Podcasts about Pathophysiology

Welcome to the Atomic Anesthesia podcast hosted by CRNA professor Dr. Rhea Temmermand and Co-Founder Sachi Lord. On this show, you'll hear clear, clinically grounded discussions designed for nurse anesthesia residents and CRNAs who want to feel more confident in complex pharmacology, physiology, and real-world anesthesia decision-making. Want more content like this? Become a member of our learning platform: http://atomicanesthesia.com In this episode: The cardiovascular, pulmonary, renal, and coagulation changes of normal pregnancy you need to know before you can recognize what's broken in preeclampsia Why preeclampsia is fundamentally a placenta problem that becomes a vascular endothelium problem — sFlt-1, soluble endoglin, VEGF neutralization, and the cascade that drives every symptom HELLP syndrome — microangiopathic hemolysis, hepatic involvement, and how it changes your anesthetic plan Magnesium sulfate pharmacology — NMDA antagonism, the dosing regimen, toxicity ladder, and why you must cut your non-depolarizing NMB dose by 30 to 50 percent Neuraxial vs general anesthesia in the severe preeclamptic — when neuraxial is safe, how to manage platelet thresholds, and how to blunt the catecholamine surge of laryngoscopy when general is unavoidable

ARDS is one of the most important—and intimidating—topics in critical care, so we thought it was the perfect time to reboot one of our most comprehensive episodes. Whether you're hearing it for the first time or need a refresher on the latest evidence and core principles, this episode is packed with practical pearls that still hold up today.Check out the original show notes on our website. Hosted on Acast. See acast.com/privacy for more information.

Group A strep in the pediatric ED: from strep throat to invasive disease and toxic shock. Host: Ellen Duncan, MD, PhD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Group_A_Strep.mp3 Download Leave a Comment Tags: Infectious Diseases, Pediatrics Show Notes Background Group A strep = Streptococcus pyogenes — gram-positive organism that colonizes the pharynx, but also the perianal and genital mucosa (worth remembering when the source isn’t the throat). Extremely common. The episode cites an estimated ~289 million cases/yr of strep pharyngitis in children 5–14 (NIH). For a U.S.-specific, verifiable anchor: the CDC estimates strep throat drives ~5.2 million outpatient visits/yr in people

Do you suddenly feel emotionally reactive, impatient, or irritated… only to realize a migraine is coming hours later?In this episode of Migraine Heroes Podcast, host Diane Ducarme explores why irritability before a migraine is often a neurological warning sign — not a personality flaw. Blending neuroscience with holistic healing insights, this episode explains what happens inside the brain and nervous system in the early stages of a migraine attack.You'll discover:

Do you feel like your brain notices everything — every noise, smell, emotion, light, or tiny body sensation — since living with migraines?In this episode of Migraine Heroes Podcast, host Diane Ducarme explores why chronic migraine sufferers often become hyper-aware and constantly “on alert.” Through a blend of neuroscience and holistic healing insights, this episode unpacks how repeated overstimulation can reshape the nervous system over time.You'll discover:

On this episode of White Coat Radio, we're joined by Dr. Kelly Covert, Associate Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy. She precepts third- and fourth-year student pharmacists, as well as pharmacy residents, on an adult medicine rotation at Johnson City Medical Center (JCMC). Dr. Covert is the college's PGY2 Residency Program Director. In this episode she discusses a day in the life of her practice site at JCMC, as well as tips for rotations and pursuing a residency.   Transcript: 00:00:00:00 - 00:00:25:03 Kelly Covert If I have a student who can see a problem and try to to learn how to solve that problem, if they can see a med they're not familiar with and go look it up and tell me what they found versus me having to ask them to do that. I think that's the mark of someone who's going to really excel in their pharmacy career 00:00:55:12 - 00:01:18:12 Michele Williams Welcome to White Coat Radio, a podcast from East Tennessee State University. Bill Gatton College of Pharmacy in Johnson City, Tennessee. Each episode we cover a wide range of topics about the pharmacy school experience, from study tips to deep dives with faculty and student pharmacists. I'm one of your host doctor Michelle Williams, assistant professor and director of academic success. 00:01:18:15 - 00:01:50:05 Stephen Woodward And I'm Stephen Woodward, marketing and communications manager. Today we welcome Doctor Kelly Covert, associate professor of pharmacy practice, who joined Gatton faculty in 2016. She precepts third and fourth year student pharmacists, as well as pharmacy residents on an adult medicine rotation at Johnson City Medical Center. Doctor covert is a 2014 graduate of the University of Tennessee Health Science Center College of Pharmacy, and completed her pharmacotherapy residency at the Medical University of South Carolina from 2014 to 2016. 00:01:50:07 - 00:01:57:19 Stephen Woodward At Gatton she serves as a PGY2 internal medicine residency program director. Now let's get to our interview. 00:01:57:21 - 00:02:00:01 Michele Williams Welcome to White Coat radio, Dr. Covert. 00:02:00:02 - 00:02:02:13 Kelly Covert Thank you. I'm excited to be here. 00:02:02:15 - 00:02:23:06 Michele Williams So, I'll get us started. You teach a number of courses here, at the college. And you're the course coordinator for the pharmacotherapy two course. Which students take in spring of therapy two year. What makes this course challenging for students, would you say? 00:02:23:09 - 00:02:52:27 Kelly Covert Yeah. I think, a piece of it is the design of the course. So when we redesigned the curriculum, there was a lot of intentionality in trying to kind of meld together. Pathophysiology and pharmacology and pharmacotherapy. And so this course does that to a certain degree. So we do expect students to do some pre-reading with regard to pathologies prior to coming into the course, which often students are less used to having to do. 00:02:52:29 - 00:03:15:25 Kelly Covert And then as the course builds, the disease states that they have learned earlier in the course, if treated incorrectly, end up leading to disease state. They learn later. So everything kind of builds, and we try to be intentional about not forgetting content that they had not only earlier in pharmacotherapy too, but also in therapy. One in the fall semester. 00:03:15:27 - 00:03:19:21 Stephen Woodward Can you tell us about your teaching specialties and what got you interested in those areas? 00:03:19:22 - 00:03:39:15 Kelly Covert Yeah. So when I first came to Gatton, gosh, almost ten years ago, I knew that I would be taking over the then Renal Integrated series and the GI integrated series, which works perfectly for me. In residency, I had a strong interest in solid organ transplant, and where I trained, most of our transplants were kidneys and livers. 00:03:39:22 - 00:04:04:02 Kelly Covert And so I had a strong, just interest in those disease states at baseline, not only the post-transplant stuff, but also all of the disease states that lead you to potentially needing a kidney transplant, or a liver transplant. And so it was an interest area of mine. And then I just got lucky that that's what the college needed, and have been fortunate to keep most of the content that I was kind of given at the very beginning of when I started here. 00:04:04:04 - 00:04:06:02 Kelly Covert Okay. Yeah. 00:04:06:04 - 00:04:09:24 Michele Williams So what do you like best about teaching again? 00:04:09:27 - 00:04:29:15 Kelly Covert Oh, lots of things. Number one, and this is not me saying this because I am a faculty member. I love our faculty members. I consider all of them really close friends of mine. And so I think we have a good group of people who care a lot about teaching students well. But I also like having a smaller cohort of students that it lets us get to know them really well. 00:04:29:18 - 00:04:52:18 Kelly Covert And you get to see people grow and change over time. If I notice, you know, maybe a student, a student seems off or someone who normally makes, you know, a B grades is struggling. I feel like we can recognize that more easily. And then the last thing that I appreciate is, I think in a lot of colleges, it doesn't always feel like everyone's on the same team. 00:04:52:21 - 00:05:12:11 Kelly Covert But especially when we were redesigning the curriculum, it definitely felt like a all hands on deck in a positive way effort. Like, everyone was willing to kind of put pride aside and say, yeah, I'll teach this, or yeah, you're right, that's too many hours for this, this disease state. So I just there's a lot of collegiality that I appreciate. 00:05:12:13 - 00:05:15:02 Michele Williams That's great. Yeah, I agree with you. Cool. 00:05:15:03 - 00:05:17:05 Kelly Covert Yeah. Awesome. Yeah. 00:05:17:07 - 00:05:22:14 Stephen Woodward Well, what tips for success or any advice would you give to our current students. 00:05:22:16 - 00:05:39:29 Kelly Covert Studying more than you think you need to. I, I was actually telling this to a student the other day. I think a lot of times, especially if you are a student who, in high school and undergrad didn't have to study very hard, you may have never really learned how to study, to be honest. That was me as a student. 00:05:40:01 - 00:06:01:11 Kelly Covert I kind of coasted through, and got to pharmacy school. And it's not that our material is harder, in my opinion. Still, to this day, physics is the hardest class I've ever taken by a lot. It's just that there's a higher volume and so if you don't know how to study and then the volume is so much higher, it just sets you up for a really challenging first semester. 00:06:01:14 - 00:06:23:04 Kelly Covert So I always tell students, study for more than you think you need to start earlier than you think. You need to break things down into smaller pieces than you think you might need to. Because the things that might have worked in undergrad when you were taking maybe 1 or 2 math and science courses, and then some fluffier or less intensive courses just probably won't work in pharmacy school. 00:06:23:06 - 00:06:27:03 Kelly Covert And then I always refer them to to Michele. Literally, always. 00:06:27:06 - 00:06:33:10 Michele Williams Thanks for that. Yeah. Yeah. I agree with you falling behind. 00:06:33:12 - 00:06:55:09 Kelly Covert It's just impossible to dig out. Yeah. And the challenge is everything builds. So, like, if you have a really rocky first semester, not to say your second semester will be equally as rocky, but if you don't learn things well on the front end, you're just going to be having to work that much harder to relearn something you were supposed to have already known, to then learn the new content for that semester. 00:06:55:11 - 00:06:56:24 Michele Williams Yeah, it does make things a lot harder. 00:06:56:25 - 00:07:00:12 Kelly Covert Yeah, for sure. 00:07:00:15 - 00:07:12:03 Michele Williams So, you oversee the residency teaching and learning program here at Gatton? And you direct the Pgy two internal medicine residency here, too? 00:07:12:07 - 00:07:12:26 Kelly Covert I you do that as well. 00:07:12:27 - 00:07:27:25 Michele Williams Yeah. And you yourself were a resident at the Medical University of South Carolina, right. What advice would you give a student who's interested in pursuing a residency that they might not get from a brochure or. 00:07:27:25 - 00:07:49:07 Kelly Covert Yeah. Yeah. I think the earlier you can identify that you might want to do a residency the better, because it it really will change how you set up the rest of your pharmacy school time. So, for instance, if you knew without a shadow of a doubt that you wanted to go own your own independent pharmacy, you would pick very different electives. 00:07:49:07 - 00:08:10:14 Kelly Covert And if you knew that you wanted to go be an infectious diseases clinical specialist at a hospital. And so I think if you can identify that early, it just helps you set up what you want the rest of your time at Gatton to look like. So it might make pursuing research interests more or less important to you. If you want to pursue residency, it might make you change the way that you rank your rotations. 00:08:10:16 - 00:08:28:29 Kelly Covert It might make you change the electives that you take. Or if you choose to pursue the residency track or not. And so I just think it's always a challenge of students realizing their fourth year they want to do residency, but haven't necessarily set themself up to be a great applicant from the beginning, because there's there's ground that's hard to make up after that point. 00:08:29:06 - 00:08:31:23 Michele Williams That makes sense. That makes sense. 00:08:31:25 - 00:08:46:16 Stephen Woodward So in addition to teaching and overseeing residencies, you also are a practicing pharmacist and preceptor. Could you kind of tell us about what a day in the life of teaching here and going to practice is, like where you practice at what is what is a day in the life of that look. 00:08:46:16 - 00:09:06:26 Kelly Covert Like a day in the life? Sure thing. So I practice over at Johnson City Medical Center. So just across the parking lot from us, which is nice. I can pop back and forth between the college in the hospital. I work with an inpatient family medicine team, so the way I describe it is all of my patients are sick enough to be in the hospital, but not so sick that they're necessarily requiring, the intensive care unit. 00:09:06:28 - 00:09:26:15 Kelly Covert We see a ton of different patients with different disease states and different levels of acuity. So some of our patients are much closer to discharge, and we might be dealing with more kind of chronic disease state management, not quite ambulatory care, but kind of in that vein. And then some of our patients are really quite sick and could be transferred to the unit. 00:09:26:15 - 00:09:52:12 Kelly Covert And so it's a variety. My team is comprised of an attending physician, three family medicine residents myself, a gaggle of medical students and pharmacy students, and sometimes pharmacy residents. And then also occasionally a psychiatry intern. So our team is large, interprofessional. And basically, my role on that team is to make sure all the meds that we're using and patient are appropriate. 00:09:52:12 - 00:10:13:15 Kelly Covert And sometimes that changes day to day, but then also to make sure that when the patient leaves the hospital, the plan that we have in place for them from a meds standpoint is, is feasible, both from a, you know, number of pills per day, cost of meds. If if a patient, doesn't have reliable ways to store their medications, that might change what we do. 00:10:13:17 - 00:10:30:16 Kelly Covert So most of my mornings and early afternoons are spent over at the hospital. We do table rounds as a team where we talk about each of our patients and make medication changes in the medical record. And then we go on walk around, and that's when we go see all of our patients and talk with them, update them on medicine changes. 00:10:30:17 - 00:10:53:22 Kelly Covert That's when me and and or my pharmacy students will do discharge counseling and making sure, again, meds are affordable and available to patients. And then my afternoons are kind of a mixed bag. If I'm teaching, it's almost always in the afternoon at the college, so I may come back over here and teach. If not, then I usually stay at the hospital and my students and I will do topic discussions or journal clubs. 00:10:53:24 - 00:11:00:18 Kelly Covert Just to kind of help. If there is any kind of loose ends we need to tie up, tie those up before we're done for the day. 00:11:00:20 - 00:11:05:04 Stephen Woodward Can you tell us what is a preceptor and what do you like most about preceptor? 00:11:05:06 - 00:11:26:05 Kelly Covert Yeah. So a preceptor, is an overseer of students who are on rotations at your site. The way I view myself is I am a safety net for students, so I encourage them to pretend as if they are a licensed pharmacist. So when you're looking at patients in the morning, if I wasn't here, what medication changes would you recommend? 00:11:26:05 - 00:11:50:29 Kelly Covert What labs would you recommend my team monitor? What would you make sure that you dose adjusted? That sort of thing. But ultimately students are licensed pharmacists. And so a preceptors role is to make sure any recommendations student makes is an appropriate one. Help guide them. If they've never been in the hospital before, help guide them on what a hospital pharmacist does, potentially help them streamline their workflow process. 00:11:50:29 - 00:12:12:22 Kelly Covert So if it's taking a student an hour to work off one patient, you know, helping them gain efficiency. And then another key part of my role is providing feedback. So students get a midpoint in the final evaluation of all of their fourth year rotations. But I also do feedback Friday on my rotation, which is basically just a touch point on how the how the week has gone. 00:12:12:22 - 00:12:35:16 Kelly Covert I have students set goals on the first day of what do you want to get out of this rotation by the end of it? And so we reflect back on those goals. How is that going? So it's it's kind of a safety net overseer, feedback giver, emotional support person occasionally. But what I like about preceptor, I mean, I a lot of times students get to my rotation. 00:12:35:17 - 00:12:59:22 Kelly Covert They haven't ever been in the hospital and they're totally freaked out by it. There's a lot of beeping, there's a lot of noises. It can be scary. And so I really appreciate seeing students go from totally fish out of water to by the end, they're integrated with my family medicine team. I'm fortunate to work with a team that's very pharmacy friendly, and so they're easy to integrate into. 00:12:59:24 - 00:13:16:00 Kelly Covert But just seeing students kind of get their sea legs and figure out how to navigate this process, even if it's not something they want to do when they're in a pharmacy school. So I have many students that want to go into ambulatory care community, but there's still a transitions of care piece that they might get to see on the rotation. 00:13:16:00 - 00:13:18:21 Kelly Covert So just seeing the growth is my favorite part. 00:13:18:23 - 00:13:20:03 Stephen Woodward Thank you. 00:13:20:05 - 00:13:35:12 Michele Williams That sounds great. What advice would you give students who might be on rotation with you. So what kinds of things do you like to see students do? Or what kinds of behaviors are you looking for? 00:13:35:14 - 00:14:04:03 Kelly Covert My number one thing that I think is most important for students on my rotation is to take some ownership of their learning. So rotations are when, you know, the reins come off a little bit and you're out in the wild doing what a pharmacist would do. And so if I have a student who wants to be told every single step in their day to get from beginning to end, that can be challenging because there's not a lot of, autonomy. 00:14:04:03 - 00:14:18:21 Kelly Covert There's not a lot of self-directed learning that happens there. So if I have a student who can see a problem and, and try to to learn how to solve that problem, if they can see a med they're not familiar with and go look it up and tell me what they found versus me having to ask them to do that. 00:14:18:23 - 00:14:45:21 Kelly Covert I think that's the mark of someone who's going to really excel in their pharmacy career, because honestly, like half the things that we teach students in pharmacy school by the time they're 5 or 10 years out, aren't accurate or relevant anymore. Just because meds change and guidelines change and drugs come on and off the market. And so if I have someone who's able to see what they don't know and try to fill that knowledge gap, I think that's my most important quality in a student. 00:14:45:24 - 00:15:05:27 Michele Williams That that makes a lot of sense. And I it, it almost sounds like between you're saying you're a safety net and you're saying, you know, kind of generate some of this stuff within yourself and do it. It almost sounds like you're saying take a take a step forward. Don't don't be a wallflower. 00:15:05:27 - 00:15:06:06 Kelly Covert Yeah. 00:15:06:11 - 00:15:11:21 Michele Williams Jump in there and give it a try. You'll catch them if they're doing something they shouldn't be doing or you'll 00:15:11:21 - 00:15:12:25 Kelly Covert 00:15:12:25 - 00:15:16:20 Michele Williams Guide them. But but to get in there and give it a try and. 00:15:16:20 - 00:15:41:10 Kelly Covert Yeah, I mean, I'll tell students, you know, depending on what their career path looks like, apps are some of the last times that they they will have a safety net. And so kind of take advantage of that and practice at the highest level that you can. That way, you know, you know where your shortfalls are, versus if you are really timid or need to be told every step from A to Z to get through your day. 00:15:41:12 - 00:15:51:17 Kelly Covert I just don't know that you're going to be able to function as independently as a pharmacist when you're done with pharmacy school, and it is your license at the end of each decision that you make. 00:15:51:19 - 00:15:54:10 Michele Williams That makes sense. That makes sense. 00:15:54:12 - 00:16:02:06 Stephen Woodward Well we'll switch gears just a little bit as we head towards the end. But what is something about you that might surprise people. 00:16:02:08 - 00:16:18:22 Kelly Covert I don't I was looking at that question I hadn't had an answer for yet. I admit this, and this is shocking, but I'm a huge sports fan. I love I have season tickets to Etsu basketball. It's one of my favorite things that from the time I got here to Gatton, we bought those tickets and it's been a blast. 00:16:18:23 - 00:16:27:02 Kelly Covert We go to the Southern Conference Championship in Asheville every year. But I feel like most pharmacists are not known for being like sports fans, but I, I'm a. 00:16:27:04 - 00:16:29:08 Michele Williams Sports. 00:16:29:11 - 00:16:30:06 Stephen Woodward Editor, most for the. 00:16:30:06 - 00:16:37:16 Kelly Covert Scene as nerds. That's what I think. Nerds. There you go. No other interests. 00:16:37:18 - 00:16:42:19 Stephen Woodward Well, thank you so much for joining us on the podcast. Yeah, we look forward to this coming up. Yeah. 00:16:42:21 - 00:16:44:14 Kelly Covert Awesome. Thanks for inviting me. 00:16:44:16 - 00:17:00:29 Stephen Woodward Thanks for listening to White Coat Radio. If you haven't already, be sure to subscribe and leave us a review. To learn more about ETSU Bill Gatton College of Pharmacy. Visit us at etsu.edu/pharmacy or follow us on social media at @ETSUpharmacy. We'll see you next time.  

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

In this episode, we have a discussion with Professor Jeffrey Katz (Rheumatologist) and Professor Ian Harris (Orthopaedic Surgeon) for an alternative viewpoint of Osteoarthritis. We explore:Pathophysiology and Drivers of change in OsteoarthritisThe role of surgery in OsteoarthritisThe relationship to scans/imaging, Osteoarthritis and painThe importance of weight bearing x-rays (Rosenberg view)Role of weight management and lifestyle changes in this populationTimeframe for referring from Physiotherapy to orthopaedic surgeonsManaging patient expectationsMultidisciplinary treatment of patients with OA

The migraine pain is gone… so why do you still feel exhausted, emotional, foggy, or completely drained afterward?In this episode of The Migraine Heroes Podcast, host Diane Ducarme explores the often-overlooked “migraine hangover” phase — also known as the postdrome stage. Blending neuroscience with holistic healing insights, this episode explains why your brain and nervous system may still be recovering long after the pain disappears.You'll discover:

Moderator: Cláudia Santos Silva (Lisbon, Portugal) Guest: Andrea Calvo (Turin, Italy) In this episode, Cláudia Santos Silva speaks with Andrea Calvo about the genetics of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). They discuss the shared genetic basis of these disorders, key disease-associated genes, and the role of genetic testing, counselling, and result interpretation in clinical practice, highlighting how genetic discoveries are advancing precision medicine and emerging gene-targeted therapies in ALS and FTD.

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems.In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation.Topics discussed in this episode:Refractory vs. recurrent V-fibThe physiology of ventricular fibrillation and re-entry tachycardiasMisconceptions about defibrillationTransthoracic impedance and how to reduce itAnterior-lateral vs. anterior-posterior pad placementDouble sequential defibrillation: evidence and objectionsKey findings from the DOSE VF trialAmerican Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I. R., & Verbeek, P. R. (2020). Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 150, 178–184. https://doi.org/10.1016/j.resuscitation.2020.02.010D. Hasegawa, A. Sharma, Y. I. Lee, & R. Sato. (2023). A systematic review and meta-analysis of esmolol for refractory ventricular fibrillation and pulseless ventricular tachycardia. Chest, 164(4 Suppl.), A1568. https://doi.org/10.1016/j.chest.2023.07.1077International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).Mentioned in this episode:CONNECT

What happens when a light switch disrupts billions of years of evolution?

Join us in this episode as we explore the evolving field of cardiovascular medicine with Michael S. Sacks, Professor and Director of the James T. Willerson Center for Cardiovascular Modeling and Simulation at the University of Texas at Austin. As a leading expert in cardiovascular modeling, Professor Sacks focuses on developing patient-specific, simulation-based technologies that improve our understanding of heart and heart valve disease. What's his goal? To advance treatment strategies by helping physicians better predict outcomes and design therapies tailored to individual patients… Click play to learn about: The two major problems with valve therapy. How computational modeling is transforming the diagnosis and treatment of heart disease. Why patient-specific simulations may improve surgical planning and clinical outcomes. The limitations of current valve replacement technologies. Professor Sacks has held numerous leadership roles throughout his distinguished career, including serving as Technical Editor of the Journal of Biomechanical Engineering. He is an inaugural Fellow of the Biomedical Engineering Society, a Fellow of the American Society of Mechanical Engineers, and a Fellow of the American Institute for Medical and Biological Engineering. His honors include the Van C. Mow Medal from the ASME Bioengineering Division, the University of Pittsburgh Chancellor's Distinguished Research Award, the Richard Skalak Distinguished Lectureship from Columbia University, and the SKT Lectureship from the City College of New York. In 2006, he was recognized as one of Scientific American's 50 Leaders in Science and Technology. Connect with Professor Sacks:  LinkedIn University of Texas Profile  Google Scholar Profile Willerson Center for Cardiovascular Modeling and Simulation Oden Institute for Computational Engineering & Sciences

On May 6th my son and I testified on the Colorado Senate floor (online) against HB26-1335 ("Concerning Access to Abortion Medication Services on Colorado College Campuses"). This law requires colleges and universities (without a religious exemption) to make abortion drugs available on campus to any student who asks for a prescription.I first cover Colorado abortion laws from 2022-2025 to show how we got to this point. Then, I play clips of our testimonies against the bill. Finally, I play a testimony from an unhinged guy in support of the bill.Sources Cited:Colorado HB22-1279 ("Reproductive Health Equity Act")Colorado SB23-188 ("Protections For Accessing Reproductive Health Care")Colorado SB23-189 ("Increasing Access To Reproductive Health Care")Colorado SB23-190 ("Deceptive Trade Practice Pregnancy-related Service")Colorado Amendment 79 ("Constitutional Right to Abortion")Colorado SB25-183 ("Coverage for Pregnancy-Related Services")Colorado SB25B-002 ("State-Only Funding for Certain Entities")Colorado HB26-1335 ("Abortion Medication Access on College Campuses")Colorado "Health & Human Services Committee, Wednesday, May 6, 2026"Alisa B Goldberg et al, "Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location"Ralph P Miech, "Pathophysiology of Mifepristone-Induced Septic Shock Due to Clostridium sordellii"We value your feedback!Have questions for Truthspresso? Contact us!

In this episode of *PICU Doc on Call*, Dr. Monica Gray and Dr. Pradip Kamat are joined by fellow Dr. Hope Vancleve to discuss a complex case of a 12-year-old with MRSA septic shock requiring VA ECMO. The conversation covers sepsis-induced myocardial dysfunction, including its pathophysiology, diagnosis, and management. The hosts also explore differential hypoxia, or Harlequin syndrome, a serious VA ECMO complication causing upper body deoxygenation, and discuss monitoring strategies and circuit reconfiguration to prevent cerebral and myocardial ischemia.Show Highlights:Clinical case discussion of a 12-year-old male patient with MRSA septic shock.Complications of sepsis, including sepsis-induced myocardial dysfunction and refractory shock.Management strategies for septic shock, including antibiotic therapy and fluid resuscitation.Use of venoarterial ECMO support in pediatric patients with severe cardiac dysfunction.Pathophysiology of sepsis-induced myocardial dysfunction and its impact on cardiac function.Differential hypoxia (North-South syndrome) in patients on femoral VA ECMO.Diagnostic approaches for sepsis-induced myocardial dysfunction, including echocardiography and biomarkers.Importance of monitoring and managing end-organ function in septic patients.Strategies for addressing differential hypoxia in ECMO patients, including circuit reconfiguration.Discussion of the risks and benefits of various ECMO configurations and management techniques.References:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care ChapterReference 1: Torre DE, Pirri C. Harlequin Syndrome in Venoarterial ECMO and ECPELLA: When ECMO and Native or Impella Circulations Collide - A Comprehensive Review. Rev Cardiovasc Med. 2025 Aug 26;26(8):39992. doi: 10.31083/RCM39992. PMID: 40927093; PMCID: PMC12415751.Reference 2 : Cove ME. Disrupting differential hypoxia in peripheral veno-arterial extracorporeal membrane oxygenation. Crit Care. 2015 Jul 22;19(1):280. doi: 10.1186/s13054-015-0997-3. PMID: 27391473; PMCID: PMC4511033.

Why does excessive yawning sometimes appear before a migraine attack even begins?In this episode of Migraine Heroes Podcast, host Diane Ducarme explores one of the most overlooked early warning signs of migraine: uncontrollable yawning. Far from being “just tiredness,” yawning can be a neurological signal that your brain is already shifting into a migraine state long before the pain arrives.Blending neuroscience with practical migraine awareness, this episode helps you understand what your body may be trying to tell you—and how to respond before the migraine escalates.You'll discover:

That perfume, scented candle, or cleaning spray you barely notice… could it be quietly triggering your migraines?In this episode of Migraine Heroes Podcast, host Diane Ducarme explores why fragrances and strong smells can overwhelm the migraine brain and overstimulate the nervous system.From perfumes and detergents to air fresheners and beauty products, we uncover how modern fragrances may impact your brain, hormones, and migraine threshold.You'll discover:

Diagnosis, workup, and the four-step treatment protocol for thyroid storm. Hosts: Annaliese Elam, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Thyroid_Storm.mp3 Download Leave a Comment Tags: Critica Care, Endocrine, Thyroid Storm Show Notes I. Pathophysiology & Diagnosis Definition: Life-threatening hypermetabolic state resulting from decompensated thyrotoxicosis. Hormonal Profile: Absolute levels of total T₄/T₃ often mirror uncomplicated thyrotoxicosis; storm is driven by rapid rate of rise, increased catecholamine sensitivity, or increased free T₄/T₃ concentrations. Clinical Presentation: Hyperpyrexia (e.g., 104.2°F) Tachycardia/Arrhythmias (e.g., 155 bpm) Altered Mentation: Agitation, delirium, or psychosis; often the primary differentiator between “storm” and “compensated” hyperthyroidism Warm, moist skin Precipitating Events: Infection, trauma, or surgery Parturition Abrupt cessation of antithyroid medications Burch-Wartofsky Point Scale (BWPS): ≥ 45: Highly suggestive of Thyroid Storm 25–44: Suggestive of impending storm < 25: Storm unlikely Note: High sensitivity but low specificity; can be skewed by unrelated febrile illness. II. Laboratory & Ancillary Findings Thyroid Panel: Characteristically low TSH with elevated free T₄ and T₃. Metabolic Abnormalities: Mild hyperglycemia (catecholamine-induced insulin inhibition) Mild hypercalcemia Elevated LFTs and leukocytosis Cardiovascular: EKG may show sinus tachycardia or atrial fibrillation with rapid ventricular response. III. Management: The Four-Step Blocking Strategy Step 1: Sympathetic Blockade (Beta Blockers) Agent of Choice: Propranolol Mechanism: Non-selective blockade; in high doses, inhibits peripheral conversion of T₄ to T₃. Dosing: PO: 60–80 mg every 4–6 hours IV: 0.5–1 mg over 10 minutes Critical Pitfall: Avoid in patients with acute decompensated heart failure with systolic dysfunction; risk of cardiovascular collapse. Step 2: Inhibition of Hormone Synthesis (Thionamides) Agent of Choice: Propylthiouracil (PTU) preferred over Methimazole in life-threatening storm. Mechanism: Blocks synthesis of new hormone and inhibits peripheral T₄-to-T₃ conversion (decreases T₃ by ~45% in 24 hours). Dosing: 200–250 mg PO every 4 hours Step 3: Inhibition of Hormone Release (Iodine) Agents: Potassium iodide (SSKI) or Lugol’s solution Critical Timing: Must wait at least 60 minutes AFTER thionamide administration. Rationale: Immediate iodine administration provides substrate for new hormone synthesis (Wolff-Chaikoff effect bypass), potentially worsening thyrotoxicosis. Step 4: Inhibition of Peripheral Conversion & Adrenal Support Agent: Glucocorticoids (Hydrocortisone) Mechanism: Inhibits peripheral T₄ to T₃ conversion and treats potential relative adrenal insufficiency. Dosing: 300 mg IV loading dose, followed by 100 mg IV every 8 hours IV. Supportive Care & Avoidance Measures Hyperpyrexia Management: Acetaminophen is the standard of care Avoid Aspirin: Salicylates displace thyroid hormone from thyroid-binding globulin (TBG), increasing free T₄/T₃ levels Volume Resuscitation: Aggressive IV fluids; patients are often profoundly dehydrated May require 3–5 liters of isotonic crystalloid per 24 hours Take Home Points I. Diagnostic Essentials Clinical Diagnosis: Based on hyperpyrexia, cardiovascular dysfunction, and altered mentation. Key Differentiator: Altered mentation (agitation, delirium, psychosis) is often the sole finding distinguishing “storm” from “compensated” thyrotoxicosis. Burch-Wartofsky Point Scale (BWPS): ≥ 45: Highly suggestive of storm. 25–44: Suggests impending storm. < 25: Storm unlikely. Note: High sensitivity, low specificity (e.g., hyperthyroid + flu can score > 45). Triggers: Infection, trauma, parturition, or abrupt cessation of antithyroid drugs. II. The Four-Step Blocking Strategy Beta Blockade (Propranolol): Dose: 60–80 mg PO q4–6h or 0.5–1 mg IV over 10 min. Action: Blocks symptoms and inhibits peripheral T4 to T3 conversion. Caution: Avoid in acute decompensated heart failure with systolic dysfunction. Thionamides (PTU): Dose: 200 to 250 mg every four hours. (note: some resources suggest a loading dose beforehand) Action: Preferred over methimazole; blocks new hormone synthesis and peripheral T4 to T3 conversion. Iodine (SSKI/Lugol’s): Timing: Must wait ≥ 60 minutes AFTER thionamide dose. Action: Blocks hormone release. Pitfall: Early iodine provides substrate for new hormone synthesis, worsening the condition. Glucocorticoids (Hydrocortisone): Dose: 300 mg IV load, then 100 mg IV q8h. Action: Blocks conversion and provides adrenal support. III. Critical Supportive Care Hyperpyrexia: Use Acetaminophen. NEVER Use Aspirin: Displaces thyroid hormone from binding proteins, acutely increasing free T4/T3 levels. Volume: Aggressive fluid resuscitation; patients may require 3–5 L/day due to profound dehydration. Read More

This week, Aebhric is again joined by Zach Andrews, who leads the latest episode of CoROM Conversations, which explores the recognition and management of severe malaria in resource-limited and austere environments. Drawing on field-relevant clinical reasoning, the discussion focuses on the progression from uncomplicated to life-threatening disease, with emphasis on Plasmodium falciparum as the primary driver of severe pathology.The conversation highlights the diagnostic challenges faced by remote medics, where laboratory confirmation may be delayed or unavailable, and underscores the importance of clinical pattern recognition, early intervention, and ongoing reassessment. Particular attention is given to complications such as cerebral malaria, severe anaemia, metabolic acidosis, and hypoglycaemia—all of which significantly increase mortality if not rapidly addressed.From a prolonged field care perspective, the episode integrates pragmatic strategies for stabilisation, monitoring, and evacuation decision-making. It reinforces the need for structured patient assessment using frameworks such as CABCDEFGH, along with trending vital signs over time. The discussion ultimately bridges tropical medicine with austere critical care, offering actionable insights for medics operating far from definitive care.Key Learning PointsSevere malaria is a time-critical diagnosis, most commonly associated with Plasmodium falciparum, requiring immediate treatment even before confirmatory testing.Red flag features include altered mental status, respiratory distress, severe anaemia, hypoglycaemia, and shock.Hypoglycaemia is both a complication of malaria and a side effect of treatment (e.g., quinine), necessitating frequent glucose monitoring.In austere environments, clinical diagnosis often precedes laboratory confirmation, requiring high suspicion in febrile patients with travel or endemic exposure.Fluid management must be cautious, balancing the risks of hypovolaemia and pulmonary oedema.Prolonged care requires integration of nursing principles (HITMAN, SHEEP VOMIT) to prevent secondary deterioration.Early administration of parenteral antimalarials (e.g., artesunate where available) is critical to survival.Evacuation planning should be initiated early, but delays must not postpone life-saving interventions.Timestamps00:00 – IntroductionOverview of the case and relevance to austere medicine02:30 – Pathophysiology of Severe MalariaMechanisms of microvascular obstruction and organ dysfunction06:00 – Clinical PresentationRecognising early vs severe disease in the field10:30 – Assessment FrameworksApplying structured approaches (CABCDEFGH, CPRO, BEAST)15:00 – Management PrioritiesAntimalarials, glucose, fluids, and airway considerations20:30 – Complications and MonitoringCerebral malaria, acidosis, anaemia, and respiratory failure25:00 – Prolonged Field Care ConsiderationsNursing care, documentation, and trending30:00 – Evacuation and Decision-MakingWhen and how to move the patient33:00 – Key Takeaways and Closing ThoughtsClinical Pearls / Take-Home MessagesTreat first, confirm later: In suspected severe malaria, delays in treatment increase mortality.Check glucose early and often: Hypoglycaemia can be rapidly fatal and easily missed.Think beyond fever: Altered mental status or respiratory changes may be the first sign of severe disease.Your greatest tool is reassessment: Trends in vital signs are more valuable than single data points.Good nursing care saves lives: Positioning, hydration, hygiene, and monitoring are critical in prolonged care environments.Suggested ReferencesWorld Health Organization. Guidelines for the Treatment of Malaria (latest edition).Joint Trauma System Clinical Practice Guidelines: Prolonged Casualty Care.World Health Organization. Severe Malaria (Tropical Medicine reference standards).White NJ et al. Malaria. The Lancet.

CME credits: 1.00 Valid until: 01-05-2027 Claim your CME credit at https://reachmd.com/programs/cme/pathophysiology-of-ibd-the-war-within/56889/ This program provides community gastroenterologists with a foundational overview of IBD, emphasizing how disease biology informs diagnosis, monitoring, and treatment selection. Faculty will cover the multifactorial drivers of disease, including genetic susceptibility, environmental exposures, the gut microbiome, and immune dysregulation. A 3D animation illustrates the pathophysiology of IBD and the immune mechanisms that contribute to chronic intestinal inflammation. Experts also discuss how various therapies interact with these pathways. The program concludes with practical insights on applying a mechanistic understanding of IBD to treatment strategy, disease monitoring, and management decisions in community gastroenterology practice.

In this week's episode, Blood editor Dr. Laurie Sehn interviews Drs. Shengwen Calvin Li and Hrishi Krishna Srinagesh on their latest articles published in Blood. Dr. Li discusses "Single-cell profiling of ANKRD26 thrombocytopenia reveals progenitor expansion and polyploid apoptosis via JUNB-p21". The study identifies reproducible abnormalities in progenitor expansion and increased apoptosis of polyploid megakaryocytes, and they propose a novel mechanism in which centrosomal over-expression of ANKRD26 drives polyploid megakaryocyte apoptosis through JUNB-mediated induction of p21 transcription. Dr. Srinagesh discusses "Blinatumomab nonresponse correlates with poor survival after brexucabtagene autoleucel in B-cell ALL" in which data collected by the Real-World Outcomes Collaborative of CAR-T in Adult ALL consortium showed that prior nonresponse to blinatumomab was associated with inferior survival after brexucabtagene in comparison to blinatumomab-naïve patients. Early CAR-T responses were uniformly high regardless of prior exposure or response. This highlights that resistance to blinatumomab may identify patients at higher risk of post–CAR T relapse despite excellent initial responses.

We discuss this ominous complication of providing local anesthesia. Hosts: Elaine Jonas, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption. Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue. Agent Profile: Bupivacaine (High Risk) Highly lipophilic with high protein binding. “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole. Myocardial Depression: Direct inhibition of Ca2+ release from the sarcoplasmic reticulum, impairing contractility. Low CC:CNS Ratio: The dose required for cardiac collapse is very close to the dose that triggers seizures (narrow safety margin). Contributing Factors: Acidosis/Hypercapnia: Increases the fraction of free drug and promotes ion trapping in the brain/heart; shifts the LA-binding curve toward higher toxicity. Hypoxemia: Exacerbates myocardial depression and lowers seizure threshold. II. Risk Assessment & Prevention Patient-Specific Risk Factors Extremes of Age: Neonates (low α-1-acid glycoprotein) and elderly (reduced clearance). Body Composition: Low muscle mass/frailty (decreased volume of distribution). Organ Dysfunction: Hepatic: Reduced metabolism of amide LAs. Renal: Accumulation of metabolites; risk of metabolic acidosis lowering seizure threshold. Cardiac: Reduced cardiac output slows hepatic delivery/clearance; heart failure patients are more sensitive to Na+ channel blockade. Pregnancy: Increased sensitivity to cardiotoxicity. Procedural Risk Factors Vascularity of Site (Highest to Lowest Risk): Intercostal blocks (highest absorption rate). Caudal/Epidural. Interfascial plane blocks (e.g., TAP block). Psoas compartment/Sciatic. Brachial plexus. Technique: Large volume infiltration, lack of ultrasound, lack of incremental injection. Prevention Mandates Weight-Based Dosing: Lidocaine (Plain): Max 4.5 mg/kg. Lidocaine (with Epi): Max 7 mg/kg. Bupivacaine: Max 2.5–3 mg/kg. Incremental Injection: 3–5 mL aliquots with frequent aspiration. Intravascular Marker: Use Epinephrine (1:200,000) to detect accidental IV placement (HR increase >10 bpmor SBP increase >15 mmHg). III. Clinical Presentation Neurologic Phase (Early to Late) Subjective: Metallic taste, tinnitus, circumoral numbness/tingling. Objective: Visual disturbances, agitation, confusion, tremors. Critical: Generalized tonic-clonic seizures, rapid progression to CNS depression, coma, and apnea. Note: Early phases are often masked in patients receiving midazolam or propofol. Cardiovascular Phase Initial: Hypertension and tachycardia (if epi used) or transient stimulatory phase. Conduction Defects: PR prolongation, QRS widening (classic sign), bundle branch blocks. Dysrhythmias: Bradycardia (most common), VT/VF, PEA, asystole. Contractility: Profound, refractory hypotension and cardiogenic shock. IV. Immediate Management Algorithm Goal: Prevent hypoxia/acidosis and sequester the toxin. 1. Initial Actions Stop Injection: Immediately halt all LA administration. Call for Help: Specify “LAST Protocol” and “Intralipid Kit.” Airway Management: 100% O2​. Hyperventilate slightly if needed to counter respiratory acidosis. Low threshold for intubation (hypoxia/acidosis rapidly worsen LAST). 2. Seizure Control First-line: Benzodiazepines (e.g., Midazolam). Avoid: Propofol if hemodynamically unstable (exacerbates cardiac depression). Neuromuscular Blockers: May be needed for ventilation, but remember they do not stop CNS seizure activity. 3. Lipid Emulsion Therapy 20% Indications: Start at first sign of serious toxicity (airway compromise, seizures, or CV instability). Bolus: 1.5 mL/kg IV over 1 minute. Infusion: 0.25 mL/kg/min immediately following bolus. If Instability Persists: Repeat bolus (up to 2 times). Increase infusion to 0.5 mL/kg/min. Upper Limit: ≈12 mL/kg total dose. 4. Modified ACLS Epinephrine: Use low doses (

Manoj Monga explores the evolving understanding of kidney stone pathophysiology, from metabolic drivers to recurrence risk. This episode unpacks how clinicians balance acute intervention with long-term prevention strategies. Timestamps: 00:00 – Monga's background 02:30 – Pathophysiology explained 05:10 – Recurrence risk factors 08:20 – Dietary management 11:00 – Prevention versus surgery

You've heard it before: “Stress triggers migraines.” But here's what most people don't realize , not all stress is created equal.In this episode of Migraine Heroes Podcast, host Diane Ducarme breaks down the five core faces of stress and reveals how each one activates a different pathway in your brain and body. Because the stress of pressure and performance does not impact your nervous system the same way as grief, overstimulation, or emotional tension.When you identify which stress pattern is driving your attacks, you move from vague advice to precise action.In this episode, you will learn:

In this special edition on Obesity as a Chronic Disease our host, Dr. Neil Skolnik will discuss epidemiology, pathophysiology and screening for CKD in People with Diabetes. This special episode is supported by an independent educational grant from Bayer. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Holly Kramer, M.D., Professor of Public Health Sciences and Medicine in the Division of Nephrology and Hypertension at Loyola University Chicago, past-president of the National Kidney Foundation, Editor-in-Chief of the National Kidney Foundation's journal,  Advances in Kidney Disease and Health (AKDH).   Selected references: Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 . The American Diabetes Association's Standards of Care 2026, Diabetes Care 2026;49 (Supplement_1) :S246–S260  

Tired of hearing “it's just stress”?  IBS experts Drs. Laurie Keefer and Darren Brenner join Kate Scarlata and Dr. Megan Riehl to set the record straight on irritable bowel syndrome.IBS is a real, biologically based disorder involving the gut–brain axis, the microbiome, immune function, and nervous system signaling. Understanding how these systems interact reshapes how we diagnose, personalize treatment, and support long-term symptom relief.If you've felt dismissed, confused, or stuck in trial-and-error care, this episode will help you feel validated, informed, and empowered with a clearer, science-backed path forward.Together we break down:The value of a positive diagnosis (not endless testing)The impact of trauma and adverse childhood experiences (ACEs) on gut sensitivity Using diet to support symptom relief without unnecessary food restrictionHow to comprehensively match treatment to your triggersSupport & Professional ResourcesIf you've experienced ACEs or trauma and want support from a GI psychologist or trauma-informed provider, these directories can help: GI Psychology (virtual services available)Rome Foundation GastroPsych Provider DirectoryTrauma-Informed Mental Health Provider DirectoryPartnering with a clinician trained in gut–brain disorders and trauma-informed care can safely address both physical symptoms and nervous system patterns. Aggeletopoulou et al. Unraveling the Pathophysiology of Irritable Bowel Syndrome: Mechanisms and Insights. Int J Mol Sci, 2025.Keefer L et al. The Role of Resilience in IBS and Other Chronic GI Conditions. Clin Gastroenterol Hepatol, 2021.Chang L et al. Sex, Anxiety, and Resilience in the Association Between Adverse Childhood Experiences and IBS. Clin Gastroenterol Hepatol, 2025.Dong et al (UCLA Church Lab). Experiences of discrimination are associated with microbiome and transcriptome alterations in the gut. Front Microbiol, 2024.Scarlata K et al. Utilization of Dietitians in the Management of Irritable Bowel Syndrome by Members of the American College of Gastroenterology. Am J Gastroenterol, 2022. How Kate Does It: Low-FODMAP Diet (AJG)This episode is sponsored by Ardelyx. Learn more about Kate and Dr. Riehl:Website: www.katescarlata.com and www.drriehl.comInstagram: @katescarlata @drriehl and @theguthealthpodcastOrder Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS. The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

This week, Aebhric is joined by Dr Harrison Steins, who is finishing his MSc in Austere Critical Care with CoROM. He also finished medical school and is starting his emergency medicine training. His master's thesis was on the complexities of swimming-induced pulmonary oedema (SIPE), a rare condition affecting athletes, particularly in high-altitude environments. The speaker, Harrison Steins, discusses the pathophysiology, clinical presentation, diagnosis, and management strategies for SIPE, emphasising the importance of context in medical practice. He shares case studies, research findings, and future directions for understanding and treating this condition, highlighting the role of ultrasound in diagnosis and the need for tailored prevention strategies.TakeawaysSwimming-induced pulmonary oedema is a rare condition with a prevalence of less than 1%.Understanding the context of patient presentation is crucial for diagnosis.Acute-onset cough and dyspnoea are key symptoms of SIPE.Diagnosis requires a broad differential, ruling out other conditions first.Management focuses on immediate life threats before addressing SIPE.Hydration strategies can prevent SIPE, especially in athletes.Sildenafil may be effective in preventing SIPE, but it is not widely recommended.Handheld ultrasound is a reliable tool for diagnosing pulmonary oedema in the field.Females may have a higher incidence of SIPE at lower elevations than males do.Knowledge of population-specific pathology is essential for effective treatment.Chapters00:00 Introduction to Swimming-Induced Pulmonary Oedema04:47 Understanding the Pathophysiology of Swimming-Induced Pulmonary Oedema09:18 Case Studies and Clinical Presentation13:48 Diagnosis and Imaging Techniques19:26 Management Strategies and Treatment24:17 Research Findings and Future Directions

On this episode, we define gout and describe its clinical presentations, etiologies, and underlying pathophysiology. We discuss current guidelines and evidence-based treatment strategies for managing gout. We also compare and contrast the efficacy, safety profiles, and appropriate use of acute and chronic gout therapies, lifestyle modifications, and patient monitoring strategies. Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com

On this episode, we discuss osteoarthritis and describe its clinical presentations, etiologies, and underlying pathophysiology.  We review current guidelines and evidence-based treatment strategies for managing osteoarthritis, including pharmacological and nonpharmacological interventions. We also compare and contrast the efficacy, safety profiles, and appropriate use of pharmacologic therapies, physical modalities, and lifestyle interventions in the treatment of osteoarthritis.  Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. If you purchase an annual membership, you'll also get a free digital copy of High-Powered Medicine 3rd edition by Dr. Alex Poppen, PharmD. HPM is a book/website database of summaries for over 150 landmark clinical trials.You can visit our Patreon page at the website below:  www.patreon.com/corconsultrx We want to give a big thanks to Dr. Alex Poppen, PharmD and High-Powered Medicine for sponsoring the podcast..  You can get a copy of HPM at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to say thank you to our sponsor, Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx We also want to thank our sponsor Freed AI. Freed is an AI scribe that listens, prepares your SOAP notes, and writes patient instructions. Charting is done before your patient walks out of the room. You can try 10 notes for free and after that it only costs $99/month. Visit the website below for more information: https://www.getfreed.ai/  If you have any questions for Cole or me, reach out to us via e-mail: Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With SyphilisSyphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers.Timestamps[0:00] Opening/Introduction[0:11] Host Welcome & Resources[0:50] Episode Introduction[1:30] Epidemiology & Rising Cases[4:30] Risk Factors & Screening[6:30] Pathophysiology & Transmission[9:30] Primary Syphilis[12:30] Secondary Syphilis[15:30] Tertiary & Latent Syphilis[18:30] Neurosyphilis[22:30] Congenital Syphilis[25:30] Ocular & Otic Syphilis[28:30] Differential Diagnosis & Pre-hospital Care[31:30] History & Physical Examination[34:30] Diagnostic Testing Overview[38:30] Testing Details & Titers[41:30] Treatment: Penicillin & Alternatives[43:30] ClosingSubscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

A lot of us aren't just tired—we're worn down. In a world that keeps demanding more attention, more productivity, and more endurance, our nervous systems are struggling to keep up. This episode kicks off our season on wellness by starting at the most basic place recovery happens: sleep.You can also watch the very first Brain Blown Podcast episode on video on our YouTube channel!>> Support the Brain Blown on Patreon>> Have questions, stories, or topics you want us to cover? Email us at info@brainblownpodcast.com.>> Learn more at www.brainblownpodcast.comREFERENCES:Falup‑Pecurariu, C., Diaconu, Ș., Țînț, D., & Falup‑Pecurariu, O. — Neurobiology of Sleep (Review)National Institute of Neurological Disorders and StrokeLee, A. E., Ancoli-Israel, S., Eyler, L. T., Tu, X. M., Palmer, B. W., Irwin, M. R., & Jeste, D. V. — Sleep Disturbances and Inflammatory Biomarkers in Schizophrenia: Focus on Sex DifferencesPocivavsek, A., & Rowland, L. M. — Basic Neuroscience Illuminates Causal Relationship Between Sleep and Memory: Translating to SchizophreniaPeever, J., & Fuller, P. M. — Neuroscience: A Distributed Neural Network Controls REM SleepAulsebrook, A. E., Jones, T. M., Rattenborg, N. C., Roth II, T. C., & Lesku, J. A. — Sleep Ecophysiology: Integrating Neuroscience and EcologySimon, K. C., Nadel, L., & Payne, J. D. — The Functions of Sleep: A Cognitive Neuroscience PerspectiveUrry, E., & Landolt, H.-P. — Adenosine, Caffeine, and Performance: From Cognitive Neuroscience of Sleep to Sleep PharmacogeneticsKay, D. B., & Buysse, D. J. — Hyperarousal and Beyond: New Insights into the Pathophysiology of Insomnia Disorder through Functional Neuroimaging StudiesZielinski, M. R., McKenna, J. T., & McCarle, R. W. — Functions and Mechanisms of SleepMarques, D. R., Gomes, A. A., Caetano, G., & Castelo-Branco, M. — Insomnia Disorder and Brain's Default-Mode Network

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/TCA865. CME/NCPD/CPE/AAPA/IPCE credit will be available until January 11, 2027.Frameworks for Identifying Systemic Sclerosis and Its Complications: From Pathophysiology to Personalized Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/TCA865. CME/NCPD/CPE/AAPA/IPCE credit will be available until January 11, 2027.Frameworks for Identifying Systemic Sclerosis and Its Complications: From Pathophysiology to Personalized Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/TCA865. CME/NCPD/CPE/AAPA/IPCE credit will be available until January 11, 2027.Frameworks for Identifying Systemic Sclerosis and Its Complications: From Pathophysiology to Personalized Care In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.Disclosure information is available at the beginning of the video presentation.

Mehlman Qbanks: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://qbanks.mehlmanmedical.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠IG: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/mehlman_medical/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Telegram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://mehlmanmedical.com/subscribe/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal SyndromeEpidemiology & Background Rising ED visits related to alcohol use. Mortality rates and spectrum of patient presentations. Importance of high suspicion and complexity of cases.Pathophysiology & Mechanisms Alcohol metabolism and neurochemical changes. Differential diagnosis: Conditions that mimic alcohol withdrawal.Prehospital & EMS Considerations Role of EMS in triage and initial management. Use of sobering centers vs. ED transport. Prehospital administration of benzodiazepines (IM midazolam).History & Risk Assessment Key questions to assess risk for alcohol withdrawal syndrome. Importance of patient history, medication use, and comorbidities. Discussion on patient honesty and rapport.Physical Exam & Scoring Systems DSM-5 criteria for alcohol withdrawal. Use of CIWA-AR, BAWS, and PAWSS scoring systems. Importance of objective measurement for monitoring and disposition.Complications & Special PresentationsComplicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens. Diagnostic workup: Labs, imaging, and co-ingestions. Special populations: End-stage liver disease, pregnancy, intubated patients.Treatment Strategies Mainstay: Benzodiazepines (types, dosing, and protocols). Phenobarbital: Indications, dosing, and evidence. Adjunctive therapies: Thiamine, glucose, magnesium. Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.Clinical Pearls & Practice Changes Early, aggressive therapy to prevent complications. Symptom-based vs. fixed-schedule treatment. Gabapentin as an alternative or adjunct. Anti-craving medications for relapse prevention.Disposition & Protocols Use of scoring systems for safe discharge, observation, or admission. Importance of protocolized approaches and community resources.Summary & Take-Home Points Five key practice-changing points. Clinical pathway.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Mehlman Qbanks: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://qbanks.mehlmanmedical.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠IG: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/mehlman_medical/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Telegram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://mehlmanmedical.com/subscribe/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In recognition of Stress Awareness Week, the NEI Podcast revisits a vital conversation with Dr. Joan Striebel about the syndrome of catatonia—a condition that can emerge from profound psychological or physiological stress. Dr. Andy Cutler and Dr. Striebel discuss its dynamic presentation, the importance of treating underlying causes, and why clinicians should maintain a high index of suspicion when evaluating complex or unexplained psychiatric symptoms. This re-release highlights key insights to help clinicians recognize and manage catatonia more effectively in practice.  Never miss an episode!

This is part 2 of a 3 part series on hypertensive disorders of pregnancy. Part one with Joe Navarrete covered the baseline physiologic changes with pregnancy. In this episode, David Barksdale is going to walk us through the pathophysiology of hypertensive disorders of pregnancy. And in the next episode, Isabella Sosa joins us to walk […]

*Content Warning: distressing themes, self-harm, rape, substance abuse, substance use disorder, child abuse, verbal abuse, mental abuse, physical abuse, institutional abuse, childhood sexual abuse, sexual abuse, suicidal ideation, death, and suicide. *Free + Confidential Resources + Safety Tips:  somethingwaswrong.com/resources    Snag your ticket for the live Home for the Holidays event here: https://events.humanitix.com/swwxtgi  Check out our brand new SWW Sticker Shop!: https://brokencyclemedia.com/sticker-shop  *SWW S23 Theme Song & Artwork:  The S24 cover art is by the Amazing Sara Stewart Follow Something Was Wrong: Website: somethingwaswrong.com  IG: instagram.com/somethingwaswrongpodcast TikTok: tiktok.com/@somethingwaswrongpodcast  Follow Tiffany Reese: Website: tiffanyreese.me  IG: instagram.com/lookieboo *Sources  Deseret News, and Amy Joi Bryson. “Teen Facility Targets Suicide Prevention.” Deseret News, Deseret News, 14 Jan. 2024, www.deseret.com/2004/7/30/19842793/teen-facility-targets-suicide-prevention Fuchs, David. “Utah Has Seen Abuse in ‘troubled Teen' Programs for Decades. Now, Momentum Slowly Builds for Change.” KUER, KUER, 24 Mar. 2021, www.kuer.org/health-science-environment/2020-12-17/utah-has-seen-abuse-in-troubled-teen-programs-for-decades-now-momentum-slowly-builds-for-change Institute of Medicine (US) Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide; Goldsmith SK, Pellmar TC, Kleinman AM, et al., editors. Reducing Suicide: A National Imperative. Washington (DC): National Academies Press (US); 2002. 5, Childhood Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK220932/ Kubler, Katherine, creator and director. The Program: Cons, Cults and Kidnapping. Netflix, 2024 https://www.imdb.com/title/tt31183637/  Lopez-Castroman, Jorge et al. “Early childhood sexual abuse increases suicidal intent.” World psychiatry : official journal of the World Psychiatric Association (WPA) vol. 12,2 (2013): 149-54. doi:10.1002/wps.20039 https://pmc.ncbi.nlm.nih.gov/articles/PMC3683267/ Myers et al v. Dr. Phil Organization et al, No. 1:2014CV00007 - Document 77 (D. Utah 2015) :: Justia, law.justia.com/cases/federal/district-courts/utah/utdce/1:2014cv00007/91862/77/ Reavy, Pat. “Family Sues Dr. Phil, Utah Treatment Center.” Deseret News, Deseret News, 28 Dec. 2023, www.deseret.com/2014/1/29/20534024/family-sues-dr-phil-utah-treatment-center/

*Content Warning: distressing themes, suicide, death, substance use disorder, drug use, sexual assault of a child, institutional child abuse, violence, childhood abuse.  *Free + Confidential Resources + Safety Tips:  somethingwaswrong.com/resources    Snag your ticket for the live Home for the Holidays event here: https://events.humanitix.com/swwxtgi  Check out our brand new SWW Sticker Shop!: https://brokencyclemedia.com/sticker-shop  *SWW S23 Theme Song & Artwork:  The S24 cover art is by the Amazing Sara Stewart Follow Something Was Wrong: Website: somethingwaswrong.com  IG: instagram.com/somethingwaswrongpodcast TikTok: tiktok.com/@somethingwaswrongpodcast  Follow Tiffany Reese: Website: tiffanyreese.me  IG: instagram.com/lookieboo *Sources  Easton, Scott D et al. “Suicide attempts among men with histories of child sexual abuse: examining abuse severity, mental health, and masculine norms.” Child abuse & neglect vol. 37,6 (2013): 380-7. doi:10.1016/j.chiabu.2012.11.007 https://pubmed.ncbi.nlm.nih.gov/23313078/ Institute of Medicine (US) Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide; Goldsmith SK, Pellmar TC, Kleinman AM, et al., editors. Reducing Suicide: A National Imperative. Washington (DC): National Academies Press (US); 2002. 5, Childhood Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK220932/ Kubler, Katherine, creator and director. The Program: Cons, Cults and Kidnapping. Netflix, 2024 https://www.imdb.com/title/tt31183637/  Lopez-Castroman, Jorge et al. “Early childhood sexual abuse increases suicidal intent.” World psychiatry : official journal of the World Psychiatric Association (WPA) vol. 12,2 (2013): 149-54. doi:10.1002/wps.20039 https://pmc.ncbi.nlm.nih.gov/articles/PMC3683267/

Sara dives into one of the most unforgettable parts of drinking → hangovers. From her worst-ever hangover in Punta Cana to the subtle shame-filled Sundays that followed too many nights out, Sara breaks down how hangovers evolved throughout her drinking years and how they became one of the biggest motivators for her sobriety. She doesn't stop at personal stories. Sara also explores the science of hangovers: what's actually happening inside your body and brain when you're feeling miserable the next day. You'll learn why alcohol leads to dehydration, inflammation, anxiety, and that 3 a.m. wake-up, plus why “hair of the dog” only keeps the cycle going. If you've ever wondered why hangovers hit so hard or need a vivid reminder of what you're leaving behind, this episode is your reality check and your motivation to keep choosing a hangover-free life. 00:00 Introduction to the Podcast and Today's Topic 02:28 The Worst Hangover Experience 09:00 Evolution of Hangovers Over the Years 15:34 The Science Behind Hangovers 25:06 Conclusion

In this solo episode, Darin pulls back the curtain on one of the most important parts of his life:  he prepares for travel. From the supplements that keep his immune system strong to hydration hacks, adaptogenic elixirs, and EMF protection, this episode is a masterclass in staying grounded and resilient on the road. Travel doesn't have to destroy your health — it can actually elevate it. With a few intentional rituals, smart packing, and awareness, you can turn every trip into an opportunity to deepen your energy, focus, and connection to yourself. What You'll Learn 00:00:00 – Why travel is stressful and how to transform it into an empowering, health-boosting experience 00:01:00 – Darin's supplement protocol: Vitamin D3/K2, probiotics, zinc, vitamin C, and glutathione for immune defense 00:03:00 – The antioxidant power of glutathione and why it's critical for long flights and radiation exposure 00:04:30 – How CBD and terpenes support stress resilience and circadian rhythm through the endocannabinoid system 00:05:20 – Why magnesium and NAD are the unsung heroes of travel recovery and energy 00:06:30 – Darin's morning elixir recipe: cacao, guarana, ashwagandha, chaga, ginseng, and monk fruit 00:08:00 – Hydration 101: how to use a manual RO filter, mineralize your water, and ditch plastic 00:10:00 – How to build nutrient density into travel days using chlorella, spirulina, Shakeology, and Barukas 00:12:00 – Travel nutrition sovereignty: packing your own snacks, fasting, and avoiding airline food 00:14:00 – Movement anywhere: Darin's “portable gym” using bungee cords and bodyweight routines 00:16:00 – The 3-hour morning ritual: NewCalm, Healing Codes, journaling, cacao, red light therapy, and breathwork 00:20:00 – How to avoid radiation scanners, mitigate EMFs, and use WaveGuard for energy field protection 00:22:00 – Why Darin microdoses nicotine for cognitive focus and immune modulation 00:23:00 – Breathing practices for immune strength: 3–4 rounds of 40 deep breaths, Wim Hof style 00:24:00 – How to pack fruit and salads in mason jars to stay hydrated and nourished on planes 00:26:00 – Grounding after flights: barefoot on the earth, morning sunlight, and re-aligning your circadian rhythm Thank You to Our Sponsors Manna Vitality: Go to mannavitality.com/ or use code DARIN20 for 20% off your order. Fatty15: Get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/DARIN and using code DARIN at checkout. Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences Key Takeaway “Preparation is sovereignty. When you take responsibility for your nutrition, your hydration, and your energy before you travel, you're no longer surviving the trip — you're expanding through it.” Bibliography Martineau AR et al. Vitamin D supplementation to prevent acute respiratory infections: systematic review. BMJ. 2017. Goldenberg JZ et al. Probiotics for prevention of respiratory infections. Cochrane Database. 2017. Hemilä H. Vitamin C and zinc in common cold. Nutrients. 2017. Blessing EM et al. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics. 2015. Morris HJ et al. Spirulina and chlorella as functional foods. Nutrients. 2022. Longo VD, Panda S. Fasting, circadian rhythms, and time-restricted feeding. Cell Metabolism. 2016. Booth FW et al. Waging war on physical inactivity. J Physiol. 2017. Balmori A. Electromagnetic pollution from radiofrequency fields. Pathophysiology. 2015. Kox M et al. Voluntary activation of sympathetic nervous system and attenuation of the innate immune response. PNAS. 2014.

High Yield Antiarrhythmic Drugs Review:Class I (Sodium Channel Blockers)Class II (Beta Blockers)Class III (Potassium channel blockers)Class IV (Calcium Channel Blockers) for your PANCE, PANRE, Eor's and other Physician Assistant exams.Review for your PANCE, PANRE, Eor's, Physician Assistant exams, Medical, USMLE, Nursing Exams.►Paypal Donation Link: https://bit.ly/3dxmTql (Thank you!)Included in review: Pathophysiology of antiarrhythmics, cardiac action potential, phases 0–4, Phase 0 depolarization, Phase 1 initial repolarization, Phase 2 plateau, Phase 3 repolarization, resting membrane potential, cardiomyocytes, pacemaker cells, funny current (If), L-type calcium channels, T-type calcium channels, effective refractory period (ERP), conduction velocity, reentry, rate control, rhythm control, AV node, SA node, QT prolongation, torsades de pointes, post-MI arrhythmias, structural heart disease, supraventricular tachycardia, atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, ACLS, catecholamines, cAMP, PKA, beta-1 receptors, calcium influx, nodal blockade, non-dihydropyridine vs dihydropyridine, Disopyramide, Quinidine, Procainamide, Lidocaine, Mexiletine, Flecainide, Propafenone, Metoprolol, Atenolol, Bisoprolol, Betaxolol, Esmolol, Acebutolol, Propranolol, Carvedilol, Labetalol, Nadolol, Pindolol, Timolol, Sotalol, Amiodarone, Dronedarone, Ibutilide, Dofetilide, Verapamil, Diltiazem, Amlodipine, Nifedipine, Nicardipine, Amiodarone adverse effects, blue-gray skin discoloration, interstitial lung disease, thyroid dysfunction, corneal microdeposits, hepatotoxicity, beta-blocker contraindications, asthma caution, bradycardia, AV block, cardiogenic shock, diabetes caution, CCB adverse effects, constipation, AV block, bradycardia.Become a supporter of this podcast: https://www.spreaker.com/podcast/cram-the-pance--5520744/support.

a focus on its acute presentations and the care we can deliver to improve outcomes for our patients. Sickle cell disease (SCD) is a lifelong inherited blood disorder that affects over 15,000 people in the UK, and millions worldwide. It's caused by the production of abnormal haemoglobin molecules, which distort red blood cells into a crescent, or “sickle,” shape. These rigid cells can block small blood vessels, leading to painful vaso-occlusive crises and organ damage. While the condition has long been most prevalent in parts of Africa, the Middle East, the Mediterranean and India, today it's a global health issue, and one we encounter regularly in UK emergency care. Tragically, failings in care have too often led to avoidable harm. The 2021 parliamentary report “No One's Listening” laid bare some of these cases, highlighting missed opportunities, poor awareness, and systemic issues that cost lives, such as the death of Evan Nathan Smith. So why are we revisiting this now? In 2024, RCEM published new Best Practice Guidelines on managing sickle cell disease in the ED. These provide clear, evidence-based standards for recognition, triage, analgesia, infection control, and safe discharge. In this episode, we take you through the key elements; Pathophysiology – how a genetic mutation drives sickling, vaso-occlusion and inflammation. Clinical presentations – from painful crises and acute chest syndrome, to stroke, anaemia, infection, priapism and pregnancy-related complications. Recognition and triage – why timely pain control within 30 minutes is a must, and how to spot red flags. Investigations and treatment – including the role of reticulocytes, the importance of knowing a patient's baseline haemoglobin, and principles of analgesia, transfusion, oxygen, and supportive care. Discharge and ongoing care – ensuring safe, joined-up planning, and involving haematology and specialist pathways wherever possible. The take-home message? Every sickle cell crisis is a medical emergency. We need to listen to patients, escalate early, involve haematology, and deliver care that meets the standards they deserve. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon, Rob & James

Angioedema – Recognition and Management in the ED Hosts: Maria Mulligan-Buckmiller, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Angioedema.mp3 Download Leave a Comment Tags: Airway Show Notes Definition & Pathophysiology Angioedema = localized swelling of mucous membranes and subcutaneous tissues due to increased vascular permeability. Triggers increased vascular permeability → fluid shifts into tissues. Etiologies Histamine-mediated (anaphylaxis) Associated with urticaria/hives, pruritus, and redness. Triggered by allergens (foods, insect stings, medications). Rapid onset (minutes to hours). Bradykinin-mediated Hereditary angioedema (HAE): C1 esterase inhibitor deficiency (autosomal dominant). Acquired angioedema: Associated with B-cell lymphoma, autoimmune disease, MGUS. Medication-induced: Most commonly ACE inhibitors; rarely ARBs. Typically lacks urticaria and itching. Gradual onset, can last days if untreated. Idiopathic angioedema Unknown cause; diagnosis of exclusion. Clinical Presentations Swelling Asymmetric, non-pitting, usually non-painful. May involve lips, tongue, face, extremities, GI tract. Respiratory compromise Upper airway swelling → stridor, dyspnea, sensation of throat closure. Airway obstruction is the most feared complication. Abdominal manifestations

Often, the first symptom of hypertrophic cardiomyopathy is sudden death. But sometimes, we get a warning— and that's where clinical judgment at the bedside saves lives.Today, Sarah goes over the case of her patient Ben, a 20-year-old experiencing syncope and chest pain. As his condition quickly deteriorated, the team had to carefully manage the patient before reaching a diagnosis of hypertrophic cardiomyopathy. Hear what pointed them to this diagnosis, why some standard interventions can be dangerous in HCM cases, and the critical decisions made during his treatment.Listen now for a deep dive into the pathophysiology and treatment of hypertrophic cardiomyopathy!Topics discussed in this episode:Case presentation of a young patient with chest painHow we got to the patient's diagnosis Pathophysiology of hypertrophic cardiomyopathyWhy the patient deteriorated and our treatment approachEmergency management of HCMOther types of cardiomyopathyKey takeaways for bedside nursesListen to episode 98, “Broken Heart Syndrome” aka Takotsubo Cardiomyopathy, here: https://healthpodcastnetwork.com/episodes/rapid-response-rn/98-broken-heart-syndrome-aka-takotsubo-cardiomyopathy/Mentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7

High Yield Polycystic Ovary Syndrome (PCOS) ReviewReview for your PANCE, PANRE, Eor's, Physician Assistant exams, Medical, USMLE, Nursing Exams.Merchandise Link: https://cram-the-pance.creator-spring.com/►Paypal Donation Link: https://bit.ly/3dxmTql (Thank you!)Included in review: Pathophysiology, PCOS symptoms ,PCOS diagnosis, PCOS treatment, PCOS infertility, Rotterdam criteria, LH/FSH imbalance, Hyperandrogenism, Anovulation, Insulin resistance in PCOS, Letrozole, Clomiphene, PCOS vs NCCAH, PCOS ultrasound findings, 17-hydroxyprogesterone, PCOS and endometrial hyperplasia, Combined estrogen-progestin oral contraceptives, Medical mnemonics for examsBecome a supporter of this podcast: https://www.spreaker.com/podcast/cram-the-pance--5520744/support.