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Listener discretion is advised. References: Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson LK, Schmidt R. Management of Xylazine Withdrawal in a Hospitalized Patient: A Case Report. J Addict Med. 2022 Sep-Oct 01;16(5):595-598. doi: 10.1097/ADM.0000000000000955. Epub 2022 Jan 11. PMID: 35020700. London KS, Huo S, Murphy L, Warrick-Stone T, Goodstein D, Montesi M, Carter M, Butt S, Alexander K, Satz W, Tasillo A, Xu L, Arora M, Casey E, McKeever R, Lowenstein M, Durney P, Hart B, Perrone J. Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study From Philadelphia, PA. J Addict Med. 2025 Aug 1. doi: 10.1097/ADM.0000000000001560. Epub ahead of print. PMID: 40747932. Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513303/

An overview of what is a hiatus hernia (including sliding & paraesophageal classification), the causes of a hiatus hernia as well as the most common signs and symptoms. Also includes diagnosis and treatment of hiatus hernia. PDFs available here: https://rhesusmedicine.com/pages/gastroenterologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is  Hiatal Hernia0:27 Hiatal Hernia Causes / Pathophysiology1:09 Hiatal Hernia Symptoms2:05 Epidemiology (Who gets a Hiatal Hernia)2:20 Hiatal Hernia Classification3:09 Hiatal Hernia Diagnosis3:53 Hiatal Hernia TreatmentLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferenceNational Center for Biotechnology Information (NCBI), 2024. Hiatal hernia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK562200/. NCBIHyun, J.J., 2011. Clinical significance of hiatal hernia. PMC Articles, PMCID PMC3166665. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166665/. PMCEmbleton, D.B. et al., 2018. Congenital hiatus hernia: a case series. PMC Articles, PMCID PMC6593919. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593919/. PMCHopkins Medicine, 2022. Hiatal hernia. [online] Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernias/hiatal-hernia. Hopkins MedicinePatient.info, 2025. Hiatus hernia: symptoms, causes and treatment. [online] Available at: https://patient.info/digestive-health/acid-reflux-and-oesophagitis/hiatus-hernia#nav-5. PatientMSD Manuals, 2025. Hiatus hernia – esophageal and swallowing disorders. [online] Available at: https://www.msdmanuals.com/en-gb/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia.Disclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Myopericarditis includes both myocarditis and pericarditis. In this video we cover what is myopericarditis, as well as causes of myocarditis and pericarditis, signs and symptoms of pericarditis and myocarditis, as well as the diagnosis and treatment. PDFs available here: https://rhesusmedicine.com/pages/cardiologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Myopericarditis? (What is Myocarditis / What is Pericarditis?)0:15 Anatomy - Pericardium & Layers of the Heart 1:41 Infectious Causes of Myocarditis / Pericarditis 2:31 Non Infectious Causes of Myocarditis / Pericarditis 3:22 Signs and Symptoms4:19 Diagnosis of Myopericarditis5:45 Treatment of Myocarditis and Pericarditis LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesMSD Manuals Professional, 2025. Myocarditis – Cardiovascular Disorders. [online] Available at: https://www.msdmanuals.com/professional/cardiovascular-disorders/myocarditis-and-pericarditis/myocarditis. Reviewed/Revised May 2024; Modified Oct 2025. MSD ManualsManda, Y. & Baradhi, K., 2023. Myopericarditis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK534776/. NCBIWikipedia, 2025. Myopericarditis. [online] Available at: https://en.wikipedia.org/wiki/Myopericarditis. en.wikipedia.orgDisclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Depression, also known as major depressive disorder, is projected to be the number 1 cause of disease burden by 2030. We look at the causes and risk factors, the DSM 5 diagnostic criteria, and the treatment of depression.PDFs available here: https://rhesusmedicine.com/pages/psychiatryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 Major Depressive Disorder0:23 DSM 5 Criteria - Major Depressive Disorder 1:58 Depression Causes & Risk Factors 3:10 Depression Pathophysiology 4:28 Depression Epidemiology 4:59 Depression Diagnosis 5:39 Depression Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Reference:Bains, N. & Abdijadid, S., 2023. Major Depressive Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK559078/. NCBIPsycom, 2025. DSM-5 depression criteria – Major Depressive Disorder. [online] Available at: https://www.psycom.net/depression/major-depressive-disorder/dsm-5-depression-criteria.Wikipedia, 2025. Major depressive disorder. [online] Available at: https://en.wikipedia.org/wiki/Major_depressive_disorder.National Institute of Mental Health (NIMH), 2025. Depression. [online] Available at: https://www.nimh.nih.gov/health/topics/depression.Bondy, B., 2002. Pathophysiology of depression and mechanisms of treatment. Dialogues in Clinical Neuroscience, 4(1), pp.7–20. [online] Available at: https://www.tandfonline.com/doi/full/10.31887/DCNS.2002.4.1/bbondy. Taylor & Francis OnlineDisclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

A complete look at asthma, including asthma pathophysiology, causes, as well as asthma signs and symptoms. Also includes how asthma is diagnosed as well as asthma treatment.PDFs available at: https://rhesusmedicine.com/pages/respiratoryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Asthma / Asthma Definition0:22 Asthma Pathophysiology - Anatomy1:09 Asthma Molecular Pathology  (Early v Late Phase) 3:12 Airway Remodelling3:40 Asthma Causes & Risk Factors4:40 Asthma Symptoms 5:38 Asthma Diagnosis (Chronic - Includes Spirometry)7:15 Acute Exacerbation of Asthma (Mnemonic)8:00 Asthma Treatment - Stepwise ApproachLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesNational Center for Biotechnology Information (NCBI), 2018. Asthma. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157154/. PubMed CentralWiley Online Library, 2023. Allergic disease article. Allergy [online] Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/all.14607. (Exact article title assumed – if you want the full title, provide the page text).National Center for Biotechnology Information (NCBI), 2025. Pathophysiology of Asthma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK551579/. NCBIMoore, V.C., 2025. Spirometry: step by step. Breathe, 8(3), pp.232-240. [online] Available at: https://publications.ersnet.org/content/breathe/8/3/232. ERS PublicationsReddel, H.K. et al., 2021. Global Initiative for Asthma (GINA) Strategy 2021 – Executive summary and rationale for key changes. European Respiratory Journal, 59(1):2102730. [online] Available at: https://erj.ersjournals.com/content/59/1/2102730. ERS PublicationsBMJ Best Practice, 2025. BMJ Best Practice: Info. [online] Available at: https://bestpractice.bmj.com/info/.Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Welcome to Episode 51 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Segment 1 Rodríguez, M. Á., Quintana-Cepedal, M., Cheval, B., Thøgersen-Ntoumani, C., Crespo, I., & Olmedillas, H. (2025, October 7). Effect of exercise snacks on fitness and cardiometabolic health in physically inactive individuals: Systematic review and meta-analysis. British Journal of Sports Medicine. Advance online publication. https://doi.org/10.1136/bjsports-2025-110027 Rodgers, L. (2025, October 17). As pickleball continues to gain players, injuries are increasing. JAMA. https://doi.org/10.1001/jama.2025.18833 Segment 2 Baos, S., Lui, M., Walker-Smith, T., Pufulete, M., Messenger, D., Abbadi, R., Batchelor, T., Casali, G., Edwards, M., Goddard, N., Abu Hilal, M., Alzetani, A., Vaida, M., Martinovsky, P., Saravanan, P., Cook, T., Malhotra, R., Simpson, A., Little, R., Wordsworth, S., Stokes, E., Jiang, J., Reeves, B., Culliford, L., Collett, L., Maishman, R., Chauhan, N., McCullagh, L., McKeon, H., Abbs, S., Lamb, J., Gilbert, A., Hughes, C., Wynick, D., Angelini, G., Grocott, M., Gibbison, B., & Rogers, C. A. (2025). Gabapentin for pain management after major surgery: A placebo-controlled, double-blinded, randomized clinical trial (the GAP Study). Anesthesiology, 143(4), 851-861. https://doi.org/10.1097/ALN.0000000000005655 NEJM Journal Watch. (2024, December 30). Growing evidence of harms associated with gabapentinoid drugs. JWatch. https://www.jwatch.org/na58203/2024/12/30/growing-evidence-harms-associated-with-gabapentinoid-drugs Moeindarbari, S., Beheshtian, N., & Hashemi, S. (2022). Cerebral vein thrombosis in a woman using oral contraceptive pills for a short period of time: A case report. Journal of Medical Case Reports, 16, Article 260. https://doi.org/10.1186/s13256-022-03473-w Peckham, A. M., Evoy, K. E., Ochs, L., & Covvey, J. R. (2018). Gabapentin for off-label use: Evidence-based or cause for concern? Substance Abuse: Research and Treatment, 12, 1178221818801311. https://doi.org/10.1177/1178221818801311 The 2 View: Emergency Medicine PAs & NPs. (2025, January 22). 41 – RCVS and CVT, CPR care science, prehospital tourniquets, blood pressure [Audio podcast episode]. Fireside. https://2view.fireside.fm/41 Strahan, A. E., Rikard, S. M., Schmit, K. M., Zhang, K., Guy, G. P., Jr., & [Additional Authors]. (2025). Trends in dispensed gabapentin prescriptions in the United States, 2010 to 2024. Annals of Internal Medicine. Advance online publication. https://doi.org/10.7326/ANNALS-25-01750 Segment 3 Brown, R. F., Lopez, K., Smith, C. B., & Charles, A. (2025). Diverticulitis: A review. JAMA, 334(13), 1180-1191. https://doi.org/10.1001/jama.2025.10234 Carr, S., & Velasco, A. L. (2024, July 25). Colon diverticulitis. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541110/ Bob Tubbs on Emergency Radiology: https://youtu.be/Jg1JG67eoJQ Our social media: TikTok: https://www.tiktok.com/@ccmecourses Instagram: https://www.instagram.com/ccmecourses Facebook: https://www.facebook.com/CenterForMedicalEducation LinkedIn: https://www.linkedin.com/in/rickbukata Our podcasts: The 2 View Podcast (Free): Subscribe on Apple Podcasts https://apple.co/3rhVNZw​ Subscribe on Google Podcasts: http://bit.ly/2MrAHcD​ Subscribe On Spotify: http://spoti.fi/3tDM4im Risk Management Monthly Podcast (Paid CME): https://www.ccme.org/riskmgmt ** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. emergencymedicine #cme

A quick and easy way to remember the Salter Harris classification, using the mnemonic SALTR.PDFs available here: https://rhesusmedicine.com/pages/orthopaedicsConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesGaillard F, Silverstone L, Walizai T, et al. Salter-Harris classification. Radiopaedia.org. Last revised 11 February 2025. Available at: https://radiopaedia.org/articles/salter-harris-classification?lang=gbPhyseal (growth plate) injuries. The Royal Children's Hospital Melbourne. Available at: https://www.rch.org.au/fracture-education/growth_plate_injuries/physeal_growth_plate_injuries/Levine RH, Thomas A, Nezwek TA, et al. Salter-Harris Fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. [Updated 10 August 2023] Available at: https://www.ncbi.nlm.nih.gov/books/NBK430688/Image EM/79444. UpToDate. Available at: https://www.uptodate.com/contents/image?imageKey=EM%2F79444Disclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition.  The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice. 

Post Traumatic Stress Disorder (PTSD) is a frequent complication of exposure to trauma. We look at PTSD symptoms and causes, as well as the diagnosis and treatment of post traumatic stress disorder. PDFs available at: https://rhesusmedicine.com/pages/psychiatryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is PTSD? 0:48 Signs and Symptoms of PTSD2:27 PTSD Diagnosis3:30 PTSD Pathophysiology4:56 PTSD Risk Factors6:03 PTSD TreatmentReferences:BMJ Best Practice. (2024). Post-traumatic stress disorder. [online] Available at: https://bestpractice.bmj.com/topics/en-gb/430 (BMJ Best Practice)Mann, S.K., Marwaha, R. & Torrico, T.J. (2024). Posttraumatic Stress Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Last update 25 February 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559129/ (NCBI)PTSD UK. (n.d.). PTSD Stats – PTSD UK. [online] Available at: https://www.ptsduk.org/ptsd-stats/ (PTSD UK)PTSD UK. (2019). Secondary Trauma – PTSD UK. [online] Available at: https://www.ptsduk.org/secondary-trauma/ (PTSD UK)Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Nephrotic Syndrome explained clearly (including differences from Nephritic Syndrome), looking at causes and pathophysiology, as well as symptoms, diagnosis and treatment options. PDFs available at: https://rhesusmedicine.com/pages/nephrologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 Nephrotic vs Nephritic Syndrome1:02 Nephrotic Syndrome Pathophysiology2:01 Nephrotic Syndrome Signs and Symptoms 4:42 Nephrotic Syndrome Causes 7:34 Nephrotic Syndrome Epidemiology / Risk Factors8:07 Nephrotic Syndrome Diagnosis9:15 Nephrotic Syndrome Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Nephrotic Syndrome in Adults. Last reviewed 2025. Available at: https://www.niddk.nih.gov/health-information/kidney-disease/nephrotic-syndrome-adultsWikipedia contributors. Nephrotic syndrome. Last updated July 2025. Available at: https://en.wikipedia.org/wiki/Nephrotic_syndromeStatPearls. Nephrotic Syndrome. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available at: https://www.statpearls.com/articlelibrary/viewarticle/25713/Geeky Medics. Nephrotic vs Nephritic Syndrome | Renal. Last updated August 2025. Available at: https://geekymedics.com/nephrotic-vs-nephritic-syndrome/AMBOSS. Nephrotic syndrome. Last updated March 2025. Available at: https://www.amboss.com/us/knowledge/Nephrotic_syndromePubMed. Thrombosis in nephrotic syndrome. Published 2013. Available at: https://pubmed.ncbi.nlm.nih.gov/23625754/BMJ Best Practice. Assessment of nephrotic syndrome – Differential diagnosis of symptoms. Last updated March 2025. Available at: https://bestpractice.bmj.com/topics/en-gb/356Italian Journal of Pediatrics (Biomed Central). The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I – Diagnosis and treatment of the first episode and the first relapse. Published 2017. Available at: https://ijponline.biomedcentral.com/articles/10.1186/s13052-017-0356-xDisclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice

Chronic Kidney Disease (CKD) explained, including causes and pathophysiology, as well as symptoms and complications. We also look at diagnosis and treatment options. PDFs available here: https://rhesusmedicine.com/pages/nephrologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Chronic Kidney Disease?1:45 Chronic Kidney Disease Symptoms & Complications4:51 Chronic Kidney Disease Causes7:20 Chronic Kidney Disease Pathophysiology 8:14 Chronic Kidney Disease Epidemiology / Risk Factors 8:53 Chronic Kidney Disease Diagnosis10:30 Chronic Kidney Disease Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesNICE Clinical Knowledge Summaries (CKS). Definition of Chronic Kidney Disease. Last revised May 2025. Available at: https://cks.nice.org.uk/topics/chronic-kidney-disease/background-information/definition/ (NICE)StatPearls. Chronic Kidney Disease. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Last updated July 31 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535404/ (NCBI, PubMed)Wikipedia contributors. Chronic kidney disease. Last updated August 2025. Available at: https://en.wikipedia.org/wiki/Chronic_kidney_disease (Wikipedia)GPCPD (HEIW Wales). Prescribing in Acute Kidney Injury (AKI). Updated 2025. Available at: https://gpcpd.heiw.wales/clinical/acute-kidney-injury-in-primary-care/prescribing-in-aki/Kidney International. Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 2022 Apr;12(1):7–11. Available at: https://www.kidney-international.org/article/S0085-2538(22)00518-X/fulltext (PubMed)Disclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Nephritic Syndrome explained clearly, including differences from Nephrotic Syndrome, clinical features and the causes made easy to remember- including pathology. PDFs available at: https://rhesusmedicine.com/pages/nephrologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Nephritic Syndrome?0:33 Nephritic vs Nephrotic Syndrome1:29 Nephritic Syndrome Pathophysiology3:20 Nephritic Syndrome Signs and Symptoms3:45 Rapidly Progressive Glomerulonephritis5:18 Anti Glomerular Basement Membrane Disease (Goodpasture's Disease) 6:09 IgA Nephropathy7:25 Post Streptococcal Glomerulonephritis8:47 Diffuse Proliferative Glomerulonephritis 9:38 Pauci Immune – ANCA Vasculitis 10:49 Alport's Syndrome 11:29 Membranoproliferative Glomerulonephritis12:20 Nephritic Syndrome Diagnosis 13:08 Nephritic Syndrome Treatment LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesGeeky Medics. Nephrotic vs Nephritic Syndrome | Renal. Last updated 18 August 2025. Available at: https://geekymedics.com/nephrotic-vs-nephritic-syndrome/StatPearls. Nephritic Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK562240/AMBOSS. Nephritic syndrome. Last updated 23 May 2025. Available at: https://www.amboss.com/us/knowledge/Nephritic_syndromeWikipedia contributors. Nephritic syndrome. Last updated 30 August 2025. Available at: https://en.wikipedia.org/wiki/Nephritic_syndromeClinicalKey. Nephritic Syndrome. Last updated 2025. Available at: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0095454320300579?scrollTo=%23hl0000359MedBullets. Nephritic Syndrome. Last updated 28 February 2025. Available at: https://step2.medbullets.com/renal/120698/nephritic-syndromeDisclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Shoulder dislocation (Glenohumeral Joint Dislocation) is the most common large joint dislocation. We look at the mechanisms (Anterior, Posterior and Inferior) as well as X-Ray findings and treatment. PDFs available at: https://rhesusmedicine.com/pages/orthopaedicsConsider subscribing on (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 Shoulder Joint Anatomy1:45 Anterior Shoulder Dislocation2:48 Posterior Shoulder Dislocation4:03 Inferior Shoulder Dislocation4:25 Shoulder Dislocation Complications5:12 Diagnosis (Anterior Shoulder Dislocation X-Ray) 6:13 Posterior Shoulder Dislocation X-Ray6:54 Shoulder Dislocation TreatmentReferencesTeachMeAnatomy. The Shoulder Joint – Structure – Movement. Last updated October 8, 2024. Available at: https://teachmeanatomy.info/upper-limb/joints/shoulder/ (TeachMeAnatomy)Radiopaedia. Hill-Sachs Defect | Radiology Reference Article. Published 8 months ago (circa December 2024). Available at: https://radiopaedia.org/articles/hill-sachs-defect?lang=us (Radiopaedia)Radiopaedia. Posterior Shoulder Dislocation | Radiology Reference Article. Published 10 months ago (circa October 2024). Available at: https://radiopaedia.org/articles/posterior-shoulder-dislocation (Radiopaedia)Physiopedia. Shoulder Dislocation. Available at: https://www.physio-pedia.com/Shoulder_Dislocation (Physiopedia)Abrams, R. & Akbarnia, H. Shoulder Dislocations Overview. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Last updated August 8, 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459125/ (NCBI)MedBullets. Anterior Shoulder Dislocation. Published 3.7 years ago (circa early 2022). Available at: https://step2.medbullets.com/orthopedics/120534/anterior-shoulder-dislocation (step2.medbullets.com)Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

A break in a bone of the ankle (Talocrural Joint) is known as an ankle fracture, and there are multiple different kinds. We look at normal ankle anatomy, as well as the types of fracture (including Danis-Weber Classification), the diagnosis (including X Ray findings) and treatment options. PDFs available at: Orthopaedics – Rhesus MedicineConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineReferences:American Academy of Orthopaedic Surgeons (AAOS). Ankle Fractures (Broken Ankle). OrthoInfo. Last reviewed September 2022. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/ankle-fractures-broken-ankle/Orthobullets. Ankle Fractures. Orthobullets. Updated 2023. Available at: https://www.orthobullets.com/trauma/1047/ankle-fracturesTeachMeSurgery. Ankle Fracture. TeachMeSurgery. Updated 2023. Available at: https://teachmesurgery.com/orthopaedic/ankle-and-foot/ankle-fracture/TeachMeAnatomy. Ankle Joint. TeachMeAnatomy. Updated 2023. Available at: https://teachmeanatomy.info/lower-limb/joints/ankle-joint/Smith, J. M. & Varacallo, M. (2025 Jan). Ankle Fractures. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Last updated August 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK542324/Geeky Medics. Ankle X-ray Interpretation. Last updated April 2025. Available at: https://geekymedics.com/ankle-x-ray-interpretation/Disclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition.  The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice. 

Tennis Elbow and Golfer's Elbow (also more recently called Lateral and Medial Elbow Tendinopathies) explained, including symptoms, pathophysiology, diagnosis and treatment. PDFs Available at: https://rhesusmedicine.com/Consider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Tennis Elbow / What is Golfer's Elbow? 0:25 Lateral Epicondylitis Pathophysiology / Medial Epicondylitis Pathophysiology1:55 Lateral Epicondylitis (Tennis Elbow) Signs and Symptoms 2:40 Medial Epicondylitis (Golfer's Elbow) Signs and Symptoms3:16 General Epicondylitis / Tendinosis Signs and Symptoms 3:42 Lateral Epicondylitis (Tennis Elbow) & Medial Epicondylitis (Golfer's Elbow) Diagnosis 4:07 Tennis Elbow Treatment / Golfer's Elbow TreatmentLINK TO MNEMONICS:https://www.youtube.com/watch?v=p-XE7PiwGgE&list=PLGNSE_HvIV4t7a33bbHN1fq-j_tge0GmpLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/References:American Academy of Orthopaedic Surgeons (AAOS). Tennis Elbow (Lateral Epicondylitis). OrthoInfo. Last reviewed June 2022. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/tennis-elbow-lateral-epicondylitis/Buchanan, B. K., & Varacallo, M. (2025 Jan). Lateral Epicondylitis (Tennis Elbow). In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Last update August 4 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK431092/Wikipedia contributors. (2025). Tennis elbow. Wikipedia. Last updated August 2025. Available at: https://en.wikipedia.org/wiki/Tennis_elbowReece, C. L., Li, D., & Susmarski, A. J. (2025 Jan). Medial Epicondylitis. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Last update May 2 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557869/Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition.  The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice. 

Producer Madi educates the masses on teeth disease. Audio Intro: “Pantyhose” by TV GirlFrom the Free Music ArchiveCC BY NC 4.0Audio Outro: “Pantyhose” by TV GirlFrom the Free Music ArchiveCC BY NC 4.0“Necrotizing Periodontitis.” Center for Advanced Periodontics & Implant Dentistry, advancedperio.org/p/BLOG-106627-2023.8.7-Necrotizing-Periodontitis-p.asp.Ogunleye, Rachel, Obioma Ukoha, Weronika Nasterska, Ewen McColl, Fatima Dantata, and Ifeoluwa Adetula. “Necrotising Periodontal Diseases: An Update on Classification and Management.” BDJ Team, vol. 10, 2023, pp. 22–25. doi:10.1038/s41407-023-1749-x.Balaji, Thodur Madapusi, et al. “Necrotizing Periodontal Diseases in Human Immunodeficiency Virus-Infected Patients Receiving Highly Active Antiretroviral Therapy: A Review.” Disease-a-Month, vol. 67, no. 9, Sept. 2021, Art. 101168, doi:10.1016/j.disamonth.2021.101168.Novak, M. J. “Necrotizing Ulcerative Periodontitis.” Annals of Periodontology, vol. 4, no. 1, Dec. 1999, pp. 74-78. doi:10.1902/annals.1999.4.1.74Herrera, David, et al. “Acute Periodontal Lesions (Periodontal Abscesses and Necrotizing Periodontal Diseases) and Endo-Periodontal Lesions.” Journal of Clinical Periodontology, vol. 45, Suppl. 20, June 2018, pp. S78–S94. doi: 10.1111/jcpe.12941.Gasner NS, Brizuela M, Schure RS. Necrotizing Periodontal Diseases. 2025 Jul 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32491349.

Night terrors are dramatic but benign episodes that can leave caregivers frightened and confused. In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we explore the clinical features of night terrors, how to differentiate them from other nocturnal events, and when to consider further evaluation such as polysomnography. We also discuss management strategies that center on sleep hygiene, reassurance, and safety, with a special look at the role of scheduled awakenings and when medication is appropriate. Learning Objectives By the end of this episode, listeners will be able to: Describe the typical clinical presentation and age range of children with night terrors. Differentiate night terrors from other parasomnias and nocturnal seizures based on clinical features and timing. Discuss non-pharmacologic and pharmacologic management strategies for night terrors, including when to consider polysomnography. References Petit D, Touchette E, Tremblay RE, et al. Dyssomnias and parasomnias in early childhood. Pediatrics. 2007;119(5):e1016-e1025. Morse AM, Kotagal S. Parasomnias of childhood, including sleepwalking. In: Chervin RD, ed. UpToDate. Hoppin AG, deputy ed. Waltham, MA. Accessed November 2025. Van Horn NL, Street M. Night Terrors. Updated May 29, 2023. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493222/ Transcript This transcript was provided via use of the Descript AI application Welcome to PEM Currents, The Pediatric Emergency Medicine Podcast. As always, I'm your host Brad Sobolewski. In this episode, we're talking about night terrors, also known as sleep terrors. A dramatic, confusing, and often terrifying experience for caregivers to witness. But they're usually benign and self-limited for the child. Kind of like a lot of the things in childhood actually, what are we gonna talk about? Well, what are night terrors? How do we diagnose them? How to differentiate them from seizures or other parasomnias key counseling for parents in the emergency department, when to refer for sleep studies or neurology evaluation, and what role, if any, medications play. So let's start with talking about what night terrors actually look like. They're part of a group of disorders called non REM parasomnias, which also includes sleepwalking and confusion arousals. They are not nightmares and they are not signs of psychological trauma. Children experiencing night terrors typically sit up suddenly during sleep, scream, cry or appear terrified. Show signs of autonomic arousal. So rapid breathing, tachycardia, sweating. They're confused or inconsolable for several minutes and they have absolutely no recollection of the event the next morning. These events usually occur in the first third of the night when children are in deep, slow wave sleep, so stage N three, and they can last five to 15 minutes, but trust me, they seem to last much longer to observers. Night terrors occur most commonly between ages three and seven with a peak around five years of age. They're rare before 18 months and unusual after age 12. Preschool aged children are most affected because they spend more time in deep, slow wave sleep. They have more fragmented sleep architecture, and they may not have fully developed arousal regulation mechanisms. Episodes can start as early as toddlerhood, especially if the child has a family history of parasomnias. So like sleep, walking night terrors or other things, sleep deprivation or stressful life events like starting daycare or a new sibling or a move, although less common, older children and even adolescents can experience night terrors, especially in the context of stress, sleep deprivation or comorbid sleep disorders like sleep apnea. Why do they happen? Well, they're usually due to incomplete arousal from deep sleep, so the brain is essentially stuck between sleep and wakefulness. Factors that increase the risk of frequency of night terrors include again, sleep deprivation, recent illness, stress, or anxiety. Sleep disordered breathing, or a family history of parasomnias, there's a real strong genetic component. Up to 80% of children with night terrors have a first degree relative with similar episodes. The diagnosis is entirely clinical and based on history. You should ask parents, what time of night did these episodes occur? Is the child confused, frightened, or hard to wake? Is there amnesia the next day so they don't remember the event? And are the movements variable or stereotyped? Sometimes parents will video record these, and that can really help us clarify the episodes when we're in the emergency department. You definitely do not need labs or imaging in a typical presentation. I think parents are often seeking an explanation for why their child looks so freaky. In my experience, just telling them that it's a night terror and that it's benign and providing reassurance on how healthy their kid is, is more than enough. Now, not all nighttime events are sleep terrors. You should consider neurology referral and video polysomnography or sleep studies with extended EEG when onset is very early, so younger than 18 months or late in childhood. So older than 12 or 13 episodes occur outside of the first third of the night. Again, find out when the kid went to bed. And do math. The first third of the night is the first 33% of their typical sleep time. The events are brief clustered or stereotyped. The movements are repetitive, focal or violent. If kid just moving just their right arm. That's not a night terror. Often the movements will look fearful and they'll be sort of disorganized. Rhythmic movements don't typically happen in night terrors, and there's a recent injury. The child has excessive daytime sleepiness, or there's some developmental regression or abnormality. All those are red flags. Differentiating from nocturnal frontal lobe epilepsy can be tricky. Nocturnal frontal lobe epilepsy events are usually short. Highly stereotyped. They have abrupt onset and offset, and they may include dystonic or tonic posturing. So if the family has a video of this, that can be really helpful using a good clinical history. Video recordings in EEG generally distinguish night terrors from these forms of epilepsy. But let's be honest, most of the kids you see in the ED with a typical presentation of night terrors are just night terrors. These events are really scary and we are gonna see them in the emergency departments, and so your first goal is to just reassure the family. The events are not harmful. The kid isn't aware that they had them, and the child suffers no ongoing psychological harm. That doesn't mean that the parent isn't freaked out or that nervousness doesn't linger. You wanna avoid sleep deprivation If possible, counsel families on age appropriate bedtimes and naps. Stick to a routine consistent bedtime routines. Reduce sleep fragmentation, which is a known risk factor for children with frequent or predictable night terrors. Try waking them 15 to 30 minutes before the usual episode happens. So I've seen lots of kids with frequent night terrors, and they usually happen around the same time at night. And you wanna do this, this 15 to 30 minute awakening before the usual episodes each night for about two to four weeks. That's labor intensive as a parent, but it can help these awakenings interrupt the sleep cycle and break the pattern. Keep kids safe. Use baby gates, door alarms. Make sure windows are locked, don't put younger kids in bunk beds and remove sharp obstacles or objects near the bed. So if they've got a pointy ended nightstand, oh, that's just something for the kid to fall into or smack against. Do we ever use medications for night terrors? Well, almost never. You know, pharmacologic therapy such as low dose benzodiazepines or tricyclic antidepressants is really only reserved for severe episodes. Kids with substantial risk for injury or disruption of the family life or school in a substantial way. I'm not gonna make that call in the emergency department. And these are sleep specialist referral guided therapies. You also wanna consider evaluating children for comorbid sleep disorders, especially in recurrent night terrors, like obstructive sleep apnea, restless leg syndrome. This may worsen the parasomnias. For kids in which you're unsure, polysomnography can be used. This is an overnight sleep study that monitors brainwaves via EEG, eye movements, muscle activity, heart rhythm, breathing effort, and airflow and oxygen saturation. But it's also done in a hospital and not during the kid's usual sleep routine. So most children that have night terrors, if you get the right history, you can make the diagnosis clinically and the kids don't need any expensive or expanded testing to get to the bottom of things. Alright, take home points for this brief episode. Night terrors are common, especially in preschool aged children. They occur in non REM sleep in the first third of the night. The episodes are very dramatic, but they're benign and children don't remember them. But trust me, parents do. The diagnosis is clinical. No labs or imaging are needed unless there's atypical features. You should reassure families, promote sleep hygiene and use scheduled awakenings for frequent and recurrent cases, and refer for sleep studies and or neurology of episodes or violent stereotyped, or suggest nocturnal seizures. Thanks for listening to this episode. I hope you found it educational about a topic that you will encounter in the emergency department. As with many things in children that are scary, there's a benign explanation and parents are just looking to know that their kid's gonna be okay. Often doing a thorough history in physical and really listening to the parents' concerns and then providing useful information is all you gotta do. That's why pediatrics is great. If you've got feedback on this episode or there's other common topics you'd like to hear about, send them my way. If you enjoyed this episode and think that other people should listen to it, share it with them. More listeners means more learners. And if you have a chance, leave a review or like the podcast on your favorite podcast site for PEM Currents, the Pediatric Emergency Medicine Podcast. This has been Brad Sobolewski. See you next time.  

We must be thorough in reviewing patients who have had direct trauma to their eyes.  Objects that are small enough that the orbit provides no protection are of increased concern.  In addition to other injuries, we need to be aware of orbital floor fractures and commotio retinae.     Check out the Stat Pearls page on Orbital Floor injuries Koenen L, Waseem M. Orbital Floor Fracture. [Updated 2023 Dec 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.  Check out the Radiopaedia page by  Alejandro Planas Callao   Check out the paper mentioned Raman Bhakhri and Nicole Landry.  Commitio Retinae: A teaching Case Report. Optometric Education: Volume 48 Number 2 (Winter-Spring 2023)     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice, always consult your usual doctor 

We should be aware of the early signs of ocular siderosis, also known as siderosis bulbi which would indicate a retained metallic intraocular foreign body.     Check out the Stat Pearls page. Acharya I, Raut AA. Siderosis Bulbi. [Updated 2023 Jan 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-   www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice, always consult your usual doctor 

Learn how to sharpen your pediatric intubation skills and make evidence-based decisions at the bedside. Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania expertly dissect the nuances of selecting optimal induction agents for critically ill children in the PICU. Through engaging, real-world case scenarios, our hosts guide you through drug choices in complex situations such as cardiogenic shock, septic shock, and elevated intracranial pressure—always prioritizing hemodynamic stability and patient safety. Gain valuable insights into the advantages, limitations, and clinical pearls of agents like propofol, fentanyl, ketamine, and midazolam, along with practical strategies for rapid sequence intubation, neuromuscular blockade, and individualized patient care. Don't miss this high-yield discussion, packed with actionable knowledge!Show Highlights:Induction agents for endotracheal intubation in critically ill childrenClinical scenarios highlighting optimal choices of induction agents and neuromuscular blockersImportance of maintaining hemodynamic stability during intubationPharmacology and clinical considerations of various induction agents (e.g., propofol, ketamine, fentanyl, etomidate)Use of neuromuscular blocking agents (NMBAs) in pediatric intubationDifferences between depolarizing and non-depolarizing neuromuscular blockersRisks associated with specific induction agents in patients with cardiac dysfunction or septic shockModified rapid sequence intubation (RSI) techniques for unstable patientsKey takeaways for managing critically ill pediatric patients requiring intubationPractical tips for optimizing intubation conditions and minimizing complicationsReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care 6th Edition. Chapters 127 - 135, Pages 1510 - 1610Hendrix JM, Regunath H. Intubation Endotracheal Tube Medications. [Updated 2025 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459276/Agrawal, Dewesh. Rapid sequence intubation (RSI) in children for emergency medicine: Medications for sedation and paralysis. UpToDate. Last updated Dec 4, 2024.Vanlinthout LE, Geniets B, Driessen JJ, Saldien V, Lapré R, Berghmans J, Uwimpuhwe G, Hens N. Neuromuscular-blocking agents for tracheal intubation in pediatric patients (0-12 years): A systematic review and meta-analysis. Paediatr Anaesth. 2020 Apr;30(4):401-414. doi: 10.1111/pan.13806. Epub 2020 Mar 9. PMID: 31887248.Tarquinio KM, Howell JD, Montgomery V, Turner DA, Hsing DD, Parker MM, Brown CA 3rd, Walls RM, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children; Pediatric Acute Lung Injury and Sepsis Investigators Network. Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study. Pediatr Crit Care Med. 2015 Mar;16(3):210-8. doi: 10.1097/PCC.0000000000000319. PMID: 25581629.Conway JA, Kharayat P, Sanders RC Jr, Nett S, Weiss SL, Edwards LR, Breuer R, Kirby A, Krawiec C, Page-Goertz C, Polikoff L, Turner DA, Shults J, Giuliano JS Jr, Orioles A, Balkandier S, Emeriaud G, Rehder KJ, Kian Boon JL, Shenoi A, Vanderford P, Nuthall G, Lee A, Zeqo J, Parsons SJ, Furlong-Dillard J, Meyer K, Harwayne-Gidansky I, Jung P, Adu-Darko M, Bysani GK, McCarthy MA, Shlomovich M, Toedt-Pingel I, Branca A, Esperanza MC, Al-Subu AM, Pinto M, Tallent S, Shetty R, Thyagarajan S, Ikeyama T, Tarquinio KM, Skippen P, Kasagi M, Howell JD, Nadkarni VM, Nishisaki A; National Emergency Airway Registry for Children (NEAR4KIDS) and for the Pediatric Acute Lung Injury and Sepsis Investigators...

Mornings can set the tone for the rest of your day, and with PCOS, the right habits can make a huge difference. In this episode, I'm sharing five simple habits that support stable blood sugars, a regulated appetite, better focus, and healthier cortisol management. These aren't complicated or Instagram-perfect routines, but doable shifts you can start right away to make mornings less chaotic and create a ripple effect for the rest of your day. Ready to boost your energy, regulate cycles and feel confident with a clear plan to thrive with PCOS? Our PCOS Recovery Program is now open for enrolment - we start Sept 24th! This is your chance to move beyond short-term diets and finally feel confident in your health. Join us. If you enjoyed this episode, we'd love to hear it - please leave a rating and review! References:Malone JC, Thavamani A. Physiology, Gastrocolic Reflex. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549888/ Witbracht M, Keim NL, Forester S, Widaman A, Laugero K. Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure. Physiol Behav. 2015 Mar 1;140:215-21. doi: 10.1016/j.physbeh.2014.12.044. Epub 2014 Dec 27. PMID: 25545767. Xiao K, Furutani A, Sasaki H, Takahashi M, Shibata S. Effect of a High Protein Diet at Breakfast on Postprandial Glucose Level at Dinner Time in Healthy Adults. Nutrients. 2022 Dec 24;15(1):85. doi: 10.3390/nu15010085. PMID: 36615743; PMCID: PMC9824806.

Ready for a deep dive into a real-life pediatric ICU situation? Today, Dr. Pradip Kamat, Dr. Monica Gray, and Dr. Rahul Damania will walk you through the case of a seven-year-old girl with Hemoglobin SC (HbSC) disease, who presents with abdominal swelling, pneumonia, low oxygen, and pain.In this episode, our team unpacks the spleen's anatomy and its crucial role in immunity, then zooms in on how sickle cell disease can throw a wrench in splenic function. You'll hear how they approach the diagnosis and management of acute splenic sequestration crisis, sharing clinical pearls along the way. Plus, they'll break down why quick recognition is so important and discuss strategies for both immediate and long-term care in pediatric sickle cell patients. Don't miss these practical insights from the frontlines of pediatric critical care!Show Highlights:Case study of a seven-year-old girl with hemoglobin SC diseasePresentation of symptoms: abdominal distension, pneumonia, hypoxia, and body painDiscussion of acute splenic sequestration crisis as a complication of sickle cell diseaseAnatomy and physiology of the spleenThe role of the spleen in sickle cell disease and how sickled cells affect splenic functionAcute splenic sequestration crisis, including clinical features and laboratory evaluationsManagement strategies for acute splenic sequestration crisis in the ICUImportance of blood transfusions and supportive care in treatmentProphylactic measures to prevent recurrence of splenic sequestrationEducational emphasis on recognizing clinical signs and the need for timely interventionReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 88. Hemoglobinopathies. Baender, MA, Marsh Anne. Pages: 1457-1470Rogers' textbook of pediatric intensive care: Hematologic Emergencies. McCory MC, Bhar S, and Blaine E. Pages 2003-2005Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol. 2014 Jul;166(2):165-76. doi: 10.1111/bjh 12950. Epub 2014 May 26. PMID: 24862308.Waleed S, Aldabsa M, Gouher S. Splenic Sequestration Induced by Parvovirus B19: A Case Report. Cureus. 2024 May 23;16(5):e60937. doi: 10.7759/cureus. 60937. PMID: 38915956; PMCID: PMC11195323.Solanki DL, Kletter GG, Castro O. Acute splenic sequestration crises in adults with sickle cell disease. Am J Med. 1986 May;80(5):985-90. doi: 10.1016/0002-9343(86)90649-2. PMID: 3706382.Karna B, Jha SK, Al Zaabi E. Hemoglobin C Disease. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559043/

Welcome to "PICU Doc on Call," the podcast where real cases meet real expertise at the bedside! Join Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania as they unravel the mysteries of pediatric critical care. In today's episode, our team dives into the compelling case of a previously healthy seven-year-old girl who arrives with seizures, right arm weakness, and sudden respiratory failure. Together, they'll break down the diagnosis and management of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, also known as MOGAD. This autoimmune demyelinating disorder can challenge even the most seasoned clinicians. Tune in as our experts walk you through the clinical features, essential diagnostic workup, and the critical importance of early immunosuppressive therapy. Whether you're at the bedside or on the go, this episode is packed with practical pearls and a multidisciplinary approach to recognizing and treating acute pediatric neuroimmunological emergencies in the PICU. Let's get started!Show Highlights:Presentation of a complex pediatric case involving a seven-year-old girl with new-onset seizures and acute respiratory failureDiscussion of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) as an autoimmune demyelinating disorderOverview of the clinical presentation and diagnostic criteria for autoimmune encephalitisImportance of a broad differential diagnosis, including infectious and autoimmune causes, in pediatric patients with seizures and neurological deficitsDiagnostic approach involving MRI, lumbar puncture, and antibody testing for MOGADManagement strategies for MOGAD, including stabilization, seizure control, and immunosuppressive therapyNeurocritical care considerations for monitoring and treating elevated intracranial pressureLong-term management challenges and the need for multidisciplinary care in pediatric patients with MOGADDiscussion of potential outcomes and the risk of relapse in children with MOGAD.Emphasis on the importance of early and comprehensive diagnostic testing to avoid misdiagnosisReferences:Fuhrman & Zimmerman - Pediatric Critical Care 6th Edition, Chapter 64Gole S, Anand A. Autoimmune Encephalitis. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578203/Salama S, Khan M, Pardo S, Izbudak I, Levy M. MOG antibody-associated encephalomyelitis/encephalitis. Mult Scler. 2019 Oct;25(11):1427-1433. doi: 10.1177/1352458519837705. Epub 2019 Mar 25. PMID: 30907249; PMCID: PMC6751007Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis. J Clin Neurol. 2016 Jan;12(1):1-13. doi: 10.3988/jcn.2016.12.1.1. PMID: 26754777; PMCID: PMC4712273.Fisher KS, Illner A, Kannan V. Pediatric neuroinflammatory diseases in the intensive care unit. Semin Pediatr Neurol. 2024 Apr;49:101118. Doi: 10.1016/j.spen.2024.101118. Epub 2024 Feb 1. PMID: 38677797.Hébert J, Muccilli A, Wennberg RA, Tang-Wai DF. Autoimmune Encephalitis and Autoantibodies: A Review of Clinical Implications. J Appl Lab Med. 2022 Jan 5;7(1):81-98. Doi: 10.1093/jalm/jfab102. PMID: 34996085.Lopez JA, Denkova M, Ramanathan S, Dale RC, Brilot F. Pathogenesis of autoimmune demyelination: from multiple sclerosis to neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease. Clin Transl Immunology. 2021 Jul 26;10(7):e1316. doi: 10.1002/cti2.1316. PMID: 34336206; PMCID: PMC8312887.

Listener discretion is advised. References: Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocrit Care. 2020 Jun;32(3):647-666. doi: 10.1007/s12028-020-00959-7. PMID: 32227294; PMCID: PMC7272487. Desai A, Damani R. Hyperosmolar therapy: A century of treating cerebral edema. Clin Neurol Neurosurg. 2021 Jul;206:106704. doi: 10.1016/j.clineuro.2021.106704. Epub 2021 May 20. PMID: 34045110. Mount CA, Das JM. Cerebral Perfusion Pressure. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537271/ Susanto M, Riantri I. Optimal Dose and Concentration of Hypertonic Saline in Traumatic Brain Injury: A Systematic Review. Medeni Med J. 2022 Jun 23;37(2):203-211. doi: 10.4274/MMJ.galenos.2022.75725. PMID: 35735001; PMCID: PMC9234368.

Do you perform a DRE before referring a suspected case of cauda equina syndrome?   Check out the Stat Pearls page Rider LS, Marra EM. Cauda Equina and Conus Medullaris Syndromes. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-   Check out the papers mentioned Sherlock KE, Turner W, Elsayed S, Bagouri M, Baha L, Boszczyk BM, McNally D. The Evaluation of Digital Rectal Examination for Assessment of Anal Tone in Suspected Cauda Equina Syndrome. Spine (Phila Pa 1976). 2015 Aug 1;40(15):1213-8. doi: 10.1097/BRS.0000000000000902. PMID: 25811266. Link   Tabrah J, Wilson N, Phillips D, Böhning D. Can digital rectal examination be used to detect cauda equina compression in people presenting with acute cauda equina syndrome? A systematic review and meta-analysis of diagnostic test accuracy studies. Musculoskelet Sci Pract. 2022 Apr;58:102523. doi: 10.1016/j.msksp.2022.102523. Epub 2022 Feb 9. PMID: 35180641. Link    Curtis Lopez C, Berg AJ, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Br J Neurosurg. 2024 Aug;38(4):923-927. doi: 10.1080/02688697.2021.2005775. Epub 2021 Nov 19. PMID: 34796788. Link   www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Join medical students Binal Patel and Aashka Sheth as they discuss adolescent gynecology with pediatrician Dr. Shreeti Kapoor.  Specifically, they will discuss: What exactly is adolescent gynecology. The proper approach to taking a comprehensive history for a pediatric patient with a gynecologic chief complaint. The various causes of dysmenorrhea in the early menarche period and its presentation. The diagnostic approach to dysmenorrhea in adolescents. The approach to treatment of dysmenorrhea in a pediatric population. And how to approach addressing safe sex practices and sexually transmitted infections with adolescents. References: 21 reasons to see a gynecologist before you turn 21. ACOG. (n.d.). https://www.acog.org/womens-health/infographics/21-reasons-to-see-a-gynecologist-before-you-turn-21   Adams Hillard P. J. (2008). Menstruation in adolescents: what's normal?. Medscape journal of medicine, 10(12), 295.  Breehl L, Caban O. Physiology, Puberty. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534827/  Centers for Disease Control and Prevention. (n.d.). About heavy menstrual bleeding. Centers for Disease Control and Prevention. https://www.cdc.gov/female-blood-disorders/about/heavy-menstrual-bleeding.html  Primary dysmenorrhea in adolescents. UpToDate. (n.d.). https://www.uptodate.com/contents/primary-dysmenorrhea-in-adolescents?search=Primary+Dysmenorrhea+&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2  professional, C. C. medical. (2024, September 20). Pediatric gynecology. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/24574-pediatric-gynecology  professional, C. C. medical. (2025, February 18). Puberty. Cleveland Clinic. https://my.clevelandclinic.org/health/body/puberty   Sachedin, A., & Todd, N. (2020). Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. Journal of Clinical Research in Pediatric Endocrinology, 12(1), 7–17. https://doi.org/10.4274/jcrpe.galenos.2019.2019.s0217   Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. (2020). Topics in Antiviral Medicine, 28(2). https://pmc.ncbi.nlm.nih.gov/articles/PMC7482983/pdf/tam-28-459.pdf   UpToDate. (n.d.). Abnormal uterine bleeding in adolescents. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-adolescents-evaluation-and-approach-to-diagnosis?search=heavy%2Bbleeding&usage_type=default&source=search_result&selectedTitle=3~150&display_rank=3  

In this episode of 'Science of Slink,' Dr. Rosy Boa addresses common misconceptions about the role of the Latissimus Dorsi (lats) muscles in pole dancing. She explains the anatomy and function of the lats, debunks myths about their role in overhead movements, and offers tips on when and how to effectively train these muscles. Essential for pole dancers, the episode also covers related topics like muscle contraction, scapula stabilization, and potential causes of pain from tight lats. Dr. Boa recommends resources and exercises for better shoulder mechanics and performance in pole dancing.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true Chapters:00:00 Introduction and Episode Overview01:14 Common Misconceptions About Lats01:52 Understanding Muscle Function03:15 Anatomy of the Lats05:50 Lats in Pole Dancing07:36 Scapula Mechanics and Misconceptions11:03 Training and Flexibility Recommendations15:18 Conclusion and Further ReadingCitations: Bhatt CR, Prajapati B, Patil DS, Patel VD, Singh BG, Mehta CD. Variation in the insertion of the latissimus dorsi & its clinical importance. J Orthop. 2013 Mar 7;10(1):25-8. doi: 10.1016/j.jor.2013.01.002. PMID: 24403744; PMCID: PMC3768243.https://pmc.ncbi.nlm.nih.gov/articles/PMC3768243/ Miniato MA, Mudreac A, Borger J. Anatomy, Thorax, Scapula. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538319/Paksoy, A., Akgün, D., Gebauer, H., Karczewski, D., Lacheta, L., Tokish, J. M., ... & Moroder, P. (2024). The latissimus dorsi creates a dynamic track for the inferior angle of the scapula during arm abduction in humans. Journal of Orthopaedic Surgery and Research, 19(1), 193.Pouliart N, Gagey O. Significance of the latissimus dorsi for shoulder instability. I. Variations in its anatomy around the humerus and scapula. Clin Anat. 2005 Oct;18(7):493-9. doi: 10.1002/ca.20185. PMID: 16092134.Links:Learn more about join the Science of Slink membership www.scienceofslink.comJoin the Essentials of Slink waitlist! https://mailchi.mp/slinkthroughstrength.com/essentials-of-slinkUse the code “TURNINGTHREE” for 25% off any drop in class: https://www.slinkthroughstrength.com/online-pole-dancing-classes-sign-up

Send us a textRiley's doctor recommended bariatric surgery as the solution to their health concerns, but when Riley came to me for advice, I realized they hadn't been told about the real risks. From anastomosis leaks with 15% mortality rates to spontaneous bowel perforations years later, the complications of weight loss surgery extend far beyond what most patients are counseled about. In this episode, I walk through the evidence-based risks that every patient deserves to know before making this life-altering decision, because informed consent requires the whole truth. If you or someone you know is considering weight loss surgery, then be sure to send them a link to this episode!References:Lim, Robert et al. “Early and late complications of bariatric operation.” Trauma surgery & acute care open vol. 3,1 e000219. 9 Oct. 2018Silva, Ana Flávia da et al. “Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature.” Revista latino-americana de enfermagem vol. 31 (2023)Complications of bariatric surgery: presentation and emergency management--a review.” Annals of the Royal College of Surgeons of England vol. 91,4 (2009): 280-6.Benotti, Peter et al. “Risk factors associated with mortality after Roux-en-Y gastric bypass surgery.” Annals of surgery vol. 259,1 (2014): 123-30. Coupaye, Muriel et al. “Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid.” Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery vol. 13,4 (2017): 681-685 Husain, Syed et al. “Small-bowel obstruction after laparoscopic Roux-en-Y gastric bypass: etiology, diagnosis, and management.” Archives of surgery (Chicago, Ill. : 1960) vol. 142,10 (2007): 988-93 Seeras K, Acho RJ, Lopez PP. Roux-en-Y Gastric Bypass Chronic Complications. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519489/Got a question for the next podcast? Let me know! Connect With Me FREE GUIDES: evidence-based, not diet nonsense NEWSLETTER: Life-changing insights straight to your inbox UNSHRINKABLE: Find out why your body is not designed to shrink MASTERCLASSES: All the evidence doctors should give you NO WEIGH PROGRAM: Join the revolution against weight-loss lies THE WEIGHTING ROOM: A community where authenticity thrives and every voice matters CONSULTATION: For the ultimate transformation in your healthcare journe Find me on Instagram, YouTube, and LinkedIn.

What to consider when faced with an ear laceration.   Williams CH, Sternard BT. Complex Ear Lacerations. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Link   Link to the Laceration Repair Blog     www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Vitamin B6 is both a prescribed medication and available in many over-the-counter preparations.  In high and prolonged doses, it can be a cause of peripheral neuropathy.     Check out the Prescriber Update for June 2025   Check out the StatPearls page Hemminger A, Wills BK. Vitamin B6 Toxicity. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-   www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

In this episode of 'Science of Slink,' hosted by Dr. Rosy Boa, the focus is on the details of dancing in pole heels, a theme for June 2025. Dr. Boa outlines essential tips for choosing the right shoes, including the benefits of platforms, the significance of a sturdy stiletto, and the importance of proper shoe fit. She delves into the mechanics of balance, the challenges posed by the additional weight of heels, and strategies to avoid foot cramps. Additionally, Dr. Boa emphasizes the importance of acknowledging the roots of pole dancing in strip clubs and supporting sex workers, highlighting her studio's monthly contributions to various support organizations. Lastly, practical advice is offered on warming up properly to prevent foot cramps and ensuring better performance while dancing in heels.Are you a pole nerd interested in trying out online pole classes with Slink Through Strength? We'd love to have you! Use the code “podcast” for 10% off the Intro Pack and try out all of our unique online pole classes: https://app.acuityscheduling.com/catalog/25a67bd1/?productId=1828315&clearCart=true Chapters:00:00 Introduction and Theme Announcement00:51 Acknowledging the Roots of Pole Dancing01:49 The Mechanics of Dancing in Heels06:16 Choosing the Right Pole Heels12:47 Preventing Foot Cramps and Injuries16:19 Addressing Bunions and Final ThoughtsCitations:More information on the intrinsic muscles of the footCard, R. K., & Bordoni, B. (2023). Anatomy, Bony Pelvis and Lower Limb, Foot Muscles. In StatPearls [Internet]. StatPearls Publishing.Despite popular belief there is no strong scientific evidence that shoes or high heels cause bunions.Nix, S. E., Vicenzino, B. T., Collins, N. J., & Smith, M. D. (2012). Characteristics of foot structure and footwear associated with hallux valgus: a systematic review. Osteoarthritis and cartilage, 20(10), 1059-1074.Not even if you dance in shoes (including pointe shoes!).Kennedy, J. G., & Collumbier, J. A. (2008). Bunions in dancers. Clinics in sports medicine, 27(2), 321-328.Bunions seem to be mostly genetic.Coughlin, M. J., & Jones, C. P. (2007). Hallux valgus: demographics, etiology, and radiographic assessment. Foot & ankle international, 28(7), 759-777. Hannan, M. T., Menz, H. B., Jordan, J. M., Cupples, L. A., Cheng, C. H., & Hsu, Y. H. (2013). High heritability of hallux valgus and lesser toe deformities in adult men and women. Arthritis care & research, 65(9), 1515-1521. Piqué-Vidal, C., Solé, M. T., & Antich, J. (2007). Hallux valgus inheritance: pedigree research in 350 patients with bunion deformity. The Journal of foot and ankle surgery, 46(3), 149-154.

There are a few Hutchinson's signs, but this one relates to Herpes Zoster Ophthalmicus.     Check out the StatPearls page on Herpes Zoster Ophthalmicus Minor M, Payne E. Herpes Zoster Ophthalmicus. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.    www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Synovial chondromatosis is a benign process that results in the formation of numerous loose bodies within a joint. This can lead to significant functional limitations as well as pain. In this episode, we discuss its pathogenesis, diagnosis and management options. Habusta SF, Mabrouk A, Tuck JA. Synovial Chondromatosis. 2023 Apr 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29262110 Find out More about our Doctors: Dr. Izuchukwu Ibe: www.linkedin.com/in/izuchukwu-ibe-a073537a/ Dr. Elyse Brinkmann: www.linkedin.com/in/elyse-brinkmann/

In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.Show Highlights:Case presentation of a 16-year-old male with severe carbon monoxide poisoningPathophysiology of carbon monoxide toxicity and its effects on hemoglobinClinical manifestations and symptoms associated with carbon monoxide poisoningDiagnostic workup for suspected carbon monoxide exposureManagement principles for treating carbon monoxide poisoning in pediatric patientsSources and scenarios leading to carbon monoxide poisoningComplications arising from carbon monoxide exposure including neurological injuriesImportance of early oxygen administration and monitoring in treatmentDiscussion of hyperbaric oxygen therapy and its indicationsKey takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning casesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman's Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

Send us a textDescription: An immersive reading of A Hymn to God the Father by John Donne with reflection on medical errors and confession. Website:https://anauscultation.wordpress.comWork:A Hymn to God the Father by John DonneWilt thou forgive that sin where I begun,         Which was my sin, though it were done before?Wilt thou forgive that sin, through which I run,         And do run still, though still I do deplore?                When thou hast done, thou hast not done,                        For I have more.Wilt thou forgive that sin which I have won         Others to sin, and made my sin their door?Wilt thou forgive that sin which I did shun         A year or two, but wallow'd in, a score?                When thou hast done, thou hast not done,                        For I have more.I have a sin of fear, that when I have spun         My last thread, I shall perish on the shore;But swear by thyself, that at my death thy Son         Shall shine as he shines now, and heretofore;                And, having done that, thou hast done;                        I fear no more.References:Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000 Mar 18;320(7237):726-7. doi: 10.1136/bmj.320.7237.726. Finkelstein A, Brezis M, Taub A, Arad D. Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives. Isr J Health Policy Res. 2024 Mar 11;13(1):13.Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248.

In this episode, I make a brave confession and explore how Terrifier (2016) reflects the psychological phenomenon of imposter syndrome.Mental Health is Horrifying is hosted by Candis Green, Registered Psychotherapist and owner of Many Moons Therapy...............................................................Show Notes:Join Out Of The Broom Closet if you would like to move from shame to pride in claiming your identity as a witch, and confidently step out of the broom closet. This course includes psychoeducation about shame, trauma, and exile within our cultural context, and witch-positive exercises to connect with your authentic self including tarot, journaling, spellwork, and creative visualization. Want to work together? I offer 1:1 psychotherapy (Ontario), along with tarot, horror, and dreamwork services, both individually and through my group program, the Final Girls Club. Podcast artwork by Chloe Hurst at Contempo MintTerrifier 2025 ConferenceHuecker MR, Shreffler J, McKeny PT, Davis D. Imposter Phenomenon. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 36251839.

In this episode, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray dive into a critical case involving a five-week-old baby facing acute respiratory failure due to pertussis. They chat about how this condition shows up, how it's diagnosed, and the best ways to manage it, especially considering the serious complications it can cause in infants, like pulmonary hypertension and the potential need for ECMO. The conversation underscores the importance of catching it early and providing supportive care, while also highlighting how crucial vaccination is in preventing pertussis. Tune in to learn how severe this disease can be and why staying alert in pediatric care is so important.Show Highlights:Clinical case of a five-week-old infant with acute respiratory failure and pertussis diagnosisEpidemiology and public health impact of pertussis, including vaccination rates and outbreak patternsPathophysiology of pertussis and its effects on respiratory health, particularly in infantsClinical presentation of pertussis, including stages of the disease and atypical symptoms in infantsDiagnostic approaches for pertussis, including laboratory findings and PCR testingManagement strategies for severe pertussis, including supportive care and antibiotic therapyPotential complications associated with pertussis, especially in young infantsDifferential diagnosis considerations for pertussis and distinguishing features from other infectionsImportance of vaccination in preventing pertussis and reducing morbidity and mortalityECMO as a treatment option for severe cases and its associated challenges, and outcomesWe welcome you to share your feedback, subscribe & place a review on our podcast! Please visit our website picudoconcall.org.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter and Rogers texbook of Pediatric intensive care -both do not have any Pertussis mentioned in their index.Rowlands HE, Goldman AP, Harrington K, Karimova A, Brierley J, Cross N, Skellett S, Peters MJ. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants. Pediatrics. 2010 Oct;126(4):e816-27. doi: 10.1542/peds.2009-2860. Epub 2010 Sep 6. PMID: 20819895.Lauria AM, Zabbo CP. Pertussis. [Updated 2022 Oct 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519008/Berger JT, Carcillo JA, Shanley TP, Wessel DL, Clark A, Holubkov R, Meert KL, Newth CJ, Berg RA, Heidemann S, Harrison R, Pollack M, Dalton H, Harvill E, Karanikas A, Liu T, Burr JS, Doctor A, Dean JM, Jenkins TL, Nicholson CE; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN). Critical pertussis illness in children: a multicenter prospective cohort study. Pediatr Crit Care Med. 2013 May;14(4):356-65. doi: 10.1097/PCC.0b013e31828a70fe. PMID: 23548960; PMCID: PMC3885763.Cousin, V.L., Caula, C., Vignot, J. et al. Pertussis infection in critically ill infants: meta-analysis and validation of a mortality score. Crit Care 29, 71 (2025). https://doi.org/10.1186/s13054-025-05300-2Domico M, Ridout D, MacLaren G, Barbaro R, Annich G, Schlapbach LJ, Brown KL. Extracorporeal Membrane Oxygenation for Pertussis: Predictors of Outcome Including Pulmonary Hypertension and Leukodepletion. Pediatr Crit Care Med. 2018 Mar;19(3):254-261. doi:...

Understanding HIV and AIDS, including HIV virology, epidemiology as well as HIV symptoms (including WHO clinical classification and CDC CD4 count classification). Also covered is diagnosis and treatment including anti retroviral therapy (ART). Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is HIV? 0:28 HIV Microbiology1:36 HIV Pathophysiology2:17 HIV Epidemiology3:17 HIV Symptoms & Clinical Stages6:25 HIV Diagnosis8:00 HIV TreatmentReferencesBMJ Best Practice (2025) - “HIV in adults”. Available at https://bestpractice.bmj.com/topics/en-gb/555Mpiko Ntsekhe, MD, PhD and Jason V. Baker, MD, MSc (2022) - “Cardiovascular Disease Among Persons Living With HIV: New Insights Into Pathogenesis and Clinical Manifestations in a Global Context”. Available at https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.057443Virology Research Services (2022) - “The Virus of the Month - HIV”. Available at https://virologyresearchservices.com/2022/09/04/the-virus-of-the-month-hiv/Waymack JR, Sundareshan V. Acquired Immune Deficiency Syndrome. [Updated 2023 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available at https://www.ncbi.nlm.nih.gov/books/NBK537293/Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition. Geneva: World Health Organization; 2016. ANNEX 10, WHO clinical staging of HIV disease in adults, adolescents and children. Available at https://www.ncbi.nlm.nih.gov/books/NBK374293/fVirtual Mentor. 2010;12(3):202-206. doi: 10.1001/virtualmentor.2010.12.3.cprl1-1003. Available at https://journalofethics.ama-assn.org/article/who-clinical-staging-system-hivaids/2010-03Please remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

Send us a textDescription: An immersive reading of Thoughts by Myra Viola Wilds with reflection on psychotherapy, meditation, cognitive behavioral therapy and vision loss. Website:https://anauscultation.wordpress.comWork: Thoughts by Myra Viola Wilds   In your travels day by dayAre they bright and lofty visions,    Or neglected, gone astray?Matters not how great in fancy,     Or what deeds of skill you've wrought; Man, though high may be his station,     Is no better than his thoughts. Catch your thoughts and hold them tightly,    Let each one an honor be; Purge them, scourge them, burnish brightly,    Then in love set each one free.References:Chand SP, Kuckel DP, Huecker MR. Cognitive Behavior Therapy. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/(2025, March 5). Overview - Cognitive behavioural therapy (CBT). nhs.uk. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/ 

In this episode, Melanie talks about a rare congenital condition called medullary sponge disease (MSD) or medullary sponge kidney (MSK) and how people with the disease CAN still prevent kidney stones!  Garfield K, Leslie SW. Medullary Sponge Kidney. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470220/    Submit a question for Melanie to answer on the podcast! Connect with The Kidney Dietitian! Work with Us! |  Instagram | Facebook | Pinterest | Facebook Group | Newsletter www.thekidneydietitian.org All information in this podcast is meant for educational purposes only and should not be used in place of advice from a medical professional.  

In this episode, we explore the critical role nurses play in advancing health equity within the ICU. Jennifer Adamski, president of the American Association of Critical-Care Nurses, shares insights on how nurses can make a difference at the bedside and the challenges they face. We also discuss strategies for empowering nurses and fostering a culture of equity in critical care.This episode is sponsored by Medtronic.Areia C, King E, Ede J, Young L, Tarassenko L, Watkinson P, Vollam S. Experiences of current vital signs monitoring practices and views of wearable monitoring: A qualitative study in patients and nurses. Journal of advanced nursing. 2022 Mar;78(3):810-22Williams EC, Polito V. Meditation in the Workplace: Does Mindfulness Reduce Bias and Increase Organisational Citizenship Behaviours? Front Psychol. 2022 Apr 11;13:747983. doi: 10.3389/fpsyg.2022.747983. PMID: 35478759; PMCID: PMC9035788.Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook. 2023 Sep-Oct;71(5):102032. doi: 10.1016/j.outlook.2023.102032. Epub 2023 Sep 6. PMID: 37683597.Bhavani SV, Wiley Z, Verhoef PA, Coopersmith CM, Ofotokun I. Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements in Hospitalized Patients. JAMA. 2022;328(9):885–886. doi:10.1001/jama.2022.12290P Malhotra, L Shaw, J Barnett, E Hayter, N Hill, P Stockton. St Helens and Knowsley. P179 Patient safety alert: a prospective study on 100 patients highlighting inaccuracy of pulse oximeter finger probes used on ear lobes. Teaching Hospitals NHS Trust, Prescot, UK. 10.1136/thorax-2018-212555.336Torp KD, Modi P, Pollard EJ, Simon LV. Pulse Oximetry. 2023 Jul 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29262014Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl). 2014 Jul 8;7:231-9. doi: 10.2147/MDER.S47319. PMID: 25031547; PMCID: PMC4099100Giuliano KK, Bilkovski RN, Beard J, Lamminmäki S. Comparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions. J Clin Monit Comput. 2023 Dec;37(6):1451-1461. doi: 10.1007/s10877-023-01029-x. Epub 2023 Jun 2. PMID: 37266709; PMCID: PMC10651546Gudelunas MK, Lipnick M, Hendrickson C, et al. Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024;138(3):552-561. doi:10.1213/ANE.0000000000006755

Weight loss medications are a hot topic.  But what are they? Who do they help and how? Join Mindy and Cheryl as they start a conversation about GLP-1 medications.  Mindy gives us her thoughts and client experience as a Registered Dietitian.  Our guest, Erika, shares her story. Listen to hear how these medications helped her on her journey (for reasons you may not have considered) and why she is no longer taking them. Erika‘s inspiring story reminds us that often life is not one size fits Article Mindy references:Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK551568/We are so glad you are here. Want to stay in touch?Follow us on social media: Mindy - @strongover40_dietitian Cheryl - @training.with.cheryl Mindy & Cheryl - @mcfitadventures Email us: mcfitadventures@gmail.com Thank you so much for listening to Sweat & Laughter. M & C

Medical errors are a common cause of harm to patients. In this episode of Critical Incident from Knowledgeable Provider, Jody recalls some of his own errors in the hope of encouraging all medical professionals to be honest and transparent about mistakes. References: 1) Rodziewicz TL, Houseman B, Vaqar S, et al. Medical Error Reduction and Prevention. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499956/ 2) Kimberly N. Williams, Crystal M. Fausett, Elizabeth H. Lazzara, Yuval Bitan, Anthony Andre, Joseph R. Keebler, Investigative approaches: Lessons learned from the RaDonda Vaught case, Human Factors in Healthcare, Volume 4, 2023, 100054, ISSN 2772-5014, https://doi.org/10.1016/j.hfh.2023.100054. 3) Newman-Toker DE, Nassery N, Schaffer AC, et alBurden of serious harms from diagnostic error in the USABMJ Quality & Safety 2024;33:109-120. 4) Makary M A, Daniel M. Medical error—the third leading cause of death in the US BMJ 2016; 353 :i2139 doi:10.1136/bmj.i2139

Episode 173: Acute OsteomyelitisFuture Dr. Tran explains the pathophysiology of osteomyelitis and describes the presentation, diagnosis and management of acute osteomyelitis. Dr. Arreaza provides information about    Written by Di Tran, MSIII, Ross University School of Medicine. 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.What is osteomyelitis?Osteomyelitis, in simple terms, is an infectious disease that affects both bone and bone marrow and is either acute or chronic.  According to archaeological findings of animal fossils with a bone infection, osteomyelitis was more than likely to be known as a “disease for old individuals”.Our ancestors over the years have used various vocabulary terms to describe this disease until a French surgeon, Dr. Nelaton, came up with the term “Osteomyelitis” in 1844. This is the beauty of medical terms, Latin sounds complicated for some people, but if you break up the term, it makes sense: Osteo = bone, myelo = marrow, itis = inflammation. So, inflammation of the bone marrow.Traditionally, osteomyelitis develops from 3 different sources:First category is the “hematOgenous” spread of the infection within the bloodstream, as in bacteremia. It is more frequent in children and long bones are usually affected. [Arreaza: it means that the infection started somewhere else but it got “planted” in the bones]Second route is “direct inoculation” of bacteria from the contiguous site of infection “without vascular insufficiency”, or trauma, which may occur secondary to fractures or surgery in adults.  In elderly patients, the infection may be related to decubitus ulcers and joint replacements.And the third route is the “contiguous” infection “with vascular insufficiency”, most seen in a patient with a diabetic foot infection.Patients with vascular insufficiency often have compromised blood supply to the lower extremities, and poor circulation impairs healing. In these situations, infection often occurs in small bones of the feet with minimal to no pain due to neuropathy.They can have ulcers, as well as paronychia, cellulitis, or puncture wounds.Thus, the importance of treating onychomycosis in diabetes because the fungus does not cause a lot of problems by itself, but it can cause breaks in the nails that can be a port of entry for bacteria to cause severe infections. Neuropathy is an important risk factor because of the loss of protective sensation. Frequently, patients may step on a foreign object and not feel it until there is swelling, purulent discharge, and redness, and they come to you because it “does not look good.”Acute osteomyelitis often takes place within 2 weeks of onset of the disease, and the main histopathological findings are microorganisms, congested blood vessels, and polymorphonuclear leukocytes, or neutrophilic infiltrates.What are the bugs that cause osteomyelitis?Pathogens in osteomyelitis are heavily depended on the patient's age.  Staph. aureus is the most common culprit of acute hematogenous osteomyelitis in children and adults.  Then comes Group A Strep., Strep. pneumoniae, Pseudomonas, Kingella, and methicillin-resistant Staph. aureus.  In newborns, we have Group B Streptococcal. Less common pathogens are associated with certain clinical presentations, including Aspergillus, Mycobacterium tuberculosis, and Candida in the immunocompromised.Salmonella species can be found in patients with sickle cell disease, Bartonella species in patients with HIV infection, and Pasteurella or Eikenella species from human or animal bites.It is important to gather a complete medical history of the patient, such as disorders that may put them at risk of osteomyelitis, such as diabetes, malnutrition, smoking, peripheral or coronary artery disease, immune deficiencies, IV drug use, prosthetic joints, cancer, and even sickle cell anemia. Those pieces of information can guide your assessment and plan.What is the presentation of osteomyelitis?Acute osteomyelitis may present symptoms over a few days from onset of infection but usually is within a 2-week window period.  Adults will develop local symptoms of erythema, swelling, warmth, and dull pain at the site of infection with or without systemic symptoms of fever or chills.Children will also be present with lethargy or irritability in addition to the symptoms already mentioned.It may be challenging to diagnose osteomyelitis at the early stages of infection, but you must have a high level of suspicion in patients with high risks. A thorough physical examination sometimes will show other significant findings of soft tissue infection, bony tenderness, joint effusion, decreased ROM, and even exposed bone. Diagnosis.As a rule of thumb, the gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathology findings and tissue culture. There is leukocytosis, but then WBC counts can be normal even in the setting of acute osteomyelitis.Inflammatory markers (CRP, ESR) are often elevated although both have very low specificity. Blood cultures should always be obtained whenever osteomyelitis is suspected.  A bone biopsy should also be performed for definitive diagnosis, and specimens should undergo both aerobic and anaerobic cultures.  In cases of osteomyelitis from diabetic foot infection, do the “probe to bone” test. What we do is we use a sterile steel probe to detect bone which is helpful for osteomyelitis confirmation.Something that we can't miss out on is radiographic imaging, which is quite important for the evaluation of osteomyelitis.  Several modalities are useful and can be used for the work-up plan; plain radiographs often are the very first step in the assessment due to their feasibility, low cost, and safety.  Others are bone scintigraphy, CT-scan, and MRI.  In fact, the MRI is widely used and provides better information for early detection of osteomyelitis than other imaging modalities.  It can detect necrotic bone, sinus tracts, and even abscesses. We look for soft tissue swelling, cortical bone loss, active bone resorption and remodeling, and periosteal reaction.  Oftentimes, plain radiography and MRI are used in combination. Treatment:Treatment of osteomyelitis actually is a teamwork effort among various medical professionals, including the primary care provider, the radiologist, the vascular, the pharmacist, the podiatrist, an infectious disease specialist, orthopedic surgeons, and the wound care team.Something to take into consideration, if the patient is hemodynamically stable it is highly recommended to delay empirical antibiotic treatment 48-72 hours until a bone biopsy is obtained.  The reason is that with percutaneous biopsy ideally done before the initiation of antibiotic treatment, “the microbiological yield will be higher”.We'll have a better idea of what particular bugs are causing the problem and guide the treatment appropriately. The choice of antibiotic therapy is strongly determined by susceptibilities results.  The antibiotic given will be narrowed down only for the targeted susceptible organisms.  In the absence of such information, or when a hospitalized patient presents with an increased risk for MRSA infection, empiric antibiotic coverage is then administered while awaiting culture results. It should be broad-spectrum antibiotics and include coverage for MRSA, broad gram-negative and anaerobic bacteria.  For example, vancomycin plus piperacillin-tazobactam, or with broad-spectrum cephalosporin plus clindamycin.  Treatment will typically be given for 4 to 6 weeks.The duration between 4-6 weeks is important for complete healing, but a small study with a small sample showed that an even shorter duration of 3 weeks may be effective, but more research is needed. In certain situations, surgery is necessary to preserve viable tissue and prevent recurrent infection, especially when there are deep abscesses, necrosis, or gangrene, amputation or debridement is deemed appropriate. If the infected bone is completely removed, patients may need a shorter course of antibiotics, even a few days only. Amputation can be very distressing, especially when we need to remove large pieces of infected bone, for example, a below-the-knee amputation. We need to be sensitive to the patient's feelings and make a shared decision about the best treatment for them.In patients with diabetes, additional care must be taken seriously, patient education about the need for compliance with treatment recommendations, with careful wound care, and good glycemic control are all beneficial for the healing and recovery process. Because this is a very common problem in the clinic and at the hospital, we must keep our eyes wide open and carefully assess patients with suspected osteomyelitis to detect it promptly and start appropriate treatment. Adequate and timely treatment is linked to fewer complications and better outcomes._________________________Conclusion: Now we conclude episode number 173, “Acute Osteomyelitis.” Future Dr. Tran explained the pathophysiology, diagnosis, and management of osteomyelitis. A bone biopsy is the ideal method of diagnosis. Delaying antibiotic treatment a few days until you get a biopsy is allowed if the patient is stable, but if the patient is unstable, antibiotics must be started promptly. Dr. Arreaza mentioned the implications of amputation and that we must discuss this treatment empathically with our patients. This week we thank Hector Arreaza and Di Tran. 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:Bury DC, Rogers TS, Dickman MM. Osteomyelitis: Diagnosis and Treatment. Am Fam Physician. 2021 Oct 1;104(4):395-402. PMID: 34652112.Cunha BA. Osteomyelitis in elderly patients. Clin Infect Dis. 2002 Aug 1;35(3):287-93. doi: 10.1086/341417. Epub 2002 Jul 11. PMID: 12115094.Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008 Dec;36(1):nihpa116823. doi: 10.3810/psm.2008.12.11. PMID: 19652694; PMCID: PMC2696389.Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 1;84(9):1027-33. PMID: 22046943.Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, Stoddart MJ, Richards RG, Zaat SAJ, Moriarty TF. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020 Jun;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007. Epub 2020 Mar 16. PMID: 32194053.Momodu II, Savaliya V. Osteomyelitis. [Updated 2023 May 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532250/Royalty-free music used for this episode: Trap Chiller by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net 

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers Antipsychotic Side Effects with our very own expert Dr Alex Raben, a staff psychiatrist in chronic care at the Centre for Addiction and Mental Health in Toronto. Dr. Raben graduated from medical school and completed residency at the University of Toronto. His academic interests include teaching and medical education scholarship with a particular interest in novel modalities of knowledge translation within the field of psychiatry. He is a founding member and Executive Director of PsychEd, this educational psychiatry podcast which aims to empower medical learners to seek out current knowledge from mental health experts to share with their colleagues around the world. The learning objectives for this episode are as follows: By the end of this episode, the listener will be able to… Outline the side effects of antipsychotics and their known/potential mechanisms Discuss management options for the different side effects Identify which antipsychotics are more likely to cause certain side effects Guest: Dr Alex Raben Hosts: Angad Singh and Kate Braithwaite Audio editing by: Angad Singh Show notes by: Angad Singh and Kate Braithwaite Interview Content: Introduction - 0:00 Primer on antipsychotics - 1:54 Anti-dopamine side effects - 5:04 Drug potency as it relates to side effects - 38:46 Anticholinergic side effects - 41:37 Antiadrenergic side effects - 47:30 Metabolic side effects - 50:29 Sedation - 56:46 Please note that this episode does not include a discussion of the life threatening side effects of antipsychotics. These include neuroleptic malignant syndrome, torsades de pointes, laryngospasm, and seizure. Resources: PsychEd Episode 10: Treatment of Schizophrenia Part II with Dr. Albert Wong — PsychEd Podcast PsychEd Episode 60: Metabolic Psychiatry with Dr. Cindy Calkin – Psyched Podcast AIMSExtendedSample - YouTube Anticholinergic Mnemonics: Toxicology Mnemonic Challenge • LITFL • Toxicology Conundrum References: de Silva VA, Suraweera C, Ratnatunga SS, Dayabandara M, Wanniarachchi N, Hanwella R. Metformin in prevention and treatment of antipsychotic induced weight gain: a systematic review and meta-analysis. BMC psychiatry. 2016;16:1-0. Migirov A, Datta AR. Physiology, Anticholinergic Reaction. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546589/ Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):3-7. PMID: 16001094; PMCID: PMC487011. Roerig JL, Steffen KJ, Mitchell JE. Atypical antipsychotic-induced weight gain: insights into mechanisms of action. CNS drugs. 2011;25:1035-59. Stahl SM. Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press; 2021. Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry. 2018;17(3):341-56. For more PsychEd, follow us on Instagram (@psyched.podcast), Twitter (@psychedpodcast), and Facebook (PsychEd Podcast). You can provide feedback by email at psychedpodcast@gmail.com. For more information, visit our website at psychedpodcast.org.

Did you know that the treatments used to cure pediatric cancers can potentially cause a life-threatening event known as tumor lysis syndrome (TLS)? Arfa Ul-Haque and Yazmin Reategui, two third-year medical students, are joined by Pediatric intensivist, Dr. Smitha Mathew, to discuss the evaluation and management for TLS so that it is promptly recognized and treated in the inpatient hospital setting.   Specifically, they will:  Review the basic assessment skills and evaluation for a child presenting with potential TLS   Discuss the influence of chemotherapy, initial presentation, diagnostic options, and management of electrolyte imbalances found in TLS  Medications reviewed: daunorubicin, cytarabine, calcium gluconate, Rasburicase, allopurinol  Anticipatory guidance to medical professionals for potential onset of TLS  Special thanks to Dr. Eric Ring and Dr. Rebecca Yang for peer reviewing this episode. References: Tumor lysis syndrome. (2022, October 4). Medscape.com. https://emedicine.medscape.com/article/282171-overview Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Cheung WL, Hon KL, Fung CM, Leung AKC. Tumor lysis syndrome in childhood malignancies. Drugs in Context 2020; 9: 2019-8-2. DOI: 10.7573/dic.2019-8-2 Cheung, Ho Hung MBBSa; She, Wong Hoi MBBSa,∗; Yap, Desmond Y.H. MDb; Tsang, Simon H.Y. MBChBa; Cheung, Tan To MDc. A case report of tumor lysis syndrome after stage-one ALPPS. Medicine 101(10):p e29040, March 11, 2022. | DOI: 10.1097/MD.0000000000029040 Flood, K., Rozmus, J., Skippen, P., Matsell, D. G., & Mammen, C. (2021). Fluid overload and acute kidney injury in children with tumor lysis syndrome. Pediatric Blood & Cancer, 68(12), e29255. https://doi.org/10.1002/pbc.29255 Barbar T, Jaffer Sathick I. Tumor Lysis Syndrome. Adv Chronic Kidney Dis. 2021 Sep;28(5):438-446.e1. doi: 10.1053/j.ackd.2021.09.007. PMID: 35190110. Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Shenoy MT, D'Souza B, Akshatha LN, D'Souza V, Rajan MG. Spontaneous Tumor Lysis Syndrome in an Infant: A Case Report. Indian J Clin Biochem. 2015 Jul;30(3):360-2. doi: 10.1007/s12291-014-0472-y. Epub 2015 Feb 14. PMID: 26089626; PMCID: PMC4469048. Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther. 2017 Feb 2;10:597-605. doi: 10.2147/OTT.S103864. PMID: 28203093; PMCID: PMC5295804. Kollathodi SB, Parameswaran KK, Madhavan L, Kuruvilla S. Hematological malignancies presenting as spontaneous tumor lysis syndrome: A case series. J Family Med Prim Care. 2018 Sep-Oct;7(5):1116-1119. doi: 10.4103/jfmpc.jfmpc_171_18. PMID: 30598972; PMCID: PMC6259502.    

The Ozempic episode is HERE (Part 1). By this point, most of us have heard of the celebrities taking Ozempic/ Wegovy. If not, you must not watch the news or be on social media...lucky you! These drugs are being called "a miracle" and the "end of the ob*sity epidemic". Is this true? Abbey is joined by her intern, Nicole, to discuss all things weight loss drugs. Together they cover: what Ozempic is, how it works for diabetes and for weight loss, the difference between Ozempic and Wegovy, common side effects, and more. There's a lot of discourse in this episode, so buckle up! TW: "ob*se and ov*rweight terms are used in the episode to describe the research and BMI qualifiers. Be sure to rate the podcast and subscribe! Join the Fork Diet Culture Community! Work with Abbey 1-on-1 More about Abbey Follow on IG and TT: @fork.diet.culture Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2023 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/ Shetty R, Basheer FT, Poojari PG, Thunga G, Chandran VP, Acharya LD. Adverse drug reactions of GLP-1 agonists: A systematic review of case reports. Diabetes Metab Syndr. 2022;16(3):102427. doi:10.1016/j.dsx.2022.102427 Kapoor I, Sarvepalli SM, D'Alessio D, Grewal DS, Hadziahmetovic M. GLP-1 receptor agonists and diabetic retinopathy: A meta-analysis of randomized clinical trials. Surv Ophthalmol. 2023;68(6):1071-1083. doi:10.1016/j.survophthal.2023.07.002 Suran M. As Ozempic's Popularity Soars, Here's What to Know About Semaglutide and Weight Loss. JAMA. 2023;329(19):1627-1629. doi:10.1001/jama.2023.2438 Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725 Novo Nordisck. Ozempic. https://www.novocare.com/diabetes/products/ozempic.html Web site. Updated 2024 Gómez Lumbreras A, Tan MS, Villa-Zapata L, Ilham S, Earl JC, Malone DC. Cost-effectiveness analysis of five anti-obesity medications from a US payer's perspective. Nutr Metab Cardiovasc Dis. 2023;33(6):1268-1276. doi:10.1016/j.numecd.2023.03.012 Gordon A, Hobbs M. Maintenance Phase; Ozempic. 2023;Podcast

BRASH es un acrónimo relativamente nuevo que describe un síndrome de bradicardias con hipotensión severa en el contexto de fallo renal e hiperkalemia. Usted está atendiendo a un masculino de 62 años de edad con debilidad general y desorientación progresivamente peor desde hace varias horas. Mantiene su propia vía aérea y respira espontáneamente, pero no tiene pulsos periféricos palpables. Los signos vitales son 28, 20, 86%, 82/38. Usted coloca al paciente en el monitor cardiaco y observa un bloqueo AV de 3er grado sin ondas P y con un complejo de escape ventricular. De inmediato le coloca oxígeno al paciente mediante mascarilla de no-reinhalación, obtiene dos accesos vasculares, administra 1 mg de atropina y se prepara para realizar intervenciones de segunda línea para aumentar la frecuencia cardiaca, entre ellas, la administración de una infusión de adrenalina y la colocación de un marcapasos externo. Los algoritmos están hechos para evitar desastres. No necesariamente representan el mejor cuidado posible. En este caso, el algoritmo de bradicardia nos dice qué acciones debemos hacer de inicio para mantener al paciente vivo. Sin embargo, no está funcionando. ¿Por qué? Debido a la hiperkalemia. Los medicamentos que causan bloqueo de la conducción a través del nodo atrioventricular (AV) pueden provocar episodios de hipotensión severa y refractaria en el contexto de fallo renal agudo. Bloqueo AV + fallo renal agudo El fallo renal puede ocurrir por cualquier causa no relacionada. El fallo renal pre-renal puede ocurrir, por ejemplo, por deshidratación severa o cualquier otra causa de pobre perfusión sistémica. El fallo renal produce hiperkalemia. La hiperkalemia y el bloqueo del nodo AV por los bloqueadores beta y/o por los bloqueadores de canales de calcio produce la hipotensión. BRASH: un acrónimo a recordar cuando se trata bradicardias sintomáticas Bradicardia Fallo Renal Bloqueo AV Shock Hiperkalemia Cada una de estas condiciones presenta un problema por sí mismo. Cuando se combinan, tienen un efecto sinergístico. Es decir, tiene un efecto más potente que la suma de sus partes individuales. BRASH no es un diagnóstico por separado, sino una descripción de los signos y síntomas asociados al ciclo vicioso de bradicardia, shock, fallo renal e hiperkalemia. Ciclo vicioso de bradicadia, shock, fallo renal e hiperkalemia La bradicardia puede venir por los medicamentos y/o por la hiperkalemia. En el paciente que ya toma estos medicamentos de forma continua, es posible que un deterioro súbito en la función renal de paso a la hiperkalemia. La causa del deterioro súbito de la función renal puede ser por cualquier causa pre-renal, renal o pos-renal. Una causa común de fallo renal pre-renal es cualquier causa de shock que provoque un episodio sostenido de pobre perfusión renal. El resultado es un aumento en los niveles de potasio debido a la pobre eliminación renal. La hiperkalemia produce bloqueo AV y bradicardia, lo que puede agravar aún más la bradicardia y agravar aún más la pobre perfusión renal, lo que provoca a su vez una peor hiperkalemia. SAMPLE El historial clínico del paciente es fundamental para entender el problema. Signos y síntomas Alergias Medicamentos Padecimientos Última ingesta ("last meal") Evento que precedió la emergencia Pistas importantes del historial El historial puede dar a relucir el hecho de que el paciente esté tomando medicamentos que bloquean el nodo AV. Quizás un cambio reciente en la dosis, o la introducción de otro medicamento que tenga un efecto en los niveles de potasio puede ser el detonante reciente. El historial puede dar a relucir el hecho de que el paciente ya padezca de una condición renal previa. El historial puede dar a relucir algún evento reciente que haya provocado el deterioro agudo en la función renal. Trate la bradicardia, la hiperkalemia y la causa de la pobre perfusión El manejo de la bradicardia puede no ser suficiente para lograr estabilizar hemodinámicamente al paciente con BRASH. Es importante reconocer rápidamente y tratar de inmediato de la hiperkalemia. Aunque las ondas T picudas e hiperagudas son signos clásicos de la hiperkalemia, son signos demasiado tempranos. La evolución natural de la condición va a producir bloqueo AV y prolongamiento del complejo QRS. Es decir, es la propia bradicardia y bloqueo AV el mejor signo de que el paciente puede tener una hiperkalemia. Simultáneo al manejo de la bradicardia y de la hiperkalemia, es esencial tratar la causa que está provocando la pobre perfusión renal (por ejemplo, fallo pre-renal por pobre perfusión). Si esto no se corrige, el escenario va a volver a repetirse. Pequeños estímulos con grandes efectos Como mencionado anteriormente, el efecto de esta combinación es sinergístico. Es decir, el efecto combinado es más grande que la suma de sus efectos individuales. No tiene que haber ocurrido un cambio en la dosis que el paciente está tomando del medicamento que bloquea el nodo AV, ni tiene que ser una dosis especialmente alta. Puede ser la misma dosis que ha tomado por largo tiempo sin efectos adversos. Un episodio reciente de deshidratación no tiene que llevar a fallo renal pre-renal. Sin embargo, en presencia del efecto del medicamento que bloquea el nodo AV, tiene un efecto dramático en el riñón. La hiperkalemia no tiene que ser de inicio muy alta. Es decir, no hay una correlación entre niveles específicos de potasio en sangre y los efectos observados. Peor aún, los cambios en el EKG no necesariamente van a progresar de la misma manera que siempre se habla de la hiperkalemia (primero ondas T hiperagudas). Como mencioné anteriormente, la bradicardia quizás es el único indicio. Entonces, cada uno de los estímulos no tiene que ser muy significativo: una dosis normal del medicamento que siempre ha tomado, un episodio relativamente benigno de deshidratación (por ejemplo), un nivel de potasio levemente elevado... pero la combinación produce una bradicardia severa, con fallo renal, bloqueo AV, shock e hiperkalemia... mejor conocido como BRASH. Referencias Arif AW, Khan MS, Masri A, Mba B, Talha Ayub M, Doukky R. BRASH Syndrome with Hyperkalemia: An Under-Recognized Clinical Condition. Methodist Debakey Cardiovasc J. 2020 Jul-Sep;16(3):241-244. doi: 10.14797/mdcj-16-3-241. PMID: 33133361; PMCID: PMC7587309. Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167. Lizyness K, Dewald O. BRASH Syndrome. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570643/ https://emcrit.org/ibcc/brash/ https://litfl.com/brash-syndrome/

As the topic of mental health has gained attention over the past several years, you've no doubt heard a couple of related phrases you're not familiar with. One is the vagus nerve. The other is heart rate variability. Here, we'll delve into the vagus nerve and what it's all about. What is the Vagus Nerve? The vagus nerve, also known as the 10th cranial nerve or cranial nerve X, is the longest and most complex of the cranial nerves. It is also known as the "wanderer nerve" due to its long, winding course through the body, connecting various organs and systems. It is a key part of the parasympathetic nervous system, which controls involuntary body functions such as digestion, heart rate, and immune response.“Vagus Nerve: What It Is, Function, Location & Conditions.” Cleveland Clinic, https://my.clevelandclinic.org/health/body/22279-vagus-nerve. Accessed 6 Feb. 2024. The vagus nerve originates in the medulla oblongata, a part of the brain that connects to the spinal cord, and extends down through the neck to the vital abdominal organs.Segal, Dayva. “Vagus Nerve: What to Know.” WebMD, https://www.webmd.com/brain/vagus-nerve-what-to-know. Accessed 6 Feb. 2024. It contains both motor and sensory fibers, which means it can send and receive information.Kenny BJ, Bordoni B. Neuroanatomy, Cranial Nerve 10 (Vagus Nerve) [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537171/ The vagus nerve carries signals between the brain, heart, and digestive system. It is responsible for various bodily functions, including digestion, heart rate, and breathing. It also plays a role in controlling mood, immune response, and the regulation of food intake, satiety, and energy homeostasis.Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018 Mar 13;9:44. doi: 10.3389/fpsyt.2018.00044. PMID: 29593576; PMCID: PMC5859128. Vagus nerve stimulation (VNS) is a treatment method that uses electrical impulses to stimulate the nerve. It's used to treat some cases of epilepsy and depression that don't respond to other treatments. Damage to it can lead to conditions like gastroparesis, where food does not move into the intestines, and vasovagal syncope, a condition where people faint from low blood pressure. Vagal Tone Vagal tone is often used to assess heart function, emotional regulation, and other processes that alter or are altered by changes in parasympathetic activity. A higher resting vagal tone means you have a reserve capacity for stress. You're more stress resilient.Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol. 2017 Feb 20;8:213. doi: 10.3389/fpsyg.2017.00213. PMID: 28265249; PMCID: PMC5316555. Vagal tone is typically measured indirectly by heart rate variability (HRV), which is the variation in time between each heartbeat. HRV is considered a marker of the body's resilience and adaptability to stress, with higher HRV (indicating greater variability in the intervals between heartbeats) generally associated with better health and fitness, greater resilience to stress, and lower risk of disease. The Vagus Nerve and the Gut-Brain Axis The vagus nerve plays a pivotal role in the gut-brain axis, a complex communication network that links the central nervous system (CNS) with the gastrointestinal (GI) tract. This bidirectional pathway allows for the exchange of signals between the gut and the brain, influencing a wide range of bodily functions, including mood, immune response, digestion, and heart rate. Here's how the vagus nerve affects the gut-brain axis: Direct and Indirect Sensing The vagus nerve can directly or indirectly sense a variety of signals from t...

While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.  Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries  - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1.     Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2.     Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3.     Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4.     Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5.     Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6.     Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47  7.     Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8.     Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9.     Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10.  Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11.  Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

While on your burn rotation, the emergency department calls due to a patient who may have been injured at his job site, coming in contact with a high-voltage line. Join Drs. Tam Pham, Clifford Sheckter, Alex Morzycki and Jamie Oh as they discuss the work-up, management, resuscitation, and subsequent complications and reconstruction for electrical injuries.  Hosts: - Dr. Tam Pham: UW Medicine Regional Burn Center - Dr. Clifford Sheckter: Stanford Medicine, Santa Clara Valley Medical Center - Dr. Alex Morzycki: UW Medicine Regional Burn Center - Dr. Jamie Oh: UW Medicine Regional Burn Center Learning Objectives: - Review the epidemiology and common mechanisms for electrical injuries  - Understand the impact of electrical injuries on different organ systems, including skin, musculoskeletal, cardiac, neurologic, and renal systems - Be able to guide initial work-up and resuscitation of acute electrical injuries including upper extremity compartment evaluation and release - Recognize possible long-term complications of electrical injuries and their subsequent management References: 1.     Daskal Y, Beicker A, Dudkiewicz M, Kessel B. [HIGH VOLTAGE ELECTRIC INJURY: MECHANISM OF INJURY, CLINICAL FEATURES AND INITIAL EVALUATION.]. Harefuah. 2019 Jan;158(1):65-69. Hebrew. PMID: 30663297. 2.     Pawlik AM, Lampart A, Stephan FP, Bingisser R, Ummenhofer W, Nickel CH. Outcomes of electrical injuries in the emergency department: a 10-year retrospective study. Eur J Emerg Med. 2016 Dec;23(6):448-454. doi: 10.1097/MEJ.0000000000000283. PMID: 25969345. 3.     Davis C, Engeln A, Johnson EL, McIntosh SE, Zafren K, Islas AA, McStay C, Smith WR, Cushing T; Wilderness Medical Society. Wilderness Medical Society practice guidelines for the prevention and treatment of lightning injuries: 2014 update. Wilderness Environ Med. 2014 Dec;25(4 Suppl):S86-95. doi: 10.1016/j.wem.2014.08.011. PMID: 25498265. 4.     Zemaitis MR, Foris LA, Lopez RA, et al. Electrical Injuries. [Updated 2023 Apr 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448087/ 5.     Leversedge F, Moore T, Peterson B, Seiler J; Compartment syndrome of the upper extremity. J Hand Surg. 2011; 36(4):P544-559. doi: https://doi.org/10.1016/j.jhsa.2010.12.008 6.     Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res 2006, 27(4): 439-47  7.     Pilecky D, Vamos M, Bogyi P, et al. Risk of cardiac arrhythmias after electrical accident: a single-center study of 480 patients. Clin Res Cardiol 2019, 108(8): 901-908 8.     Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10): 1400-33 9.     Kaergaard A, Nielsen KJ, Casrtensen O, Biering K. Electrical injury and the long-term risk of cataract: A prospective matched cohort study. Acta Ophthalmologica 2023, e88-e94 10.  Richard F. Edlich, MD, PhD and others, TECHNICAL CONSIDERATIONS FOR FASCIOTOMIES IN HIGH VOLTAGE ELECTRICAL INJURIES, The Journal of Burn Care & Rehabilitation, Volume 1, Issue 2, November-December 1980, Pages 22–26. 11.  Lee DH, Desai MJ, Gauger EM. Electrical injuries of the hand and upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2019 Jan 1;27(1):e1-8. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/