpixx of CXR. Brian and Jason  ask about their interest in wrestling, their training, and we learn what the champs like to do in their spare time. All of this ahead of their title defense against Greed. Spoiler alert: CXR won!

Before we head off to SHM CONVERGE this weekend, here are a few articles that may be of use in your practice. A random assortment from end-of-life care to ketamine in pain control, hopefully its something for everyone. | 00.05 - Intro | | 00.48 - CONVERGE - come visit me on Saturday in Hall F! Or email boostershots@ucsd.edu if you want to discuss at other times! | | 01.42 - Empagliflozin delays CKD progression in diabetic or glomerular disease, but not necessarily hypertensive or renovascular disease [ACP Journal Club 2024 (subscription required), Lancet D&E 2024] | 03.14 - Antibiotics and end of life care - I recommend you look at the paper [CID 2024] | | 06.33 - Low dose ketamine for pain control vs. morphine → Shorter onset, but shorter duration [AJEMEN 2024] | 08.00 - Using Deep Learning models to estimate CV risk using CXR only [AIM 2024] references for the groups' other studies using Deep Learning: Long-term mortality from CXR [JAMA 2019], Identifying high risk smokers for lung cancer CT screening [AIM 2020] | 09.53 - 43s Summary (yes I lied, it wasn't 30s), disclaimers, credits, etc. | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.]

We discuss a question here on a patient presenting with a Haematological Malignancy delving into the differentials and their aetiologies (more possible questions and answers revealed in the SAQ document), clinical features, CXR and CT interpretation along with complications.   Please follow the link to the SAQ on  . 

Episode 164: More Than Just A HeadacheDr. Song presents a case of a subacute headache that required an extensive workup and multiple visits to the hospital and clinic to get a diagnosis. Dr. Arreaza added comments about common causes of subacute headaches.    Written by Zheng (David) Song, MD. Editing and comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction to the episode: We are happy to announce the class of 2027 of the Rio Bravo / Clinica Sierra Vista Family Medicine Residency Program. Our new group will be (in alphabetical order): Ahamed El Azzih Mohamad, Basiru Omisore, Kenechukwu Nweke, Mariano Rubio, Nariman Almnini, Patrick De Luna, Sheila Toro, and Syed Hasan. We welcome all of you. We hope you can enjoy 3 enriching and fulfilling years. During this episode, you will hear a conversation between Dr. Arreaza and Dr. Song. Some elements of the case have been modified or omitted to protect the patient's confidentiality. 1. Introduction to the case: Headache. A 40-year-old male with no significant PMH presents to the ED in a local hospital due to over a month history of headaches. Per the patient, headaches usually start from the bilateral temporal side as a tingling sensation, and it goes to the frontal part of the head and then moves up to the top of the head. 8 out of 10 severities were the worst. Pt reports sometimes hypersensitivity to outdoor sunlight but not indoor light. OTC ibuprofen was helpful for the headache, but the headache always came back after a few hours. The patient states that if he gets up too quickly, he feels slightly dizzy sometimes, but it is only for a short period of time. There was only one episode of double vision lasting a few seconds about 2 weeks ago but otherwise, the patient denies any other neurological symptom. He does not know the cause of the headache and denies any similar history of headaches in the past. The patient denies any vomiting, chest pain, shortness of breath, cough, abdominal pain, or joint pain. The patient further denies any recent traveling or sick contact. He does not take any chronic medication. The patient denies any previous surgical history. He does not smoke, drink, or use illicit drugs. What are your differential diagnoses at this moment? Primary care: Tension headache, migraines, chronic sinusitis, and more.2. Continuation of the case: Fever and immigrant.Upon further inquiries, the patient endorses frequent “low-grade fever” but he did not check his temperature. He denies any significant fatigue, night sweats, or weight loss. He migrated from Bolivia to the U.S. 12 years ago and has been working as a farm worker in California for the past 10 years. He is married. His wife and daughter are at home in Bolivia. He is currently living with friends. He is not sexually active at this moment and denies having any sexual partners. Differential diagnoses at this moment?  Tension headache, migraine, infections, autoimmune disease, neurocysticercosis. 3. Continuation of the case: Antibiotics and eosinophilia. As we kept asking for more information, the patient remembered he visited a clinic about four months ago for a dry cough and was told he had bronchitis and was given antibiotics and the cough got better after that. He went to another local hospital ED one month after that because the cough came back, now with occasional phlegm and at that time he also noticed two “bumps” on his face but nothing significant. After a CXR at the ED, the patient was diagnosed with community-acquired pneumonia and sent home with cough medication and another course of antibiotics. His cough improved after the second round of antibiotics. We later found on the medical record that the CXR showed “mild coarse perihilar interstitial infiltrates of unknown acuity”. His blood works at the ED showed WBC 15.2, with lymphocyte 21.2%, monocyte 10.1%, neutrophil 61.7%, eosinophil 5.9% (normally 1-4%), normal kidney, liver functions, and electrolytes, and prescribed with benzonatate 100mg TID and doxycycline 100mg bid for 10 days. He went to the same ED one month before he saw us for headache and fever (we reviewed his EMR, and temp was 99.8F at the ED). After normal CBC, CMP and chest x-ray. The patient was diagnosed with a viral illness and discharged home with ibuprofen 400mg q8h.Due to the ongoing symptoms of headache and fever, the patient went back to the same clinic he went to four months ago for a dry cough and requested a complete physical and blood work. The patient was told he had a viral condition and was sent home with oseltamivir (Tamiflu®) for five days. However, the provider did order some blood work for him. Differential diagnoses at this moment?  Patients with subacute meningitis typically have an unrelenting headache, stiff neck, low-grade fever, and lethargy for days to several weeks before they present for evaluation. Cranial nerve abnormalities and night sweats may be present. Common causative organisms include M. tuberculosis, C. neoformans, H. capsulatum, C. immitis, and T. pallidum. At his physical exam visit, the patient actually asked the provider specifically to check him for coccidiomycosis because of his job as a farm worker and he heard from his friends that the infection rate is pretty high in the Central Valley of California. His serum cocci serology panel showed positive IGG and IGM with CF titer of 1:128. His HIV, syphilis, HCV, HBV are all negative. The patient was told by that clinic to come to ED due to his history of headache, fever, and very high serum coccidiomycosis titer.  The senior and resident intern were on the night shift that night and we were contacted by the ED provider at around 9:30 pm for this patient. When reviewing his ED record, his vitals were totally normal at the ED, the preliminary ED non-contrast head CT showed no acute intracranial abnormality. A lumbar puncture was performed by the ED provider, which showed WBCs (505 - 71%N, 20%L, 7%M), RBC (1), glucose (19), and protein (200). CSF: High Leukocytes, low glucose, and high protein.On the physical exam, the patient was pleasant and cooperative, he was A&O x 4, he had a normal examination except for two brown healing small nodules on his forehead and left cheek and slight neck stiffness. At that point, we knew the patient most likely had fungal meningitis by cocci except for the predominant WBC in his CSF fluid was neutrophil not the more typical picture of lymphocyte dominant. And because of his very benign presentation and subacute history, we were not 100% sure if we had a strong reason to admit this patient. We thought this patient could be managed as an outpatient with oral fluconazole and referred to infectious disease and neurology. 4. Continuation of case: Admission to the hospital.Looking back, one thing that was overlooked while checking this patient in the ED was the LP opening pressure. Later, the open pressure was reported as 340mm H2O (very high). The good thing was, after speaking to the ED attending and our attending, the patient was admitted to the hospital and started on oral fluconazole.  Three hours after the admission, a rapid response was called on him. While the floor nurses were doing their check-in physical examination, the patient had a 5-minute episode of seizure-like activity which included bilateral tonic arm/hand movements, eye deviation to the left, LOC unresponsive to sternal rub, and the patient desaturated to 77%. He eventually regained consciousness after the seizure and pulse oximetry increased to 100% on room air. The patient was started on Keppra and seen by a neurologist the following day. His 12-hour EEG was normal, but his head MRI showed “diffuse thickening and nodularity of the basal meninges are seen demonstrating enhancement, suggesting chronic meningitis, possibly related to cocci. Other etiologies including sarcoidosis and TB meningitis and/or infiltration by metastatic process/lymphoma are not excluded. The ventricles are slightly prominent in size”. MRI of the cervical, thoracic, and lumbar spines also showed extensive diffuse leptomeningeal thickening, extensive meningitis, and nodular dural thickening. Also, his chest x-ray showed “some heterogeneity and remodeling of the distal half of the left clavicle. Metabolic bone disease, infectious etiology and/old trauma considered”. This could also be due to disseminated cocci infection. The infectious disease doctor saw this patient and recommended continuing with fluconazole, serial LPs until opening pressure is less than 250 mmH2O and neurosurgery consultation for possible VP shunt placement. The neurologist recommended the patient continue with Keppra indefinitely in the context of structural brain damage secondary to cocci meningitis.Take home points: Suspect cocci meningitis in patients with subacute headache associated with respiratory symptoms, new skin lesions, photophobia, neck stiffness, nausea, vomiting, eosinophilia, erythema nodosum (painful nodules on the anterior aspect of legs). Other symptoms to look for include arthralgias, particularly of the ankles, knees, and wrists.____________________Brief summary of coccidiomycosis. Etiology Coccidioidomycosis, commonly known as Valley fever, is caused by dimorphic soil-dwelling fungi of the genus Coccidioides (C. immitis and C. posadasii). They are indistinguishable in clinical presentation and routine laboratory test results.1, 2, 3, 5Epidemiology In the United States, endemic areas include the southern portion of the San Joaquin Valley of California and the south-central region of Arizona. However, infection may be acquired in other areas of the southwestern United States, including the southern coastal counties in California, southern Nevada, southwestern Utah, southern New Mexico, and western Texas (including the Rio Grande Valley). There are also cases in eastern Washington state and in northeastern Utah. Outside the United States, coccidioidomycosis is endemic to northern Mexico as well as to localized regions of Central and South America.1, 2Overall, the incidence within the United States increased substantially over the 1998-2019, most of that increase occurred in south-central Arizona and in the southern San Joaquin Valley of California. From 1998 to2019, reported cases in California increased from 719 to 9004.1, 6The risk of infection is increased by direct exposure to soil harboring Coccidioides. Past outbreaks have occurred in military trainees, archaeologists, construction or agricultural workers, people exposed to earthquakes or dust storms. However, in endemic areas, many cases of Coccidioides infection occur without obvious soil or dust exposure and are not associated with outbreaks. Change in population, climate change, urbanization and construction activities, and increased awareness and reporting, are possible contributing factors.1, 2, 5 Pathology In the soil, Coccidioides organisms exist as filamentous molds. Small structures called arthroconidia from the hyphae may become airborne for extended periods. Arthroconidia are usually 3-5 μm—small enough to evade bronchial tree mucosal mechanical defenses and reach deep into the lungs.1, 3Once inhaled by a susceptible host into the lung, the arthroconidia develop into spherules (theparasitic existence in a host), which are unique to Coccidioides. Endospores from ruptured spherules can themselves develop into spherules, thus propagating infection locally.1, 3, 5Although rare cases of solid organ donor-derived or fomite transmitted infections have been reported, coccidioidomycosis does not occur in person-to-person or zoonotic contagion, and transplacental infection in humans has never been documented.2, 5Cellular immunity plays a crucial role in the host's control of coccidioidomycosis. Among individuals with decreased cellular immunity, Coccidioides may spread locally or hematogenously after an initial symptomatic or asymptomatic pulmonary infection to extrathoracic organs.1, 3, 7Clinical manifestationThe majority of infected individuals (about 60%) are completely asymptomatic. Symptomatic persons (40% of cases) have symptoms that are related principally to pulmonary infection, including cough, dyspnea, and pleuritic chest pain. Some patients may also experience fever, headache (common finding in early-stage infection and does not represent meningitis), fatigue, night sweats, rash, myalgia.1, 2, 3, 5In most patients, primary pulmonary coccidioidomycosis usually resolves in weeks without sequelae and lifelong immunity to reinfection. However, some patients may develop chronic pulmonary complications, such as nodules or pulmonary cavities, or chronic fibrocavitary pneumonia. Some individuals with intense environmental exposure or profoundly suppressed cellular immunity (e.g., in patients with AIDS) may develop a primary pneumonia with diffuse reticulonodular pulmonary process in association with dyspnea and fever.1, 3, 5Fewer than 1% of infected individuals develop extrathoracic disseminated coccidioidal infection. Common sites for dissemination include joints and bones, skin and soft tissues, and meninges. One site or multiple anatomic foci may be affected. 1, 2, 3, 7It is estimated that coccidioidal meningitis, the most lethal complication of coccidioidomycosis, affects only 0.1% of all exposed individuals. Patients with coccidioidal meningitis usually present with a persistent headache (rather than a self-limited headache in some patients with primary pulmonary infection), with nausea and vomiting, and sometimes vision change. Some may also develop altered mental status and confusion. Meningismus such as nuchal rigidity, if present, is not severe.Hydrocephalus and cerebral infarction may develop in some cases. Papilledema is more commonly observed in pediatric patients.1, 3, 4, 5, 7When meningitis develops, most patients may not have any respiratory symptoms nor radiographic manifestation of pulmonary infection. However, a large number of these individuals also present with other extrathoracic lesions.7DiagnosisAlthough early diagnosis carries obvious benefits for patients and the health care systems as a whole (e.g., decreases patient anxiety, reduces the cost of expensive and invasive tests, removes the temptation for empirical antibacterial or antiviral treatments, and allows for early detection of complications), considerable diagnostic delays up to several weeks to months are common in both endemic areas and non-endemic areas.3, 7 Most symptomatic persons with coccidioidal infection present with primarily pulmonary symptoms and are often misdiagnosed as community-acquired bacterial pneumonia and treated with antibiotics. In endemic areas like south-central Arizona, previous studies found up to 29% of community-acquired pneumonia is caused by coccidioidomycosis. Healthcare providers thus should maintain a high clinical suspicion for coccidioidomycosis when evaluating persons with pneumonia who live in or have traveled to endemic areas recently. Elevated peripheral-blood eosinophilia of over 5%, hilar or mediastinal adenopathy on chest radiography, marked fatigue, and failure to improve with antibiotic therapy should prompt suspicion and testing for infection with coccidioidomycosis in endemic areas.1, 3, 5Serological testing plays an important role in establishing a diagnosis of coccidioidomycosis. Enzyme immunoassay (EIA) to detect IgM and IgG antibodies is highly sensitive and therefore commonly used as the screening tool. Immunodiffusion is more specific but less sensitive than enzyme immunoassay. It is used to confirm the diagnosis of positive EIA test results. Complement fixing (CF) test, which indirectly detects the presence of coccidioidal antibodies by testing the consumption of serum complement, are expressed as titers. Serial measurements of titers are of not only diagnostic but also prognostic value.1, 2, 3, 5Other methods, including culture, microscopic, or polymerase chain reaction (PCR) exam on tissue or respiratory specimens, are limited by their availability, sample obtaining and handling, or lack of sufficient evaluation.1, 2, 3, 5Cerebrospinal fluid (CSF) examination in coccidioidal meningitis usually demonstrates lymphocyte dominated elevation of leukocytes, although polymorphonuclear leukocyte dominance can also be seen in the early stage of the infection. Profound hypoglycorrhachia and elevated protein levels in CSF examination are also very common in coccidioidal meningitis.1, 7Although isolating Coccidioides from CSF or other CNS specimens are diagnostic for coccidioidal meningitis, in practice, diagnoses are often made based on the combination of clinical presentation, CSF examination that suggesting fungal infection, and positive Coccidioides antibodies found in CSF.7Imaging, especially enhanced magnetic resonance imaging (MRI), can help in diagnosing coccidioidal meningitis. Basilar leptomeningeal enhancement is a more common finding even though hydrocephalus, cerebral infarction, and vertebral artery aneurysm can also be seen.7TreatmentMost patients with focal primary pulmonary coccidioidomycosis do not require antifungal therapy. According to 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline, antifungal therapy should be considered in patients with concurrent immunosuppression that adversely affect cellular immunity (e.g., organ transplant patients, AIDS in HIV-infected patients, and patients receiving anti–tumor necrosis factor therapy) and those with significantly debilitating illness, extensive pulmonary involvement, with concurrent diabetes, pregnant women, or who are otherwise frail because of age or comorbidities. Some experts would also include African or Filipino ancestry as indications for treatment. Conversely, humoral immunity comprise splenectomy, hypocomplementemia, or neutrophil dysfunction syndromes are not major risk factors for this disease.1, 2, 3, 4, 5Triazole antifungals (fluconazole or itraconazole) are currently considered as the first-line medications used to treat most cases of coccidioidomycosis. Amphotericin B is reserved for only the most severe cases of dissemination and patients with coccidioidal meningitis in whom triazole antifungal therapy has failed. It is also the choice of therapy for coccidioidomycosis in pregnant women during the first trimester because of the possible teratogenic effect of high-dose triazole therapy during this period of time.1, 3, 4, 5Treating coccidioidal meningitis (CM) poses a special challenge because untreated meningitis is nearly always fatal. Lifelong therapy is recommended for CM because the majority 80% patients with CM experience relapse when therapy is stopped despite initial response to antifungal treatment. Shunting of CSF is required in cases of meningitis complicated by hydrocephalus.1, 3, 4, 5, 7Prevention Avoidance of direct contact with contaminated soil in endemic areas (e.g., respirator use by construction workers) may reduce disease risk, although clear evidence of its benefit is lacking.1, 5Some special population groups may benefit from prophylactic use of antifungals, such as those about to undergo allogeneic solid-organ transplantation or patients with a history of active coccidioidomycosis or a positive coccidioidal serology in whom therapy with tumor necrosis factor α antagonists is being initiated. The administration of prophylactic antifungals is not recommended for HIV-1-infected patients even if they live in an endemic region.1, 5Conclusion: Now we conclude episode number 164, “More than just a headache.” Dr. Song explained that a headache with an indolent course, accompanied by subacute respiratory symptoms, nausea, vomiting, photophobia, neck stiffness, and skin lesions can be secondary to Valley Fever. The Central Valley of California, as well as other areas with dry climate, are endemic and we need to keep this disease in our differential diagnosis.This week we thank Hector Arreaza and Zheng (David) Song. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Roos KL, Tyler KL. Acute Meningitis. McGraw Hill Medical. Published 2023. Accessed August 18, 2023. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=192020493Information for Healthcare Professionals. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/health-professionals.html#printValley Fever (Coccidioidomycosis) a Training Manual for Primary Care Professionals. Accessed August 18, 2023. https://vfce.arizona.edu/sites/default/files/valleyfever_training_manual_2019_mar_final-references_different_colors.pdfAmpel NM. Coccidioidomycosis. Idsociety.org. Published July 27, 2016. Accessed August 18, 2023. https://www.idsociety.org/practice-guideline/coccidioidomycosis/Herrick KR, Trondle ME, Febles TT. Coccidioidomycosis (Valley Fever) in Primary Care. American Family Physician. 2020;101(4):221-228. Accessed August 18, 2023. https://www.aafp.org/pubs/afp/issues/2020/0215/p221.htmlValley Fever Statistics. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.htmlUpToDate. Uptodate.com. Published 2023. Accessed August 18, 2023. https://www.uptodate.com/contents/coccidioidal-meningitis?search=7%20Coccidioidal%20meningitis&source=search_result&selectedTitle=1~10&usage_type=default&display_rank=1Royalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from  https://www.videvo.net/

We're looking forward to chatting with CXR member, Todd Phillips the VP of Recruiting at Total Quality Logistics. He's leading two large scale initiatives to improve hiring outcomes and we're going to talk through those plans and the early results. We know many of you are focused on improving the quality of talent you bring into your organization and hope you're able to join us for this conversation - remember comments shared on LI during the livestream might be called out during the broadcast!

Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalIntroductionToday, we discuss the case of an 8-month-old infant with severe bronchospasm and abnormal blood gas. We'll delve into the epidemiology, pathophysiology, and evidence-based management of acute bronchiolitis.Case SummaryAn 8-month-old infant presented to the ER with decreased alertness following worsening work of breathing, preceded by URI symptoms. The infant was intubated and transferred to the PICU, testing positive for RSV. Initial blood gas showed 6.8/125/-4, and CXR revealed massive hyperinflation. Vitals: HR 180, BP 75/45, SPO2 92% on 100% FIO2, RR 12 (prior to intubation), now around 16 on the ventilator, afebrile.Discussion PointsEtiology & Pathogenesis: Bronchiolitis is primarily caused by RSV, with other viruses and bacteria playing a role. RSV bronchiolitis is the most common cause of hospitalization in infants, particularly in winter months. Immuno-pathology involves an unbalanced immune response and can lead to various extra-pulmonary manifestations.Diagnosis: Diagnosis is clinical, based on history and examination. Key signs include upper respiratory symptoms followed by lower respiratory distress. Blood gas, chest radiography, and viral testing are generally not recommended unless warranted by severe symptoms or clinical deterioration.Management Framework: For patients requiring PICU admission, focus on oxygenation and hydration. High-flow therapy and nasal continuous positive airway pressure (CPAP) can be used. Hydration and feeding support are crucial. Antibiotics, steroids, and bronchodilators are generally not recommended. Mechanical ventilation and ECMO may be necessary in severe cases.Immunoprophylaxis & Nosocomial Infection Prevention: Palivizumab and nirsevimab are used for RSV prevention in high-risk infants. Strict infection control measures, including hand hygiene and isolation, are essential to prevent nosocomial infections.ConclusionRSV bronchiolitis is a common and potentially severe respiratory illness in infants. Management focuses on supportive care, with a careful balance between oxygenation and hydration. Immunoprophylaxis and infection control are crucial in preventing the spread of the virus.Thank you for listening to our episode on acute bronchiolitis. Please subscribe, share your feedback, and visit our website at picudoconcall.org for more resources. Stay tuned for our next episode!ReferencesRogers - Textbook of Pediatric Critical Care Chapter 49: Pneumonia and Bronchiolitis. De Carvalho et al. page 797-823Reference 1: Dalziel, Stuart R; Haskell, Libby; O'Brien, Sharon; Borland, Meredith L; Plint, Amy C; Babl, Franz E; Oakley, Ed. Bronchiolitis. The Lancet. , 2022, Vol.400(10349), p.392-406. DOI: 10.1016/S0140-6736(22)01016-9; PMID:...

In this podcast, Dr. Gabi Hester, a pediatric hospitalist and Quality Improvement (QI) medical director for Children's Hospitals of Minnesota in Duluth, brings her knowledge and experience in  everything related to croup and bronchiolitis (specifically pertaining to in-patients and to frontline healthcare providers). *Dr. Gabi Hester, speaker for this educational event, has disclosed that she is a consultant who provides content recommendations to AvoMed. All relevant financial relationships for Dr. Hester have been mitigated.  Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: State at least 2 challenges in the recognition of and treatment of acute respiratory illnesses in children. Describe potential interventions for bronchiolitis that have not been shown to provide signigicant benefit to most patients. Recognize common "mimickers" of croup. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW CROUP (layngotracheitis)Overview - 400,000 approx. ER visits/year in U.S. - Costly, approx. $53 million/year - Scary disease due to airway obstruction - Para-influenza most common - Classically, kids are admitted after 2 racemic epinephrine nebulizers         - Dr. Hester studied croup and hospitalization (see resources below)         - Kids admitted, and no further treatment or intervention (observed) Presentation and treatment - Rhinorrhea, low grade fever, barky cough (seal bark)- Inspiratory stridor, usually worse when agitated - Rarely insp and exp stridor (if progressed disease state) - Dexamethason 0.6 mg/kg (max dose of 12-16 mg) - Nebulized racemic epinephrine (RA)       - bridge for steroid to kick in      - reserved for stridulous patient - Think about croup mimics       - not responding to racemic epinephrine       - older kids (i.e. 7 yr old), think about other diagnoses       - Epiglottitis            - cough is less barky            - respiratory distress and tripoding            - thumb print sign       - Bacterial tracheitis            - can be complication of viral croup            - can quickly decompensate - Foreign body, airway anomalies, etc. TREATMENT: - cool outdoor air can be soothing, no good studies to support - humidified air - imaging can be done (steeple sign on AP neck) but not routinely required         - Worried about foreign body? Epiglottitis?         - not responding to racemic epi         - CXR if hypoxia. Not typical of croup to be hypoxia.Research (links below) - Most kids don't need further treatment after ED course. -

Adam and Sam are joined by one of the best rapper's in the game right now, New Jersey's Chris Patrick!   Chris is a rapper and singer who is coming off the release of his amazing 2022 album, X-Files. He also had a viral freestyle on the show On the Radar. Chris has been touring across the country and opened for artists like JID, Smino, and GRIP.  Find us on social media for daily content and information regarding all things music industry Twitter: https://twitter.com/soundcentricmus Instagram:https://https://www.instagram.com/soundcentricmusic/ Tik Tok: https://www.tiktok.com/@soundcentricmusic Facebook: https://www.facebook.com/SoundCentricmusic Website: https://soundcentricmusic.com Podcast: https://www.soundcentricmusic.com   00:00:00 - Intro  00:01:35 - Playlist title of the week 00:04:55 - J. Cole says rap is like track and field/how Chris trains 00:07:20 - Meeting J. Cole in the studio 00:11:25 - Relationship with EARTHGANG and JID 00:14:40 - What made Chris an elite writer 00:18:45 - How Chris got comfortable with being authentic  00:21:35 - Making music from life experiences  00:24:45 - Sequencing Chris's album X-Files  00:26:40 - Making music that not everyone appreciates  00:29:00 - Bringing back album rollouts and creating a world with music 00:35:40 - How Chris balances rapping and singing  00:35:45 - Nerding out about GRIP's 3:16 with JID and Kenny Mason 00:37:45 - Taking vocal lessons to sing better after tour with GRIP 00:39:20 - Being put in a box as an artist  00:42:10 - JID goes viral with "Surround Sound" 00:45:10 - How Chris created a fan base  00:51:15 - Chris's On the Radar freestyle  00:57:00 - The importance of CXR as a label  01:00:00 - Chris's final thoughts  01:04:30 - A few shout outs from Chris  

In this podcast, Dr. Nicole Roeder, a pulmonologist with Ridgeview Specialty Clinics, brings her knowledge and experience to discuss how to properly diagnose and manage asthma and chronic obstructive pulmonary disease (COPD) in patients exhibiting signs and symptoms of these chronic conditions. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify signs and symptoms of asthma and chronic obstructive pulmonary disease (COPD). Review methods for diagnosing asthma and COPD. Select treatment options for asthma and COPD. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:   *See the attachment for additional information.  PODCAST OVERVIEW COPD - Major contributor - tobacco use - Environmental exposures - Types (chronic bronchitis, emphysema, mixed) - Symptoms and exam - Exacerbation red flag -  more frequent use of rescue inhaler use, more cough and wheeze - Tests (imaging - CXR, CT, pulmonary function testing, spirometry, BODE screening test, alpha antitrypsin) - Inpatient COPD management - Outpatient COPD management - Prevention (immunizations, vaccines, smoking cessation, daily maintenance medication/compliance) - Severe COPD considerations (lung transplant, endobronchial valves) - Pulmonary Rehab (9-week program, multidisciplinary team, baseline assessment, exercise/education sessions) - Pulmonary Function Testing (PFT) including spirometry, lung volume testing, lung diffusion capacity, and    methachoine challenge testing ASTHMA- Prevalence - Work-up (CXR, PFTs, CT chest, Allergy testing, referral to pulmonary) - Theophylline (bronchodialiator, antiinflammatory) - Differential Dx - consider other conditions if not improvment (CHF, PE, pneumothorax, etc.) - Peak flow testing - Action plans (Green, Yellow, Red) - Treatment - for mild, moderate and severe cases Thanks to Dr. Nicole Roeder for her expert knowledge and contribution to this podcast. Please check out the additional show notes for more information/resources.

Looking for a creative way to attract and retain early career talent? Then tune into this week's podcast as Terra Doyle, Recruitment Practice Lead Americas for Roche, talks about their involvement in a community-based organization: Indyfluence. We love talking about community here at CXR and the way this group has leveraged community is inspiring!

Texas star, Dende, helps check off a 2023 goal for Adam and Sam by joining the guys on the pod to discuss his latest release, '95 Civic.'   Make sure to subscribe and rate us on Apple, Spotify, Google Podcast, and Sound Cloud! We truly appreciate your support.     Find us on social media for daily content and information regarding all things music industry Twitter: https://twitter.com/soundcentricmus Instagram:https://https://www.instagram.com/soundcentricmusic//soundcentricmusic Tik Tok: https://www.tiktok.com/@soundcentricmusic Facebook: https://www.facebook.com/SoundCentricmusic Website: https://soundcentricmusic.com Podcast: https://www.soundcentricmusic.com/listen/    0:00 - Intro 1:05 - Playlist titles 3:45 - Decision to drop an EP before album 4:55 - Balancing making music for yourself and for audience  8:00 - The change between A Happy Man  to '95 Civic 9:55 - How Dende decides when to rap and sing 11:25 - Making personal music knowing a person may hear it 12:40 - Making music with a producer vs. in bedroom 16:30 - The importance of having a management team (CXR) 19:00 - The features on the album 22:25 - Having songs written for you 25:30 - Dende's first time touring  32:00 - New CXR collab album  33:00 - Moving to LA 34:40 - How Dende chooses to do features  35:40 - Tips for indie artists  36:45 - Closing remarks 

Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  Today, we're hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER ·       BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn't help anybody. ·       See the patient. Getting a bunch of pages? Worried about someone? Confused as to what's going on? Go see the patient and chat with the bedside team. ·       Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. ·       Load the boat. You've heard this one from us all week! Loop senior level residents in early. HYPOTENSION ·       Differential: measurement error, patient's baseline, and don't miss – SHOCK.            - Etiologies of shock: hemorrhagic, hypovolemic, ·       On the phone: full set of vitals, accurate I/Os, ·       On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day ·       In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is ·       Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. ·       Initial management: depends on etiology of hypotension; don't forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care  HYPOXEMIA ·       Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload ·       On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, pulmonary and cardiac exam, volume status exam ·       Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest ·       Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology ·       ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/  ALTERED MENTAL STATUS ·       Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium ·       On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies ·       In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient's mental status is adequate for airway protection! ·       Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. ·       Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes.  OLIGURIA ·       Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction ·       On the phone: clarify functional foley or bladder scan results, full set of vitals ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, confirm functioning foley catheter ·       Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US ·       Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies!  TACHYCARDIA ·       Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE ·       On the phone: full set of vitals, acuity of change in heart rate, updated I/Os ·       On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os ·       In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection ·       Get more info: basic labs, EKG, consider CXR, troponins ·       Initial management: depends heavily on etiology Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  You've been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don't fret, in this episode we'll give you some tips for how to handle it. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: REMEMBER HOW INTERNS DO AND DO NOT TEACH - Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture - You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it's done! MODELING - Remember how hard everything has been in the few days since you started residency? Think about all the information you've picked up, tips and tricks you're developing for efficiency, and best practices you're learning in the care of your patients. ALL of these are things you can pass on to students. - Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently). TEACHABLE MOMENTS - Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc. - Once you're getting more comfortable caring for specific disease processes, think about high yield lessons for students: - Acute trauma evaluation and management (ABCDE's), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket IN THE OR - Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you're still using to improve) - If you're not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they're going astray BE THE RESIDENT YOU WISH YOU HAD - Refer to EVERYONE with respect - Model being a kind, conscientious, and curious physician - Try to find universal lessons and crossover topics that non-surgeons need to know - A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they're learning! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

Matt chats radiology physics with medical imaging physicist Dr Zoe Brady. We find out about her job, CT generations, CXR through glass, mobile CT, mobile MRI, upcoming technology and radiation safety. Frank talks rockets, Elon and SpaceX!  Chest X-ray through glass ► https://pubmed.ncbi.nlm.nih.gov/32662037 Radiopaedia 2023 Virtual Conference ► https://radiopaedia.org/courses/radiopaedia-2023-virtual-conference Become a supporter ► https://radiopaedia.org/supporters Get an All-Access Pass ► https://radiopaedia.org/courses/all-access-course-pass Andrew's Twitter ► https://twitter.com/drandrewdixon Frank's Twitter ► https://twitter.com/frankgaillard Ideas and Feedback ► podcast@radiopaedia.org   The Reading Room is a radiology podcast intended primarily for radiologists, radiology registrars and residents. 

This week we're joined by longtime CXR friend & Community member, Larry Nash. Larry is the Americas Director of Talent Acquisition for EY and as such has been doing some interesting research into Recruitment Fraud. Join us as we seek to learn more from him about how this fraud is occurring and how job seekers can protect themselves.

New Jersey hip-hop artist Chris Patrick and Houston R&B singer Dende stopped at Schubas Tavern this month on their four-date mini tour, the “Gang Activity Tour.” Though they live in different regions of the country, the two artists got connected through the internet and have collaborated several times over the years. This year, Dende released his new album ‘'95 Civic' under small label CXR, which Chris Patrick was a founding member of. Chris notes the label hopes to foster a strong base to support smaller artists. Before their Chicago show, Chris and Dende sat down in the Vocalo studios with Bekoe to discuss touring, performing at SXSW, upcoming releases and their favorite chicken in the city. This interview originally aired on Vocalo Radio 91.1 FM during Mornings With Bekoe on Thursday, March 2. It was edited by Bekoe. Keep up with Chris Patrick and Dende by following them on Instagram @xchrispatrick and @iamdende.

Join in as Kim Collins, CXR's Managing Director, shares which 2022 episode was her favorite and why she had to go back and listen more than once.

Impact: one CXR to determine 10-yr CVD risk

CXR's Barb Ruess grabs the mic and shares what her favorite 2022 episode was and invites you to check it out if you haven't already.

Bill and Krishna discuss and predict the card for AEW's Full Gear happening this Saturday, Nov. 19, including Jon Moxley vs. MJF for the AEW World Championship and the return of the Elite as Omega and the Bucks face Death Triangle for the AEW Trios Championship. They also discuss and predict the Smash Wrestling vs. wXw card taking place at the Rec Room in Toronto, including appearances by Psycho Mike, Axel Tischer, Jody Threat and Halal Beefcake. Look for Bill and Krishna's reviews of both events later this weekend! Full Gear Predictions - starts right off the top Smash vs wXw Predictions: 40:19

CardioNerds Cofounder Dr. Amit Goyal is joined by an esteemed group of UCLA cardiology fellows – Dr. Patrick Zakka (CardioNerds Academy Chief), Dr. Negeen Shehandeh (Chief Fellow), and Dr. Adrian Castillo – to discuss a case of primary cardiac angiosarcoma. An expert commentary is provided by Dr. Eric Yang, beloved educator, associate clinical professor of medicine, assistant fellowship program director, and founder of the Cardio-Oncology program at UCLA.   Case synopsis: A female in her 40s presents to the ED for fatigue that had been ongoing for approximately 1 month. She also developed night sweats and diffuse joint pains, for which she has been taking NSAIDs. She was seen by her PCP and after bloodwork was done, was told she had iron deficiency so was on iron replacement therapy. Vital signs were within normal limits. She was in no acute distress. Her pulmonary and cardiac exams were unremarkable. Her lab studies showed a Hb of 6.6 (MCV 59) and platelet count of 686k. CXR was without significant abnormality, and EKG showed normal sinus rhythm. She was admitted to medicine and received IV iron (had not consented to receiving RBC transfusion). GI was consulted for anemia work-up. Meanwhile, she developed a new-onset atrial fibrillation with rapid ventricular response seen on telemetry, for which Cardiology was consulted. A TTE was ordered in part of her evaluation, and surprisingly noted a moderate pericardial effusion circumferential to the heart. Within the pericardial space, posterior to the heart and abutting the RA/RV was a large mass measuring approximately 5.5x5.9 cm. After further imaging work-up with CMR and PET-CT, the mass was surgically resected, and patient established care with outpatient oncology for chemotherapy.  CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - primary cardiac angiosarcoma Episode Schematics & Teaching Pearls – primary cardiac angiosarcoma The pericardium is composed of an outer fibrous sac, and an inner serous sac with visceral and parietal layers.   Pericardial masses can be primary (benign or malignant) or metastatic. There are other miscellaneous pericardial masses.  Imaging modalities for the pericardium include echocardiography, cardiac CT and cardiac MRI. There is also role for PET-CT in pericardial imaging for further characterization of pericardial masses.   Cardiac angiosarcomas are extremely rare but are the most common cardiac primary malignant tumors.  Evidence-based management if lacking because of paucity of clinical data given the rarity of cardiac angiosarcomas. Surgery is the mainstay of therapy. Radiotherapy and chemotherapy are often used as well.  Notes – primary cardiac angiosarcoma Pericardial Anatomy  The pericardium is a fibroelastic sac composed of two layers.   Outer layer: fibrous pericardium (

In this episode of BackTable Urology, Dr. Aditya Bagrodia discusses retroperitoneal lymph node dissection (RPLND) for early stage testicular cancer with Dr. Clint Cary and Dr. Timothy Masterson from Indiana University School of Medicine. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- SHOW NOTES First, the doctors discuss how to approach T1 testicular cancer, which does not show elevated markers or nodal metastases. All the doctors agree that the best approach is just surveillance of the tumor without RPLND, unless there is evidence of somatic transformation. Because some patients have anxiety about just doing surveillance, they assure them that only 10-15% of T1 tumors progress. However, there are different warning signs for different tumor histologies. It is important to get medical oncologists on board quickly in order to have a balanced presentation of treatment options for the patient. The doctors agree that surgeons must counsel patients on the possible complications of RPLND, such as retrograde ejaculation, hernias, and lymphatic leaks, but the probability of these events is low. Next, the doctors discuss whether certain tumor markers can predict the relapse of an early stage testicular cancer. They agree that LDH is not an important marker to check, as it may be falsely elevated. An elevated AFP level can be concerning, but urologists should always put the value into context by comparing to the patient's normal baseline levels and seeing if there is an upward trend. Finally, hCG levels can falsely be elevated by marijuana and hypogonadism. Then, the doctors share their imaging protocol. Standard chest, CT, and pelvic imaging is needed, and Dr. Bagrodia favors chest CT over CXR for better visualization. The doctors also note that more pre-operative imaging immediately before an orchiectomy is not always necessary if the surgeon already has recent imaging. Additionally, the doctors explore approaching T2 testicular cancer, in which there are positive nodes confined to peritoneal nodes. Dr. Masterson and Dr. Cary agree that axial CT imaging is superior. More preoperative factors would be considered such as the focality of the lymph nodes involved, the duration of surveillance time, primary histology of the tumor, and the size of mass. Depending on which lymph nodes are positive (i.e. paraaortic, pelvic. etc.), a surgeon can choose the best RPLND template (modified, unilateral, bilateral). The doctors then explain their intraoperative and postoperative anesthesia protocol. They do not routinely administer DVT prophylaxis before surgery because of the risk of lymphatic leakage. Additionally, they are careful not to disseminate disease by disrupting tumor, which can cause abnormal patterns of metastases Next, the doctors share their post-operative advice for patients. With regards to diets, a lower fat diet will lead to quicker recovery. Ejaculatory function remains normal for patients with unilateral surgery, but should recover within 8-12 months in patients with bilateral surgery. Surgical pathology can determine whether the patient should start adjuvant therapy. For N1 tumors, no adjuvant chemotherapy needed. For N2 tumors, the decision depends on histology and patient factors. Additionally, the doctors explain that extranodal extension does not always mean relapse is inevitable. For this reason, it is important to consider the histology of the tumor. The doctors end the episode by discussing new research on seminoma relapse.

Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices. In this main episode podcast, highlights from CAEP 2022 conference, Anton discusses the article 'Saving EM: Is Less More?' with Dr. Paul Atkinson and Dr. Grant Innes and offer some solutions to this current state of affairs in EM. In another CAEP highlight, trauma team leader Dr. Mathieu Toulouse delivers the latest on management of traumatic pneumothorax. He answers such questions as: Do all patients with a traumatic pneumothorax require tube thoracostomy? How do CXR and CT differ in determining which patients require a chest tube? Do all patients receiving positive pressure ventilation require a chest tube for their traumatic pneumothorax? Does the presence of hemothorax necessitate placement of a chest tube? Are 14Fr pigtail catheters adequate for all traumatic pneumothoraces? and many more... The post Ep 174 Is Less More? Saving EM and Traumatic Pneumothorax – Highlights from CAEP 2022 appeared first on Emergency Medicine Cases.

If you struggle with CXR related Qs on USMLE exams, this podcast is what you need. I discuss a somewhat different approach to almost knowing what is being tested with a CXR question before you even look at the CXR. If you want to get your thinking right on this subject, this is exactly what … Continue reading Divine Intervention Episode 404 – The Floridly HY CXR Podcast

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat My name is Rahul Damania, a current 3rd-year pediatric critical care fellow and we are coming to you from Children's Healthcare of Atlanta Emory University School of Medicine Today's episode is dedicated to the transition between NICU & PICU. We will focus on the ventilation of the ex-premature infant who graduated from NICU care and transitioned to the PICU. I will turn it over to Rahul to start with our patient case. Case: A 4-month-old ex-27 week baby boy is transferred to our PICU after an echo at an outside hospital showed elevated pulmonary pressures. The infant was born via a stat C-section due to maternal complications during pregnancy. His birth weight was 560 g. The patient was intubated shortly after delivery and had a protracted course in the NICU which included a sepsis rule out, increased ventilator settings, and a few weeks on inhaled nitric oxide (iNO). The intubation course was complicated pulmonary hemorrhage on day 1 after intubation. After such an extensive NICU course, thankfully, the infant survived & was sent home on 1/2 LPM NC, diuretics, albuterol, inhaled corticosteroids, Synthroid, multivitamin with iron as well as Vitamin D. The patient was able to tolerate breast milk via NG tube and had a home apnea monitor with pulse oximetry. After about a week's stay at home, the mother noted that the patient's SPO2 was in the low 80s. The mother took the patient to the local hospital, where the patient was started on HFNC which improved his saturations. An echo done at the OSH showed elevated RV pressures (higher than the prior echo). The patient was subsequently transferred to our hospital for further management. At our hospital, the patient presented hypoxemic, tachycardic, and tachypneic. On physical exam: Baby appeared well developed, had a systolic murmur heard throughout the precordium, and there was increased WOB with significant intercostal retraction. There was no hepatosplenomegaly. Due to worsening respiratory distress, and increasing FIO2 requirement despite maximum RAM cannula, the patient was intubated and placed on conventional MV. A blood gas prior to intubation revealed a pH of 7.1/PCO2 of 100. An arterial line and a central venous line were also placed for better access and monitoring. Initial vent settings post intubation PRVC ventilation: TV 32cc, (25/10), 0.7 time, rate 0 (patient sedated/paralyzed). To summarize, What are some of the features in H&P that are concerning for you in this case: Ex-27 week prematurity with a birth weight of 560 gms Prolonged MV in the NICU Home O2 requirement Abnormal echo showing high pulmonary pressures hypercarbia despite the use of RAM cannula As mentioned, our patient was intubated, can you tell us pertinent diagnostics which were obtained? CXR revealed: Hazy airspace opacification in the right upper lung concerning developing pneumonia. Streaky airspace opacity in the left lung base medially may represent atelectasis. I do want to highlight that the intubation of an ex-premie especially with elevated RV pressures is a high-risk scenario, it is best managed by a provider with experience, in a very controlled setting with optimal team dynamics. Adequate preparation to optimize the patient prior to the intubation as well as the knowledge to manage the post intubation cardiopulmonary interactions are essential. I would highly advise you to re-visit our previous podcast on intubation of the high-risk PICU patient by Dr. Heather Viamonte. Like many Peds ICU conditions, the management of the EX-NICU graduate in the PICU is a multidisciplinary team sport. Our patient likely has the diagnosis of Bronchopulmonary Dysplasia or BPD, Pradip, can you comment on the evolving definition of this diagnosis? Let me first define BPD — Clinically, BPD is defined by a requirement of oxygen supplementation either at...

状元：大_老婆 18清风如旧 18 浮生若夏18吓猴蹲丨心悦夏 18 榜眼： 套着文胸的猫 7 探花：yaoyao丨萌囧囧QuQ 3感谢其他帅气的神豪们东愚恨晚 a过u客 碧波天空 鱼丸粗面丨心悦夏 雷_mn 小碎片奶嘴半半1 彼岸灯火Cxr 莫亦徒喜马拉雅搜索夏夏小说《别闹，为师不出山》 vx:ssrone0QQ群：559419829新浪微博：主播夏春瑶公众号：主播夏春瑶某音：17608858直播时间：21：00-01：00

We get the chance to sit down with Your Stepdad about his strong month of April, how he's built buzz on TikTok, why every huge underground rapper is so young, and much more.Keep up with Stepdad:Instagram @deflynotdoowopTikTok @yoursteppopsNEW PLAYLIST additions (courtesy of CXR's Collin Donovan):Kendrick Lamar - Mother I SoberDende - Round Trip to AtlantaNoah - RevelationsKehlani - Little StoryMack Keane, ESTA - Never EnoughSUPPORT: Obviously, the U.S. has a horrendous problem with gun violence and gun culture. And politicians on both sides of the aisle don't seem interested in doing anything about it. I've attached a Twitter thread here with GoFundMe information for as many of the victims of the Uvalde school shooting as I could find. I'm devastated that this has become accepted as normal in the US. We need structural change immediately..To check out the Good Work we highlight each episode, check out this document:Creative consulting by Brandon Washington. Theme music by Evan Dawkins. Logos & cover art: MC Blue Matter. Sponsored by Project FILOSupport the show

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress. Initial Vitals Temp 99.9 HR 110 RR 22 BP 122/82 O2 82% on BiPAP 10/5 100%FiO2 Critical Actions Correctly interpret CXR #1 (multifocal PNA) Correctly interpret CXR #2 (bilateral PNTX) Treat with Oseltamivir […]

感谢何先生打赏的99个喜点， 感谢小子丨心悦夏3打赏的50个喜点，感谢浮生_wed打赏的12个喜点 同时也感谢 长夜的10个喜点，古风图和麦克哥哥分别6个喜点，听友191837655 和东愚恨晚 2个喜点， 作业被养的白白的 噼里啪啦轰轰 15263709qsu 四娘宝贝， 焦糖薯片。 PZXVNTD 落叶6n 彼岸灯火Cxr 1592993basy喜马拉雅搜索夏夏小说《别闹，为师不出山》 vx:ssrone0QQ群：559419829新浪微博：主播夏春瑶公众号：主播夏春瑶某音：17608858直播时间：21：00-01：30

感谢何先生打赏的99个喜点， 感谢小子丨心悦夏3打赏的50个喜点，感谢浮生_wed打赏的12个喜点 同时也感谢 长夜的10个喜点，古风图和麦克哥哥分别6个喜点，听友191837655 和东愚恨晚 2个喜点， 作业被养的白白的 噼里啪啦轰轰 15263709qsu 四娘宝贝， 焦糖薯片。 PZXVNTD 落叶6n 彼岸灯火Cxr 1592993basy喜马拉雅搜索夏夏小说《别闹，为师不出山》 vx:ssrone0QQ群：559419829新浪微博：主播夏春瑶公众号：主播夏春瑶某音：17608858直播时间：21：00-01：30

感谢何先生打赏的99个喜点， 感谢小子丨心悦夏3打赏的50个喜点，感谢浮生_wed打赏的12个喜点 同时也感谢 长夜的10个喜点，古风图和麦克哥哥分别6个喜点，听友191837655 和东愚恨晚 2个喜点， 作业被养的白白的 噼里啪啦轰轰 15263709qsu 四娘宝贝， 焦糖薯片。 PZXVNTD 落叶6n 彼岸灯火Cxr 1592993basy喜马拉雅搜索夏夏小说《别闹，为师不出山》 vx:ssrone0QQ群：559419829新浪微博：主播夏春瑶公众号：主播夏春瑶某音：17608858直播时间：21：00-01：30

CXR: Careers x Radiology is a student project to open the world of radiology, interventional radiology, and radiation oncology to medical students, one interview at a time. Learn its mission, how it started, what you can expect to hear and learn, and what's in store for upcoming episodes! Be sure to email CXR with any thoughts or questions for any of the participants or for me, Fiona, at cxrpod@gmail.com or @fidoolan on Twitter. I'll answer queries in future episodes. Be well and keep in touch!

EMplify - February 2021 Community Acquired Pneumonia - An Interview with Dr. Matthew DeLaney, FACEP 1. Pneumonia and nomenclature : healthcare associated vs hospital associated2. COVID-19 and antibiotics3. Bacteriology - Strep is only 10-15% of hospitalized pneumonia, Viral pneumonia is about 20% (pre covid)4. Conditions that predispose to pneumonia chronic lung disease (chronic obstructive pulmonary disease, bronchiectasis) smoking older age immuno-compromise proton-pump inhibitors, H2 blockers, and antipsychotic agents 5. Is there a historical or exam item most likely to be indicative of pneumonia?6. How good is a CXR?7. When should I consider a CT if the CXR is normal?8. Procalcitonin9. Blood cultures, sputum cultures, urine antigens- are these helpful?10. CURB-65 vs PSI11. Antibiotics- table 3 major and minor, history of prior infection, and doxy for everyone !12. Duration - 5 days works13. A walk through the pathway

Welcome to the emDOCs.net podcast with Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)! Join us as we review our high-yield posts from our website emDOCs.net. This episode covers awake repositioning and proning for patients with COVID-19 and hypoxemia. The second part brings you an author interview with Josh Russell, editor in chief of Journal of Urgent Care Medicine, on understanding the role of CXR for ambulatory patients in the era of COVID-19.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 

Jim Tincher, Journey Mapper-In-Chief at Heat of the Customer joins me to chat about customer experience research (CXR). In this episode we discuss some of the basics, why it's important, ways to get started in CXR and more. Lot's of great intro content and resources for those who are interested in applying CXR to their organization. SHOW HIGHLIGHTS AND WHAT YOU'LL LEARN…• A brief history on customer experience research (CXR)• The difference between customer experience (CX) and user experience (UX)• Most common adoption challenges that professionals have while advocating for the customer and customer research methods• Three types of problems to focus on when trying to drive adoption and develop an effective customer experience practice within an organization• Three best practices for developing a CX within your organization• Which CXR metrics matter• Which challenges CX leaders are solving • Thoughts on the future of CXTo view the rest of the show notes please visit https://brianlpoe.com/blog/intro-to-customer-experience-research

EM Cases Episode 82 Emergency Radiology Controversies, pearls and pitfalls: Which patients with chest pain suspected of ACS require a CXR? What CXR findings do ED docs tend to miss? How should we workup solitary pulmonary nodules found on CXR or CT? Is the abdominal x-ray dead or are there still indications for it's use? Which x-ray views are preferred for detecting pneumoperitoneum? When should we consider ultrasound as a screening test instead of, or before, CT? What are the indications for contrast in abdominal and head CT? How should we manage the patient who has had a previous CT contrast reaction who really needs a CT with contrast? What is the truth about CT radiation for shared decision making? And much more... The post Episode 82 – Emergency Radiology Controversies appeared first on Emergency Medicine Cases.

In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED... The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.

It makes sense that the treatment of primary spnontaneous pneumothorax would lend itself well to outpatient management, since patients are usually young and otherwise healthy, and the mortality and morbidity from these air leaks are really very low. Most patients would rather be managed as an outpatient rather than admitted to hospital and sending these patients home would probably end up saving the system resources and money. In this month's Journal Jam Podcast on small bore chest tube and outpatient management of pneumothorax, the highlighted article that Anton Helman and Teresa Chan discuss is Voison et al. on the “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hear from Michelle Lin, Seth Trueger, Heather Murray and the lead author himself, Stephan Jouneau. Questions posed include: In what ways is the use of small bore catheters with Heimlich valves for spontaneous pneumothorax better than needle aspiration? Is it necessary to repeat a CXR after placement of the catheter? Who should follow up these patients after they are discharged from the hospital? How can we minimize kinking and dislodgement of the catheter? and many more..... [wpfilebase tag=file id=523 tpl=emc-play /] [wpfilebase tag=file id=524 tpl=emc-mp3 /] The post Journal Jam 2: Small Bore Chest Tube and Outpatient Management of Pneumothorax appeared first on Emergency Medicine Cases.

Have you ever seen a child in your emergency department with a fever - he asks sarcastically? At the ginormous community hospital where I work, we see about 25,000 kids each year in our ED and about half of them present with fever. Yes, there still exists fever phobia in our society, which brings hoards of worried parents into the ED with their febrile kids. For most of these kids it's relatively straight forward: Most kids with fever have clinical evidence of an identifiable source of infection – a viral respiratory infection, acute otitis media, gastro, or a viral exanthem. However, about 20% have Fever Without a Source despite your thorough history and physical exam. A small but significant number of this 20% without an identifiable source of fever will have an occult bacterial infection - UTI, bacteremia, pneumonia, or even the dreaded early bacterial meningitis. These are all defined as Serious Bacterial Infections (SBI), with occult UTI being the most common SBI especially in children under the age of 2 years. In the old days we used to do a full septic work-up including LP for all infants under the age of 3 months, but thankfully, times have changed in the post-Hib and pneumoccocal vaccine age, and we aren't quite so aggressive any more with our work-ups. Nonetheless, it's still controversial as to which kids need a full septic workup, which kids need a partial septic workup, which kids need just a urine dip and which kids need little except to reassure the parents. In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Children's Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more.... The post Episode 48 – Pediatric Fever Without A Source appeared first on Emergency Medicine Cases.

Dr. David Carr, the past author of Tintinalli's chapter on occlusive arterial disease, tells us his Best Case Ever related to Aortic Dissection. In the related Episode 28: Aortic Dissection, Acute Limb Ischemia & Compartment Syndrome, we discuss the breadth of presentations and key diagnostic clues of Aortic Dissection. We review the value of ECG, CXR, biomarkers and the use of Transesophageal Echo and CTA in this sometime elusive diagnosis. We debate lots of clinical pearls and pitfalls when it comes to acute limb ischemia, and end with a discussion on the trials and tribulations of Compartment Syndrome. [wpfilebase tag=file id=398 tpl=emc-play /] [wpfilebase tag=file id=399 tpl=emc-mp3 /] The post Best Case Ever 13: Aortic Dissection appeared first on Emergency Medicine Cases.