Podcasts about Severity

The Severity of Machlokes (Korach 5786)

Zach Mabry | Be Strong Breakout SessionIn this session, Zach speaks plainly about sexual sin and how the Bible treats it. Looking at passages like 1 Corinthians 6 and Matthew 5, he'll connect the heart behind these struggles with their real-life consequences. This isn't about guilt or assuming nothing will ever change; it's about turning from sin and believing real freedom is possible. We end with practical ways to take ownership, build better habits, and pursue a life shaped by Christ.Be Strong Men's ConferencePlease leave a review on Apple or Spotify to help others grow in their faith. Click here to get our Colossians Bible study.

Research Reveals New Possible Pathogens Related to the Severity of Dental CariesBy Today's RDH ResearchOriginal article published on Today's RDH: https://www.todaysrdh.com/research-reveals-new-possible-pathogens-related-to-the-severity-of-dental-caries/Need CE? Start earning CE credits today at ⁠⁠⁠https://rdh.tv/ce⁠⁠⁠ Get daily dental hygiene articles at ⁠⁠⁠https://www.todaysrdh.com⁠⁠⁠ Follow Today's RDH on Facebook: ⁠⁠⁠https://www.facebook.com/TodaysRDH/⁠⁠⁠Follow Kara RDH on Facebook: ⁠⁠⁠https://www.facebook.com/DentalHygieneKaraRDH/⁠⁠⁠Follow Kara RDH on Instagram: ⁠⁠⁠https://www.instagram.com/kara_rdh/⁠

Audio, eng_t_rav_2026-05-13_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Audio, eng_t_norav_2026-05-13_lesson_limud-bein-haverim_n1_p4. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Audio, eng_t_norav_2026-05-13_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Video, eng_t_norav_2026-05-13_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Video, eng_t_norav_2026-05-13_lesson_limud-bein-haverim_n1_p4. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_rav_2026-05-13_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Audio, eng_t_norav_2026-05-13_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Audio, eng_t_norav_2026-05-13_lesson_limud-bein-haverim_n1_p4. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Audio, eng_t_rav_2026-05-13_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_rav_2026-05-13_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_norav_2026-05-13_lesson_limud-bein-haverim_n1_p4. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_norav_2026-05-13_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

4th Step – On Obedience The Ladder of Divine Ascent was written primarily for monks. However, the words of Saint John Climacus at the beginning of the first chapter indicate that his intention is to address every person who longs for salvation. He says: “The gates of eternal life are open to all. The goal of our life is to follow Christ and to become like Him in His divine love.”

Audio, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p2. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_rav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Video, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Video, eng_t_rav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p2. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_rav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p2. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Video, eng_t_rav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 1

Video, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n1_p2. Lesson_part :: Daily_lesson 1 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Video, eng_t_norav_2026-05-12_lesson_rb-1987-17-homrat-isur_n2_p1. Lesson_part :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987) :: Daily_lesson 2

Audio, eng_t_rav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1

Audio, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p3. Lesson_part :: Daily_lesson 1

Audio, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n2_p0. Lesson_part :: Daily_lesson 2 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Video, eng_t_rav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1

Video, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p3. Lesson_part :: Daily_lesson 1

Video, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n2_p0. Lesson_part :: Daily_lesson 2 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n2_p0. Lesson_part :: Daily_lesson 2 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Audio, eng_t_rav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1

Audio, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p3. Lesson_part :: Daily_lesson 1

Video, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n2_p0. Lesson_part :: Daily_lesson 2 :: Lessons_series. Rabash. The Severity of Teaching Idol Worshippers the Torah. 17 (1987)

Video, eng_t_norav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p3. Lesson_part :: Daily_lesson 1

Video, eng_t_rav_2026-05-11_lesson_rb-1987-17-homrat-isur_n1_p1. Lesson_part :: Daily_lesson 1

Join Rabbi Joey Rosenfeld as he guides us through the world and major works of Kabbalah, Hasidic masters, and Jewish philosophy, shedding light on the inner life of the soul. To learn more, visit JoeyRosenfeld.com

Catch up on all the footy news from AFL 360, Monday 4th of May with Gerard Whateley and Garry Lyon. Gerard Whateley and Garry Lyon break down all the biggest footy stories after the AFL finally give down their punishment and findings around Carlton's handling of the Elijah Hollands incident. Plus are the Eagles dealing with the 'second year blues' as their form turns for the worst. For more of the show tune in on Fox Footy & KAYO.See omnystudio.com/listener for privacy information.

365: Breast Implant Illness is gaining awareness and many are already familiar with my own story where I got my own breast implants removed in 2019. So today, I brought on renowned doctor Robert Whitfield who specializes in breast implant illness and breast implant removal where he has his own rehab center in Austin Texas where patients can stay and recover after their explanation as his physician aid in the detoxing process. Dr. Whitfield shares helpful tips for after an explant, signs and symptoms to look for if you suspect you may have BII, and we also get into the dangers of GLP-1s and today's beauty standards. If you've ever wondered or considered getting breast implants in the first place, or perhaps you already have them and are looking into getting them removed, I highly suggest listening and saving this episode!  Topics Discussed: → Signs and symptoms of BII → How to proceed if you want to explant → What to expect after explanting  → Options of safe reconstructive surgery  → How to detox after surgery → The mental aspect of removing breast implants  → GLP-1 dangers  → Resources for BII As always, if you have any questions for the show please email us at digestthispod@gmail.com. And if you like this show, please share it, rate it, review it and subscribe to it on your favorite podcast app.  Sponsored By:  → Bethany's Pantry | Go to https://bethanyspantry.com/ and use code PODCAST10 for $10 anything! → Timeline | Timeline's clinically proven formula is now available at a new, lower price. Mitopure now starts at $99, with the exact same science and formula. And my listeners can still get 20% off when you go to https://timeline.com/DIGEST  Timestamps: → 00:00:00 - Introduction  → 00:04:45 - Rapid Fire Yes or No  → 00:05:25 - Plastic Surgery Risks   → 00:12:35 - Bethany's Experience  → 00:13:26 - Breast Implant Illness  → 00:16:40 - Detox Pathways + Methods  → 00:20:22 - 321 Rule  → 00:21:25 - Breast Explant Surgery  → 00:23:30 - Full Capsule Removal  → 00:24:40 - Modern Beauty Standards + GLP1s   → 00:29:53 - Women's Health  → 00:33:45 - Breast Lifts + Fat Transplants  → 00:35:28 - Safest Plastic Surgery Options  → 00:36:10 - Breast Removal Stories  → 00:37:50 - Mold toxicity + Parasites  → 00:39:41 - Breast Explant Advice Further Listening: → There's a Ball of Mold In My Lungs (pt. 1) The Severity, The Treatment, How Long I've Had it Check Out Dr. Robert Whitfield: → Website → YouTube Videos → Instagram → Facebook → Podcast Check Out Bethany: → Bethany's Instagram: @lilsipper → YouTube → Bethany's Website → Discounts & My Favorite Products → My Digestive Support Protein Powder → Gut Reset Book  → Get my Newsletters (Friday Finds) Learn more about your ad choices. Visit megaphone.fm/adchoices

ICH Q9 is one of the most referenced guidelines in pharma and one of the most misunderstood.In this video, I break down what Quality Risk Management (QRM) actually is, how the process works, and how it's different from ISO 14971.We cover:What “risk” means in ICH Q9 (probability × severity)The full QRM process (initiation → assessment → control → communication → review)How to actually think through risk (not just document it)Why supply disruption is a patient riskKey differences vs ISO 14971 (planning, traceability, verification)If you work in pharma, devices, or combination products, this is foundational.TIMESTAMPS 00:00 Welcome to ICH Q900:48 What is Risk in ICH Q901:44 Scope and Core Principles03:21 Initiating QRM05:09 Risk Assessment (Hazards, Likelihood, Severity)07:27 Risk Control (Reduction and Acceptance)08:46 Risk Communication and Review10:04 ICH Q9 vs ISO 1497111:51 Wrap UpICH Q9(R1) Final Guideline: https://database.ich.org/sites/default/files/ICH_Q9-R1_Guideline_Step4_2023_0118.pdfICH Q9 Briefing Pack: https://ich.org/page/q9r1-briefing-packSubhi Saadeh is the Founder and Principal at Let's Combinate, where he helps teams develop and control drug-device combination products by aligning quality systems, development, and regulatory expectations across drug and device domains. He is a consultant, auditor, trainer, and speaker with experience across companies including Pfizer, Gilead, and Baxter, supporting the development and launch of combination products across vaccines, biologics, and generics, including leading and supporting combination product transformations across large organizations.

MY NEWSLETTER - https://nikolas-newsletter-241a64.beehiiv.com/subscribeJoin me, Nik (https://x.com/CoFoundersNik), as I interview Maurizio Cuna (https://x.com/themgmtconsult). Maurizio brings 20+ years of consulting expertise, having worked with some of the largest companies globally, and his job is literally business problem solving.I was stoked to learn his approach and better understand how to solve business problems. We entrepreneurs can apply those skills to our businesses. We dive into how consultants go beyond mere symptoms to identify the actual problem, using powerful tools like the Problem Tree and the five whys technique to help entrepreneurs problem solvePlus, Maurizio shares his consulting frameworks for prioritizing problems based on Frequency, Severity, and Willingness to Pay. Questions This Episode Answers:• How do consultants work?• How do they pinpoint the real problem, not just a symptom?• What mental models do experts use to break down complex business issues?• When facing multiple problems, how do you decide which to tackle first?• How can entrepreneurs balance quick action with careful analysis?Enjoy the conversation!__________________________Love it or hate it, I'd love your feedback.Please fill out this brief survey with your opinion or email me at nik@cofounders.com with your thoughts.__________________________MY NEWSLETTER: https://nikolas-newsletter-241a64.beehiiv.com/subscribeSpotify: https://tinyurl.com/5avyu98yApple: https://tinyurl.com/bdxbr284YouTube: https://tinyurl.com/nikonomicsYT__________________________This week we covered:00:00 Consulting Philosophy: Moving Beyond Quick Fixes03:01 Understanding the Consultant's Approach to Problem Solving05:59 Identifying the Right Problems: The Importance of Root Cause Analysis08:53 Prioritizing Problems: Frameworks for Effective Solutions12:07 Balancing Speed and Thoroughness in Problem Solving15:03 The Role of Feedback Loops in Consulting17:50 Consulting Dynamics: The Client-Consultant Relationship21:03 The Future of Consulting: Emphasizing Soft Skills23:53 Navigating Data Collection and Analysis in Consulting26:45 The Shift Towards Soft Skills in a Tech-Driven World

Ken Carman and Anthony Lima analyze whether Chase DeLauter's three-run triple officially snapped his recent hitting slump. They also weigh in on Todd Monken's reaction to Myles Garrett's absence from voluntary practices and evaluate Deshaun Watson's standing against Shedeur Sanders.

Program notes:0:34 Chronotrope type and timing of exercise1:36 Sedentary adults and morning or evening type2:36 Acting as your own control3:10 Stenting for post thrombotic syndrome4:10 Severity lower with endovascular therapy5:10 Patent in 2/3 at six months6:10 Very diverse patient populations6:28 Estimating kidney function7:28 Currently underestimate compromise8:27 Deprescribing proton pump inhibitors9:27 Three different interventions10:27 Almost 15% achieved outcome in both patient and physician12:08 End

Croup is a clinical syndrome of upper airway obstruction defined by barking cough, stridor, and hoarseness. Management hinges on severity assessment, universal corticosteroid use, and selective epinephrine. The key clinical task is distinguishing typical croup from high-risk mimics that require urgent airway intervention. Learning Objectives Differentiate croup from other causes of pediatric upper airway obstruction using key historical and physical exam features. Apply a severity-based approach to croup management, including appropriate use of corticosteroids and nebulized epinephrine. Recognize clinical features that suggest alternative or life-threatening diagnoses requiring escalation of care. References Cooke A, Conway S, Griffin L. Croup: Rapid Evidence Review. Am Fam Physician. 2026;113(3):254-258. Gates A, Johnson DW, Klassen TP. Glucocorticoids for Croup in Children. JAMA Pediatr. 2019;173(6):595-596. doi:10.1001/jamapediatrics.2019.0834 Bjornson CL, Klassen TP, Williamson J, et al. A Randomized Trial of a Single Dose of Oral Dexamethasone for Mild Croup. N Engl J Med. 2004;351(13):1306-1313. doi:10.1056/NEJMoa033534 Bjornson CL, Johnson DW. Croup. Lancet. 2008;371(9609):329-339. doi:10.1016/S0140-6736(08)60170-1 Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW. Nebulized Epinephrine for Croup in Children. Cochrane Database Syst Rev. 2013;(10):CD006619. doi:10.1002/14651858.CD006619.pub3 Transcript This transcript was generated using Descript and subsequently reviewed and lightly edited for spelling, grammar, and clarity. Minor inaccuracies may remain, and the audio recording should be considered the definitive version of this content.  Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski. And today we're gonna talk about croup. We're gonna focus on diagnosis, severity based management, and how to differentiate it from scarier high risk conditions that may present similarly, but behave very differently. So croup is best understood as a clinical syndrome of upper airway obstruction caused by inflammation at the level of the larynx and subglottis. So in most cases this is viral laryngotracheitis, most commonly due to parainfluenza virus. But as you'd expect multiple viruses can cause it. The subglottis is the narrowest portion of the pediatric airway. So even small amounts of edema create large increases in airway resistance. So that's why the clinical picture is so consistent. You've got inspiratory stridor, hoarseness, and that characteristic barking cough, which either sounds like a seal or a dog, and yes, of course, I know the difference between the two coughs because I was a biology major. This is primarily a disease of children between six months and three years of age with a peak incidence in the second year of life. It's really, really common, like one and a half percent of all ED visits, maybe 350,000 visits a year, and 85% of these kids have mild disease. Hospitalization is rare. The range is variable, about two to 8% of cases, and return visits occur in about three to 5%. Fewer than 1% of children, a lot fewer, require intensive care or airway intervention. Honestly, most kids do really well. The ones who don't can get sick very quickly, and that's been my clinical experience. In the Northern Hemisphere, we see croup throughout the fall and winter, usually starting in around November and sort of tapering off by April. But that being said, I've seen croup-like symptoms every month of the year over the past couple of decades. Croup is absolutely a classic clinical diagnosis. A typical case begins with 12 to 48 hours of viral prodrome, you know, body aches, fever, congestion, cough, followed by often abrupt nighttime onset of barky cough and stridor. Symptoms fluctuate, and they're generally worse with agitation and get better when the kid is calm. That variability is the key feature. So what you'll have is a child who wakes up after sleeping for a few hours with a barky cough and then noisy stridor. This freaks parents out, and this is not hyperbole. There's this little center in the back of your brain that's like, please don't stop breathing and die. So appropriately, they're worried about the kid, they call emergency medical services, they bring them to the emergency department, and by and large, by the time they get there, the stridor has resolved. The kid is calm, and parents will say, I swear he looked a lot worse at home. Trust me, we believe you parents, this is what croup does. When I'm taking a history of croup, I get all of these details. Are there any sick contacts? If the parents are worried about a foreign body inhalation or ingestion, then I'm worried about a foreign body inhalation or ingestion. Listen to the lungs, inspect their airway. Always check the ears for concomitant otitis and I'll feel their trachea. I'll actually grab and hold the trachea and move it. Kids with croup really don't have a painful trachea. Kids with bacterial tracheitis, aside from looking more toxic, actually have a lot of pain when they move their trachea. Testing for croup is generally unnecessary. Labs and viral studies do not change management, and imaging is really reserved for atypical presentations or when you're considering an alternative diagnosis like a foreign body. If you do get an X-ray, what you're looking for is the classic steeple sign on the AP view. It is seen in croup, but it's not 100% sensitive nor specific. Once you've made the diagnosis of croup, it's important to assess severity, and remember that I said that most kids are mild. So mild croup is defined by the absence of stridor at rest. So they may have some stridor when they're upset or even a little bit of hoarseness or noise. It's important to listen to many, many children with croup to get a sense of this. Moderate croup includes stridor at rest with mild to moderate retractions. So at rest means that the child is in a position of comfort. They're calm with a parent, and they've generally been that way for about 10 to 15 minutes. Sometimes that's how long it can take for the stridor to dissipate once you get the kid calm. Severe croup, which is fortunately rare, involves marked work of breathing, agitation, fatigue, need for oxygen, altered mental status, and this aligns with the Westley croup score. It formalizes stridor, retractions, air entry, cyanosis, and mental status. But really, in practice, most of us get very good at bedside assessment of croup. Management of croup starts with corticosteroids. This is one of the highest-yield interventions that we have in pediatric emergency medicine. Every child with croup should receive dexamethasone. Typically 0.6 milligram per kilogram as a single dose up to a maximum of 10 milligrams. Some places will use 0.15 milligram per kilogram. Locally, we often give the IV formulation orally. It's 10 milligrams per mL. Tastes bad, but pairs reasonably well with apple juice. The oral suspension is 1 milligram per mL, tastes terrible, and pairs nicely with being spit on the ground by toddlers. The evidence behind dexamethasone is very robust. The main benefit is that it reduces return visits and hospital readmissions by about half, and those return visits include doctor's offices and emergency departments. In a Cochrane review of 1,679 children, glucocorticoids reduce return visits or readmissions with a risk ratio of 0.52, so that translates to a number needed to treat of seven. I've certainly seen seven or more croup kids during one shift, so for every seven children treated with dexamethasone, one return visit is prevented. Symptom improvement begins within about two hours and lasts at least 24 hours, but maybe up to a couple of days. Hospital length of stay for kids that get steroids is reduced by an average of 15 hours as well. Serious adverse events are rare. It's well tolerated, and other than the taste, kids do fine with it. And importantly, the benefit is consistent across all severities of croup, mild, moderate, and severe. So when you explain this to families who are very scared about their kids, but now their kid is looking better and you're only giving them a single medicine, not doing any tests or X-rays or anything, I think you have to frame the medicine in terms of what it's going to do for them over the next couple of days. So one way of explaining this to families would be to say something like this is a steroid called dexamethasone. It reduces the swelling in your child's airway that's causing the barky cough and noisy breathing. Most children start feeling better within a couple of hours, and the benefit lasts at least a full day, if not longer. Without this medicine, about one in five children need to come back because symptoms get worse again. You really get two bad days with croup in most cases. With this medicine, the risk of returning drops to about one in 10, so it cuts the chance of coming back in half. We can expect your child's cough to start improving over the next day or two. Most children are feeling a lot better within 48 hours, though a little bit of hoarseness and cough can last for a week to about 10 days. So it's possible that when your child goes to sleep later tonight, they may experience that barking cough and noisy breathing again. They're almost certainly going to be upset. The steroid blunts enough of the swelling so that you are much more likely to have them free of distress and stridor, that noisy breathing, once you get them calm. So if they're upset, get them calm, and if in about 10 minutes the stridor and noisy breathing get better, that's the dexamethasone doing its job and you can safely stay home. For children with moderate or severe croup, we're gonna use nebulized racemic epinephrine. It works fast by reducing airway edema by constricting inflamed blood vessels. You'll see improvement in stridor and work of breathing often within 30 minutes. The effect is transient and largely gone by about two hours, and you need to do a structured reassessment at about 30 minutes after the racemic epinephrine. If the child's clearly better, continue that observation for up to two hours. If they're unchanged or worse, repeat the epinephrine and start thinking more carefully about your diagnosis and disposition. Because it's got such a short duration, that two hours after treatment is the most common time period, though some institutions and some children will need to be observed a little bit longer. If they remain well appearing with no stridor at rest, normal oxygenation, minimal work of breathing, and they can tolerate oral fluids, they can be discharged. If symptoms recur, they require repeated epinephrine, or they fail to improve, then you may have to escalate care and consider admission. Honestly, with croup, supportive care is still one of the most important things. You gotta keep kids calm by minimizing agitation. Parents are experts at this with their own children. Agitation worsens airway obstruction. Airway resistance is fourfold greater when the kid's upset. Give oxygen if the kid's hypoxic. Fortunately, this is rare. Antipyretics and fluids are great, do them. Humidified air has not been shown to provide meaningful benefit, and obviously we should avoid sedatives because they can suppress respiratory drive without improving airway patency. Many parents will say that their kid was better when they were exposed to cool air or mist in the shower. Those can help, but honestly, don't stick your kid's head in the freezer if it upsets them. Keep them calm, hold them, and comfort them. Alright, croup, barking cough, stridor, variable symptoms, easy, right? There are some other diagnoses that can mimic this or overlap that you shouldn't miss. Spasmodic croup is a related phenotype. You've got sudden nighttime onset, often minimal prodrome, and recurrent episodes. These kids are typically well between episodes, and the pattern becomes more apparent over time. Some kids will bark with every mild cold or stuffy nose up until about eight or nine, but they usually don't have stridor and respiratory distress. Bacterial tracheitis is progression to a more severe and dangerous airway infection. These children often start with viral symptoms and then rapidly worsen. They've got a high fever, they appear toxic. Most importantly, they fail to respond to standard croup therapy. Toxic appearance plus lack of response should immediately shift your diagnostic reasoning. These kids may have a lot of pain when you grab and move their trachea. The cough can be more junky because again, they've got purulent mucus in their trachea. Epiglottitis is defined by the absence of barking cough and the presence of drooling, dysphagia, and tripod positioning. These children are very anxious, they're very ill, their airway is at risk, and so your immediate priority is keeping them calm and having the airway managed in the safest environment, generally the operating room. Deep neck space infections, including retropharyngeal cellulitis and abscesses and peritonsillar abscesses, present with fever, neck stiffness, sometimes even torticollis, and lymphadenopathy. Kids won't really have a barky cough and the exam localizes to the neck rather than the airway alone. Acute foreign body aspiration presents with sudden onset symptoms, no viral prodrome, no barking cough, and sometimes some asymmetric exam findings. The diagnosis is frequently missed when clinicians anchor too early on croup. If you have an esophageal foreign body, remember that 70% of these get stuck at the thoracic inlet. So always think about a kid who sounded like they had croup and got croup treatments, but also has some swallowing issues and is the right age to put things in their mouth. This is when you see coins and button batteries and other things stuck not in the upper airway, but in the esophagus right behind it. Alright, now when it comes to disposition, most kids with croup are gonna be sent home. Children who improve, they have no stridor at rest, minimal work of breathing, can be discharged home with clear return precautions. Those with persistent symptoms, need for repeated racemic epinephrine, hypoxia, or concerning features should be admitted. For kids who continue to worsen despite standard therapy, escalation includes high-flow nasal cannula, noninvasive ventilation as a bridge. Heliox can be used as a temporizing measure to reduce work of breathing. Fortunately, needing to intubate a child with croup is rare, but when it's needed, it can be challenging due to subglottic narrowing. You need the best proceduralists, and you should downsize your endotracheal tube by 0.5 to 1 millimeter smaller than usual. And I'll reiterate this again. The natural course of croup is really favorable for most kids. The fear's not gonna go away for the parents, this is a scary diagnosis, but I think with some reassurance, we can help them understand that this is something that is unlikely to cause significant problems and will get better. Most kids improve significantly within 48 hours, though like any other respiratory illness, symptoms can persist for a week or so. Severe outcomes are fortunately rare, and they almost always occur in children whose severity or alternative diagnosis was not recognized early. So again, here's my take-home points. Croup is a clinical diagnosis. Severity determines your management. Steroids, dexamethasone, should be given to all patients. Racemic epinephrine is used for moderate to severe disease with mandatory reassessment and observation. And most importantly, always reassess the diagnosis when the presentation does not fit the expected patterns. Things can get rough when you're barking up the wrong tree and thinking it's croup when it's actually something else. Well, I hope you enjoyed this episode on honestly one of the most classic conditions that we see in the pediatric emergency department. If you've got any feedback on the episode, send it my way. As the kids would say, like, rate, and review. I would love it if you left a review on your favorite podcast site. It helps more people find the show. I do this as a labor of love because I enjoy teaching, and I think that this is a wonderful way to reach my colleagues and learners. If you've got suggestions on other topics or episodes, I'd love to hear them. For PEM Currents: The Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.

Roger Whitney explores why retirement planning software—especially Monte Carlo simulations—can give a false sense of confidence if misunderstood. He explains what these tools actually measure, the hidden assumptions behind them, and why retirement is a complex problem that requires judgment, flexibility, and resilience—not just a high “success rate.” Roger shares how to properly interpret results, avoid common traps, and use software as a guide rather than a decision-maker so you can build a retirement plan that supports a great life.OUTLINE OF THIS EPISODE OF THE RETIREMENT ANSWER MAN(00:00) This show is dedicated to helping you not just survive retirement, but have the confidence to lean in and rock it.(00:30) Roger introduces the episode topic—why your retirement calculator's success rate can be misleading.PRACTICAL PLANNING SEGMENT(02:50) Roger explains his perspective as a long-time practitioner and outlines his experience using Monte Carlo-based retirement tools.(05:05) Complicated vs. complex problems: why retirement can't be “solved” like a math equation and must instead be managed over time.(09:30) Concerns about overreliance on software—from advisors scaling businesses to individuals misinterpreting results.(11:30) What retirement software actually measures.(13:25) What software does NOT measure.(14:18) Best uses of planning software.(17:40) What software should NOT be used for.(19:40) Key dangers of using retirement software.(23:00) Feasibility vs. resilience: why a plan that “works” on paper may still be fragile in real life.(24:20) The real risk:Overspending early and jeopardizing later yearsUnderspending and missing out on life(26:20) The massive number of assumptions behind every plan—and how small changes can dramatically alter outcomes over time.(38:20) How to interpret results properly.(40:55) Looking beyond the number: evaluating the distribution of outcomes and plan sensitivity.(44:43) Understanding failures:Timing (early vs. late failures)Severity (minor shortfall vs. major gap)(48:27) Best practices:Hold success rates lightlyKeep plans simpleRegularly review assumptionsAvoid over-planning and constant tweakingDefine what success actually means for your lifeSMART SPRINT(56:04) Schedule time to review the assumptions in your retirement planning software—focus on understanding the inputs rather than optimizing the output.CLOSING THOUGHTS(56:50) Roger shares an update on the merger of his firm with Tanya Nichols' firm and the creation of a new company, Retire Agile.REFERENCESlivewithroger.com — Register for Noodle Live on March 28!Submit a Question for RogerSign up for The Noodle