Podcasts about thoracic

In today's episode, we will begin Chapter 8 and our discussion of the Thoracic spine.  This will include a discussion about the unique aspects of the Thoracic spine and how it differs from both the Lumbar and Cervical spine.

SHOWNOTES Apple Podcast Description: Episode Title: In this episode of All Talk Oncology, host Kenny Perkins (Your Cancer Guy) talks with Dr. Jeffrey Velotta, a thoracic surgeon practicing in Northern California, to discuss a growing and often misunderstood health crisis—lung cancer in people who have never smoked. While many people associate lung cancer primarily with smoking, Dr. Velotta explains that an alarming trend is emerging, particularly among Asian women who have never smoked. Despite California having one of the lowest smoking rates in the United States, the state continues to see some of the highest lung cancer incidence and mortality rates. Dr. Velotta breaks down the surprising risk factors behind this phenomenon, why many patients are being diagnosed at Stage IV, and what individuals can do to advocate for themselves when symptoms appear. This conversation is an essential listen for patients, caregivers, and anyone concerned about lung health—especially those who believe they are not at risk. In this episode, Dr. Castro discusses: Why lung cancer is increasing among non-smokers The alarming rise of lung cancer in Asian women Why many patients are diagnosed at Stage IV Key risk factors beyond smoking The importance of early detection and recognizing symptoms Why persistent cough should never be ignored When to request a chest X-ray or CT scan Why getting a second opinion is critical for cancer care How patients can find clinical trials and new treatment options Dr. Velotta also encourages patients to become active participants in their healthcare by asking tough questions, advocating for themselves, and seeking the best possible care. This episode provides vital insight into a growing public health issue and empowers patients with the knowledge needed to take action early. Don't forget to like, subscribe, and share to help spread awareness about lung cancer and empower patients with life-saving information. Immortalize your voice by being an ALL TALK ONCOLOGY GUEST! Just fill-out this FORM. Invite Kenny Perkins to Speak or Participate on your event. Just fill-out this FORM.   SOCIAL MEDIA LINKS: All Talk Oncology: Instagram & Facebook JOIN OUR FREE COMMUNITY: Facebook Community WEBSITE: www.alltalkoncology.com Hashtags:  #LungCancerAwareness #LungCancerInNonSmokers #ThoracicSurgery #CancerScreening #AllTalkOncology #YourCancerGuy #CancerEducation #CancerAdvocacy

Contributor: Taylor Lynch, MD Educational Pearls:  CPR is an important life-saving measure designed for anyone to perform. Chest compressions works by two mechanisms:  Cardiac pump: Direct squeezing of the heart Thoracic pump: Increasing intrathoracic pressure, causing increased blood flow Proper hand placement per current AHA guidelines:  Hands are placed in the center of the chest, on the lower half of the sternum A recent study challenged this approach, using TEE during chest compressions to visualize the cardiac structures being compressed. They found that when hands were placed ~1cm to the left of the sternum, this compressed the left ventricular outflow tract, potentially restricting forward blood flow. Hand placement ~4cm to the left of the sternum resulted in more effective compression of the left ventricle. While this is not yet reflected in AHA guidelines, the study presents an interesting finding that may influence how CPR is performed in the future.  Key takeaway: Always prioritize administering high quality compressions. References:  American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(23_suppl_1). doi:10.1161/CIR.0000000000001378. Chu S, Cheng C, Chang C, et al. Transesophageal echocardiography during CPR in patients with out-of-hospital cardiac arrest: the EXECT-CPR randomized clinical trial. JAMA Intern Med. 2026;186(5):557-566. doi:10.1001/jamainternmed.2026.0102.   Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

"Making ultrasound as widespread and as used as the stethoscope... that's the big challenge going forwards" The latest ERS Monograph podcast focuses on an area that is evolving into a cornerstone of respiratory practice: thoracic ultrasound. Guido Marchi (Monograph Early Career Member representative) talks to Guest Editors of the Thoracic Ultrasound Monograph, Vineeth George and Christian B. Laursen. Their discussion covers key milestones and advances in the field, effective training, maintaining skills, research priorities and future opportunities. It is a conversation and, indeed, a book that truly reflects a challenging and inspiring research agenda.

Many people have had an echocardiogram, CT heart scan, or other imaging test of their heart or chest during which an enlarged ascending thoracic aorta was identified--but you are almost NEVER told. Yet an enlarged aorta is a diseased aorta that puts you at risk over time of aneurysm rupture, dissection, both of which are catastrophic, and "mini-strokes" from fragmentation of atheroclerotic plaque. Here is how to know whether this applies to you and, if it does, what you can do about it. Support the showYouTube channel: https://www.youtube.com/@WilliamDavisMDBlog: WilliamDavisMD.comMembership website for two-way Zoom group meetings: InnerCircle.DrDavisInfiniteHealth.comBooks:Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose WeightWheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health; revised & expanded ed

Send us a text if you want to be on the Podcast & explain why!Shoulder discomfort can be maddening because it often shows up during perfectly normal training. We take a different route: we start with quick safety screens to rule out red flags, then we hunt for the real limiter that keeps stealing motion from the shoulder. A surprising amount of “shoulder pain” is a thoracic spine problem in disguise, and once you see it, your assessments and your programming get a lot clearer.We walk through a clean, repeatable thoracic rotation screen and the biggest mistake that creates a false pass: letting the low back and pelvis do the work. You'll hear exactly how we lock out the lumbar spine, what “good” thoracic rotation looks like, and why a simple standard matters for everyone who presses, pulls, or throws. We also share a practical control test we love: if you can't breathe and talk while holding a position, you don't own that movement, and your body will compensate the moment load shows up.Then we move from assessment to action with corrective exercises you can use right away: smarter thoracic foam rolling with neck support, banded thoracic rotation that stops pelvis cheating, and PNF-style drills that help you earn new range of motion under control. Once thoracic rotation is no longer the bottleneck, we screen humeral flexion for overhead work, show how rib flare and arching sneak in, and lay out a simple way to load new overhead range using a foam roller setup and a kettlebell. If you want better overhead mechanics, fewer flare-ups, and a clearer plan for shoulder mobility and stability, this is your playbook. Subscribe, share this with a training partner, and leave a review with the screen that revealed your biggest limiter.Want to become a SUCCESSFUL personal trainer? SUF-CPT is the FASTEST growing personal training certification in the world!Want to ask us a question?  Email info@showupfitness.com with the subject line PODCAST QUESTION to get your question answered live on the show!Website: https://www.showupfitness.com/Become a Successful Personal Trainer Book Vol. 2 (Amazon): https://a.co/d/1aoRnqANASM / ACE / ISSA study guide: https://www.showupfitness.com

Comparing Marfan Syndrome, Loeys-Dietz Syndrome, and Vascular EDS   Guest: Juan Bowen, M.D. Host: Paul Friedman, M.D.   Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome are clinical problems seen in an aortic clinic. Thoracic aortic aneurysm is a common feature, but the three conditions differ in the severity of aortic and arterial disease and in the types of extracardiac problems that require management. Making an accurate diagnosis is an essential first step in their successful management.   Topics Discussed: What mutations cause Marfan syndrome, Loeys-Dietz syndrome, and the vascular Ehlers-Danlos syndrome? What is the natural history of these three conditions? How is aortic and vascular disease managed in these three conditions? What are the non-cardiac problems most often encountered in these three conditions?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.   Recorded on: 17-February-2026

In this episode of Compassion & Courage, trauma surgeon Tim Pohlman shares his experiences from the hospital walls, the emotional toll of trauma care, and the importance of compassionate presence in medicine. Discover the realities of emergency resuscitation, ethical dilemmas, and how to maintain resilience in high-stakes environments.Resources for you: More communication tips and resources for how to cultivate compassion: https://marcusengel.com/freeresources/Connect with Marcus on LinkedIn: https://www.linkedin.com/in/marcusengel/Learn more about Marcus' Books: https://marcusengel.com/store/Subscribe to our podcast through Apple: https://bit.ly/MarcusEngelPodcastSubscribe to our podcast through YouTube: https://bit.ly/Youtube-MarcusEngelPodcastAbout Timothy Pohlman, M.D., F.A.C.S.:Timothy Pohlman, M.D., F.A.C.S. is a board-certified surgeon who specializes in Trauma Surgery. He is also board-certified in Surgical Critical Care, and board-certified in Neurocritical Care. Dr. Pohlman is former Professor of Surgery at Indiana University School of Medicine (IUSOM). During that time, Dr. Pohlman was a staff surgeon at Indiana University Health Methodist Hospital in Indianapolis, IN., Medical Director of Trauma Intensive Care, Director of Trauma Outreach, and Assistant Medical Director for LifeLine Critical Care Transport for Trauma. Dr. Pohlman graduated from Knox College in 1973 with a bachelor's degree in biology. He received a doctorate in medicine from Rush Medical College in Chicago, IL, being elected into the Alpha Omega Alpha Medical Honor Society his senior year. Dr. Pohlman then completed internship and residency in general surgery at the University of Wisconsin in Madison, WI, serving as Chief Resident his fifth year. Dr. Pohlman obtained advanced training as a Fellow in trauma and burn surgery at the University of Washington in Seattle, WA. During his training, he was supported by a National Institutes of Health Research Service Award. After fellowship training, Dr. Pohlman remained in Seattle, joining the faculty of the University of Washington as assistant professor of surgery. He was subsequently promoted to full professor, with tenure in 2000. While at the University of Washington he was awarded research grants from the National Institute of Health to study human responses to injury. In 2005 he was recruited to IUSOM in Indianapolis, IN to serve as director of Surgical Critical Care. Dr. Pohlman has received numerous awards during his career, including Outstanding Teacher of the Year from the University of Washington, School of Medicine. Dr. Pohlman is a member of over 20 professional organizations, including the Society of University Surgeons, The Eastern Association for the Surgery of Trauma, The Neurocritical Care Society, Surgical Infection Society, where he serves on the Informatics Committee, the Society of Critical Care Medicine, and the Chest Wall Injury Society, where he serves on the Publication Committee. He has authored or coauthored over 80 peer-reviewed journal articles, book chapters, eMedicine articles, and scholarly book reviews. In 2004, he was Visiting Professor in the Department of Thoracic & Cardiovascular Surgery, Mie University School of Medicine, Osaka, Japan. In Indiana, Dr. Pohlman has served on the Board of Directors of the Indiana Rural Health Association. Currently he serves on the Board of Directors of the Brain Injury Association of Indiana and is a member of the Indiana Spinal Cord and Brain Injury Research Board. He is also a member of the Medical Executive Committee of the Rehabilitation Hospital of Indiana, and a member of the Physician Advisory Committee of the Indiana Donor Network. Dr. Pohlman is a former co-chair of the Transfusion Committee for IU Health, which oversees an annual budget of $16.5 million. Dr. Pohlman also served for a number of years as track surgeon for the Indianapolis Motor Speedway. He also has been a NASCAR-certified on-track physician (designated in track radio transmissions as the “99”).Date: 7/27/2026 Name of show: Compassion & Courage: Conversations in Healthcare Episode number and title: Episode 184 – The Hidden World of Emergency Rooms with Tim Pohlmankeywordstrauma surgery, emergency medicine, resilience, medical ethics, compassionate care, hospital stories

Season 2 of the ‘You Can Fix You' podcast has come to an end!You've met some of the team, heard about how we create our programs, found out that Jenni is not actually my wife, and found out about all of our crazy marketing endeavours!!This week we're wrapping it up, and chatting about:What unexpected thing happened to us at the start of the year that sent stress levels through the roofAll about filming ‘Back to the Thoracic' (and why Jenni isn't allowed to record sound anymore…!)Why we'll never use AI for marketing or programmingAnd what the future is like for the You Can Fix You Podcast!!Let us know what your favourite moments are, and if there's anything that stuck with you from Season 2!!

Rubicon - Nolan Meyer one of the Paragon 7ven Interns joins the show to discuss his enrollment in pre medical school

Dr. Chitaru Kurihara, thoracic surgeon and surgical director of the Lung Transplant Program at Northwestern Medicine, joins John Williams to share details surrounding the first known quadruple-organ transplant involving retransplanted lung that Northwestern surgeons performed.

Dr. Chitaru Kurihara, thoracic surgeon and surgical director of the Lung Transplant Program at Northwestern Medicine, joins John Williams to share details surrounding the first known quadruple-organ transplant involving retransplanted lung that Northwestern surgeons performed.

Dr. Chitaru Kurihara, thoracic surgeon and surgical director of the Lung Transplant Program at Northwestern Medicine, joins John Williams to share details surrounding the first known quadruple-organ transplant involving retransplanted lung that Northwestern surgeons performed.

Senator Lindsay Graham recently died unexpectedly from a thoracic aortic dissection, taking the world by surprise. Is this something you should be concerned about for your own health? You may actually have already been tested for this, even if the results were not shared with you. Here is a discussion about what an aortic dissection is, why and how it occurs, how to find out if it applies to you, and what you can do to stop it from posing danger.Support the showYouTube channel: https://www.youtube.com/@WilliamDavisMDBlog: WilliamDavisMD.comMembership website for two-way Zoom group meetings: InnerCircle.DrDavisInfiniteHealth.comBooks:Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose WeightWheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health; revised & expanded ed

When is a brace the right choice? What can it realistically accomplish? And when might it actually hinder recovery? Caroline (Carrie) Adrian, BS, MSPT, PhD, helps us answer these questions and much more.We begin our two-part series on veterinary orthoses and bracing by focusing on the thoracic limb (front leg), trunk & pelvis/hip. We discuss the principles behind orthotic devices, common indications, clinical decision-making, and the importance of selecting the appropriate device for each patient.From shoulder instability to carpal hyperextension injuries, we explore how orthoses can improve function, protect healing tissues, reduce pain, and help dogs return to activity while avoiding common pitfalls.In This Episode:What is the difference between a brace, orthotic, and orthosis?Goals of orthotic management versus immobilizationConservative management +/- orthosis versus surgeryPatient selection: Which dogs are good candidates?The role of canine physical rehabilitation alongside bracingWhy custom fitting and follow-up evaluations matterThoracic Limb Topics CoveredShoulderMedial shoulder instability (MSI in dogs)The controversy surrounding hobbles and when they may—or may not—be appropriateElbowLimited indications for elbow orthosesPotential use in osteoarthritis to diminish the loadA lot of unknowns and potential for the elbowCarpus (Wrist)Carpal hyperextension injuriesWorking and sporting dogsPurpose of carpal wraps and performance supportTrunk Stability & Core SupportBenefits of trunk stabilization devicesSupports for hip dysplasia and Degenerative Myelopathy (DM) with video on our YouTube channelKey TakeawaysBraces are tools—not cures—and work best as part of a comprehensive rehabilitation plan.Correct diagnosis is essential before selecting an orthotic device.Proper fit and regular reassessment are critical to avoid complications such as skin irritation, pressure sores, or altered gait mechanics.Rehabilitation exercises remain an important component of recovery, even when a brace is being used.Coming Next: Part 2This conversation continues in our next episode, where we'll shift our focus to the pelvic limb (back leg), including:Trunk support and hip bracing reviewStifle (knee) injuries and cranial cruciate ligament diseaseMedial patellar luxationTarsal (hock, ankle) injuries and orthotic optionsAchilles tendon injuries and Graduated Flexion Orthoses (GFO)Functional bracing for recovery and long-term managementSkin management with orthosis useWhether you're a veterinary rehabilitation professional, veterinarian, technician, student, or devoted pet owner, Part 2 will continue exploring how orthotic devices can help improve mobility and quality of life for canine patients.Find Dr. Adrian at CanineIQ.net.Companies with products mentioned during this episode:DogLeggsHero BracesThera-PawWigglelessHipLignThanks for listening to PetAbility Podcast! If you enjoyed this episode, please subscribe, leave a review, and share it with colleagues and fellow animal rehabilitation enthusiasts.DisclaimerVitalVet.org, a platform for all things related to pet rehab - product information, education, and resources abound! MedcoVet (show sponsor)  Luma - advanced red-light therapy therapy that puts healing in the hands of the pet owner in the comfort of home! Use Promo Code PETPOD22  to receive discounts from our affiliates!Jope - science-backed supplements Ruff Ramp - a safe alternative to stairs Optimum Pet Vitality - education/coursework  Dr. Buzby's -Toe Grips to prevent slipping, Encore Mobility joint supplement, and Brain Boost cognitive supplement. Using this link donates 20% to PetAbility Calm & Cozy Cat Wrap - a must-have for anybody working with catsHedzUpPets Watercollars – save your dog from drowni...

In this episode, Professor Santi Trimarchi discusses the ESVS Clinical Practice Consensus Statement on Ascending Thoracic Endovascular Aortic Repair (aTEVAR). He provides a comprehensive scientific overview of the document, helping listeners gain a concise yet thorough understanding of its key recommendations and expert consensus.During the episode, we explore the unique anatomical challenges of the ascending aorta for endovascular repair, patient selection, and situations in which conservative management may be preferred over intervention. We also discuss landing zone requirements, stent graft sizing strategies, vascular access considerations, cardiac output control during stent graft deployment, contraindications for aTEVAR, the prevention and management of endoleaks, post-procedural surveillance, and future research priorities.For a detailed review of the recommendations and supporting evidence, listeners are encouraged to consult the full consensus document.References:Trimarchi S, Czerny M, Haulon S, van Herwaarden JA, de Kort JF, Roselli EE, Schermerhorn ML, Upchurch GR Jr, Wanhainen A, on behalf of the ESVS Guidelines Steering Committee. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Consensus Statement on Ascending Thoracic Endovascular Aortic Repair. European Journal of Vascular and Endovascular Surgery. 2025;70:10–23. doi:10.1016/j.ejvs.2025.05.023

Differential Diagnosis and Workup of Thoracic Aortic Aneurysm   Guest: Juan M. Bowen, M.D. Host: Malcolm R. Bell, M.D.   Thoracic aortic aneurysms are often found as incidental findings on imaging done for other indications.  In this episode, listeners will learn more about the approach the Mayo Clinic Marfan and Thoracic Aorta Clinic takes. We can often find the cause by taking a directed family history and personal history, by looking for key physical findings, and by obtaining appropriate imaging and often also genetic tests.   Topics Discussed: What is the differential diagnosis in adult patients? What questions are most helpful in the patient history, and what physical findings should the examiner look for? What cardiac and vascular imaging should be done on the initial evaluation? When should genetic tests be considered? When should preventive aortic repair be considered?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode.   Podcast episode transcript found here.   Recorded on: 14-January-2026

🧭 REBEL Rundown Click here for Direct Download of the Podcast. 💨 What Is Nitrous Oxide? Nitrous Oxide (N2O) is a colorless, odorless inhaled anesthetic that has been used for centuries, particularly in the surgical world. Mechanistically, it can induce euphoria, anxiolysis, and intoxication via NMDA receptor antagonism.During the late twentieth century, nitrous oxide was increasingly used recreationally due its accessibility and perceived benign nature.The modern day slang term for nitrous oxide is “whippets” – which tends to refer to the canisters that contain this agent and are frequently used as whipped cream foaming agents.Despite the legal nature and benign perception of nitrous, frequent use can lead to lasting and permanent neurologic effects. 🧠 How Nitrous Oxide Causes Toxicity Nitrous oxide toxicity results from its ability to oxidize the cobalt moiety in Vitamin-B12, thus leading to a functional B12 deficiency, despite adequate consumption and absorption.1Functioning B12 is needed as a cofactor for methionine synthase.2 This enzyme has two critical roles:The conversion of 5-methyl tetrahydrofolate to tetrahydrofolate; tetrahydrofolate is essential for the synthesis of our DNA.And the conversion of homocysteine to methionine; methionine is needed to maintain the integrity of the myelin sheath of our axons.As a result, nitrous toxicity leads to: a megaloblastic anemia and demyelination of both the dorsal columns and the lateral corticospinal tracts (also known as subacute combined degeneration). 🚶‍️ Clinical Manifestations of Nitrous Oxide Toxicity These patients will have a combination of both upper and lower motor neuron symptoms due to demyelination of the dorsal columns, lateral corticospinal tracts, and peripheral nerves. As a result, the following may manifest:Dorsal Columns: diminished sense of proprioception, vibration, and fine touch.Lateral Corticospinal Tracts: upgoing plantars, hyperreflexia, weakness of voluntary distal muscle controlPeripheral Nerves: numbness/tingling and weakness in a glove and stocking pattern (symptoms that start initially in the feet and hands that progressively spread proximally to the ankles and wrists)Taking all of this into account, patients may present with difficulty ambulating, positive Romberg sign, dysmetria (difficulty with finger to nose or heel to shin), upgoing Babinski reflex, and decreased strength and sensation in a glove and stocking pattern. 🔍 How to Diagnose Nitrous Oxide Neurotoxicity History is key! As with a lot of pathologies in toxicology, identifying the exposure will expedite management.A thorough neurologic exam will narrow the differential – with a particular focus to fine, peripheral motor and sensory deficits, dysmetria, proprioception, and ability to ambulate.Magnetic resonance imaging of the spine may identify enhancement and/or edema of the dorsal columns, specifically on T2 weight axial imaging – sometimes referred to as the “inverted V” or “inverted rabbit ears appearance.”3Serum B12 concentrations may be normal as the issue is with a functional deficiency as opposed to a vitamin absence. However, patients have elevated concentrations of both homocysteine and methylmalonic acid, both of which are metabolized in the presence of functional B12. 💉 Management of Nitrous Oxide Toxicity First and foremost, cessation of nitrous oxide abuse is crucial to limit/prevent toxicity.While there is no universally agreed upon treatment regimen, supplementation with intramuscular B12 is recommended.Approaches vary from daily or every other day injections until symptoms improve at which point injections can be spaced out to weekly and then monthly.Physical and occupational therapy may be needed depending on the degree of functional debility.It is important to note, that depending of the severity and chronicity of toxicity, some proportion of patients may not fully return to their baseline. 📌 Take-Home Points Though legal and seemingly benign, nitrous oxide abuse can lead to permanent neurologic dysfunction.Nitrous oxide toxicity can affect the dorsal columns, lateral corticospinal tracts, and peripheral nerves.Thus leading to a constellation of both upper and lower motor neuron deficits, particular in a glove and stocking pattern: deficits in proprioception and fine motor skills, positive Romberg, upgoing Babinski, peripheral numbness, tingling, and weakness.Magnetic resonance imaging may identify symmetric high signal intensity in the dorsal columns.Treatment includes B12 supplementation and physical/occupational therapy as needed. 📚 References Long H. Chapter 81. Inhalants. In: Nelson LS, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019Shah K, Murphy C. Nitrous Oxide Toxicity: Case Files of the Carolinas Medical Center Medical Toxicology Fellowship. J Med Toxicol. 2019 Oct;15(4):299-303. doi: 10.1007/s13181-019-00726-x. Epub 2019 Aug 6. PMID: 31388940; PMCID: PMC6825085.Schmitz ZP, Hoffman RS. Magnetic resonance imaging in a patient with nitrous oxide-induced subacute combined degeneration of the spinal cord. Clin Toxicol (Phila). 2023 Nov;61(11):1006-1008. doi: 10.1080/15563650.2023.2286205. Epub 2023 Dec 19. PMID: 38060330. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Associate Editor Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More Showing Slide 1 of 7 The post REBEL Core Cast—Nitrous Oxide Toxicity: Whippets and Neurologic Injury appeared first on REBEL EM - Emergency Medicine Blog.

Learn how to fix your pain with our “Centralization Process” here! https://rebrand.ly/ytpainfreeSubmit an application to work with us 1:1 and learn how to fix your low back! ⁠www.therehabfix.com/low-back-program⁠To view hundreds of free low back videos please follow us on instagram at @rehabfix ⁠www.instagram.com/rehabfix⁠Tired of nagging lower back pain? You don't need expensive equipment or a gym membership to find relief. In this video, I'm sharing a simple, 5-minute back pain relief routine you can do anywhere. All you need is a chair!.Most people think back pain is caused by one thing. But in reality, low back pain is often a movement problem involving multiple areas at once — tight hips, restricted hip flexors, poor thoracic mobility, stiff piriformis muscles, limited hip rotation, and too much time spent sitting in flexion.And the longer those movement restrictions build up… the more stress gets dumped into your lower back and discs.Inside this video, I'll walk you through:

Full article: Human-in-the-Loop Large Language Model–Augmented Diagnostic Reasoning in Thoracic Imaging: Impact of Radiologic Expertise Use of LLMs in the diagnostic reasoning process can either improve or hinder performance. Pranjal Rai, MD, discusses the AJR article by Song et al. exploring the association of reader expertise and reader performance when using LLMs as a diagnostic aid.

In this episode of the Unreal Results podcast, I share the case of a Navy SEAL candidate with severe scapular winging and progressive serratus anterior paralysis after months of failed treatment. I walk through the anatomy of the long thoracic nerve and serratus anterior in detail, including the entrapment sites, fascial relationships, and neural connections that can completely change how you assess and treat these cases. I also share how integrating neural manipulation, visceral treatment, mobility work, and targeted strengthening helped this athlete regain function far faster than expected.In This Episode, You'll Learn:The most common entrapment locations for the long thoracic nerve and why they matter clinicallyHow cervical compression, thoracic outlet mechanics, and breathing patterns may contribute to scapular wingingWhy upward rotation mobility is just as important as strengthening in serratus anterior rehabPractical strategies for restoring upward rotation strength, scapular control, and thoracic mobilityThis case is a great example of why treating the body as a whole organism instead of isolating a single muscle or diagnosis can completely change clinical outcomes. Resources & Links Mentioned In This Episode:Ep. 99: Navigating The Complex Case Of Diaphragm ParalysisMy Online Course I Mentioned - The Nerve Workshop with Missy Bunch and Anna HartmanMy Online Shoulder Course - Never Treat The Shoulder FirstLearn the LTAP® In-Person in one of my upcoming courses=================================================Watch the podcast on YouTube and subscribe!Join the MovementREV email list to stay up to date on the Unreal Results Podcast and MovementREV education. Be social and follow me:Instagram | Facebook | Twitter | YouTube

Dr. Clint Sliker breaks down the critical imaging findings of cardiac and non-thoracic vascular trauma, highlighting how these rare but life-threatening injuries appear on CT. He shares practical insights to help radiologists recognize subtle signs, choose the right protocols, and maintain a high index of suspicion in high-stakes trauma cases. Imaging of Cardiac and NonaorticThoracic Vascular Trauma. Costenbader and Beheshtian et al. RadioGraphics 2026; 46(2):e250097. 

In this episode, Dr. Linda Chu reviews new Radiology studies exploring how photon counting CT is transforming thoracic imaging with ultra‑high resolution and dramatically lower radiation and contrast doses. She examines whether these visually striking images translate into better diagnostic confidence and meaningful improvements in patient care for emphysema and lung cancer imaging.   Ultra-Low-Dose Photon-counting Detector CT for EmphysemaAssessment: A Head-to-Head Comparative Study with Low-Dose CT. Yuan and Yang et al. Radiology 2026; 318(1):e251609.   Photon-counting CT versus Energy-integrating Detector CTin Imaging Lung Cancer. Yang et al. Radiology 2026; 318(2):e251126.   Photon-counting CT versus Energy-integrating Detector CTPerformance for Various BMI and Tumor Sizes in Lung Cancer. Zhou and Guo et al. Radiology 2026; 318(2):e251663.   Prospective Evaluation of Ultra-Low-Dose Photon-counting CT inEmphysema Assessment. Schwartz. Radiology 2026; 318(2):e254065. 

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 3368: Eric Leija explains why thoracic mobility is a missing piece in most fitness routines and how improving it can enhance posture, breathing, and overall movement quality. By restoring flexibility in the spine, you can move more efficiently, reduce injury risk, and unlock better performance in both workouts and daily life. Read along with the original article(s) here: https://www.ericleija.com/improving-spinal-mobility-why-its-crucial-exercises-to-do/ Quotes to ponder: "Because the spine is designed to be flexible, it can move through various planes simultaneously." "Proper posture can help reduce pressure on your knees and lower back, which can help ease joint pain and/or inflammation." "If your spine is stiff, like wood, it has a higher likelihood of breaking during an impact. Instead, if it is bendy, like bamboo, it is less likely to break under force." Learn more about your ad choices. Visit megaphone.fm/adchoices

Discover all of the podcasts in our network, search for specific episodes, get the Optimal Living Daily workbook, and learn more at: OLDPodcast.com. Episode 3368: Eric Leija explains why thoracic mobility is a missing piece in most fitness routines and how improving it can enhance posture, breathing, and overall movement quality. By restoring flexibility in the spine, you can move more efficiently, reduce injury risk, and unlock better performance in both workouts and daily life. Read along with the original article(s) here: https://www.ericleija.com/improving-spinal-mobility-why-its-crucial-exercises-to-do/ Quotes to ponder: "Because the spine is designed to be flexible, it can move through various planes simultaneously." "Proper posture can help reduce pressure on your knees and lower back, which can help ease joint pain and/or inflammation." "If your spine is stiff, like wood, it has a higher likelihood of breaking during an impact. Instead, if it is bendy, like bamboo, it is less likely to break under force." Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Angel Velazquez from OrthoCincy joined us to discuss a few Reds-related injury issues, from Emilio Pagan's hamstring scare, to Jose Trevino's thoracic spine strain, to Nick Lodolo's blisters, and more. Learn more about OrthoCincy by going here.Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.Listen Live: ESPN1530.com/listenGet more: https://linktr.ee/MoEggerPodcasts of The Mo Egger Radio Show are a service of Longnecks Sports Grill.See omnystudio.com/listener for privacy information.

Dr. Angel Velazquez from OrthoCincy joined us to discuss a few Reds-related injury issues, from Emilio Pagan's hamstring scare, to Jose Trevino's thoracic spine strain, to Nick Lodolo's blisters, and more. Learn more about OrthoCincy by going here.Listen to the show live weekday afternoons 3:00 - 6:00 on ESPN1530.Listen Live: ESPN1530.com/listenGet more: https://linktr.ee/MoEggerPodcasts of The Mo Egger Radio Show are a service of Longnecks Sports Grill.See omnystudio.com/listener for privacy information.

We’re excited today to launch our first episode in collaboration with the Irish Thoracic Society and their podcast series. The Irish Thoracic Society represents respiratory professionals throughout Ireland and is dedicated to championing excellence in the prevention, diagnosis, and clinical care of respiratory disease through its work in advocacy, education and research. In today’s episode, we explore the complex and often overlooked world of refractory chronic cough — a condition that can significantly impact patients' quality of life but is frequently misunderstood or underdiagnosed. With insights from leading respiratory specialists in Ireland and the United States, we discuss the latest thinking on diagnosis, management, and emerging treatments aimed at improving outcomes for patients and helping clinicians navigate this challenging area of respiratory medicine. Joining us are renowned experts Professor Lorcan McGarvey and Professor Brendan Canning, both internationally recognised leaders in respiratory medicine and cough research. Together, they share their perspectives on the neurobiology of chronic cough, the considerable morbidity experienced by patients, and how clinicians can approach diagnostic investigations more effectively. We also explore current treatment strategies and promising new therapies on the horizon as chronic cough increasingly gains recognition as a disease in its own right — rather than simply a symptom. Whether you’re a clinician, researcher, or simply interested in advances in respiratory medicine, this episode offers valuable insights into a condition that is finally receiving the attention it deserves. Meet Our Co-Hosts Marissa O'Callaghan is an Irish trained Respiratory fellow currently undertaking a post-doc fellow working in Erasmus MC Rotterdam in the Netherlands. She finished her Irish respiratory and Internal medicine training and Phd in 2025. Her areas of interest are interstitial and rare lung diseases. She enjoys clinical research, Med Ed, and dreaming up new medical innovations. Together with cohost Sandra Green, she founded the ITS podcast series in June 2024. Marissa O’Callaghan –LinkedIn Sandra Green is an Irish-trained respiratory fellow with a strong track record in climate advocacy and multidisciplinary sustainable initiatives, as co-founder of Irish Doctors for the Environment. She has an MSc in Leadership and Innovation in Healthcare at the Royal College of Surgeons Ireland (2023–2025). With Marisssa, she co-founded the Irish Thoracic Society Podcast Productions, launching the platform in 2024 to share knowledge, insights, and innovations in respiratory care. Sandra Green – LinkedIn Meet Our Guests Lorcan McGarvey is a professor of respiratory medicine at the University of Belfast, with a focus on the neurobiology of cough. His research has significantly contributed to the understanding of cough hypersensitivity syndrome and the development of new therapeutic strategies. Lorcan is a respected voice in the field, known for his collaborative work and dedication to advancing respiratory health. Brendan Canning is a distinguished researcher at Johns Hopkins University, specializing in the mechanisms of cough and airway diseases. His pioneering studies on neural pathways and receptor targets have paved the way for novel treatments in refractory chronic cough. Brendan’s expertise and innovative approach make him a key figure in the ongoing efforts to redefine chronic cough management. In This Episode The definitions and classifications of chronic cough, including unexplained, refractory, and unexplained refractory cough The importance of a thorough clinical history and focused diagnostics over exhaustive testing Common causes of chronic cough The role of personalized, multidisciplinary management—combining pharmacologic, speech therapy, and psychological support—to improve quality of life for even the most challenging patients. The concept of cough hypersensitivity syndrome and its role in refractory cases Evidence-based approach to treatment, including pharmacologic and non-pharmacologic options Emerging therapies on the horizon, including novel receptor modulators and neuromodulatory agents and ongoing clinical trials in this rapidly evolving field The impact of chronic cough on mental health, social life, and overall quality of life The importance of reframing chronic cough as a disease entity in its own right References and Further Reading Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371(9621):1364-1374. Gibson PG, Vertigan AE. Management of chronic refractory cough. BMJ. 2015;351:h5590. Matsumoto H, Kanemitsu Y, Ohe M, Tanaka H, Terada K, Nishi K, et al. Real-world usage and response to gefapixant in refractory chronic cough. ERJ Open Res. 2025;11(4):01037-2024. doi:10.1183/23120541.01037-2024. McGarvey LP, Birring SS. Cough hypersensitivity syndrome: a novel paradigm for understanding cough. Lancet Respir Med. 2014;2(8):647-656. Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Ribas CD, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, et al. British Thoracic Society clinical statement on chronic cough in adults. Thorax. 2023;78(Suppl 1):S3-S19. Smith JA, Woodcock A. Chronic cough. N Engl J Med. 2006;354(2):136-144. Song WJ, Dupont L, Birring SS, Chung KF, Dąbrowska M, Dicpinigaitis P, et al. Consensus goals and standards for specialist cough clinics: the NEUROCOUGH international Delphi study. ERJ Open Res. 2023;9(6):00618-2023. doi:10.1183/23120541.00618-2023. Song WJ, McGarvey L, Cho PSP, Mazzone SB, Chung KF, editors. Chronic cough. Sheffield: European Respiratory Society; 2025.

Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization. Hosts:- Dr. Alfred J. Casillan, MD, PhDAttending Thoracic Surgeon Johns Hopkins Hospital - Kyla Rakoczy, MD Johns Hopkins General Surgery ResidentReferences:Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

We welcome Dr. Tracey Weigel of Albany Thoracic and Esophageal Surgery. Ray Graf hosts.

Dr. Rice evaluates a patient with a chief complaint of mid-thoracic pain radiating around the left lateral rib cage. The patient reports symptoms worsen with deep breathing and coughing, but are not reproduced with spinal movement, rib mobilization, or palpation. Neurological screening is unremarkable. Which of the following structures is MOST likely referring pain to this region?A) Thoracic facet joint dysfunctionB) Intercostal muscle strainC) The pleuraD) The pancreashttp://www.nptecheatsheets.com

I believe that before you chase advanced flexibility… you need to clear two key benchmarks.Not Instagram range. Not circus tricks.Foundational positions.First:✓ A comfortable, relaxed arse-to-grass squat.Not falling over. Not heels lifting. Not shaking.You should be able to sit there and breathe for two or three minutes.That position tells us your ankles, hips, and spine can access deep range without compensation.Second:✓ A behind-the-head press while sitting in that same deep squat.That requires shoulder mobility. Thoracic extension. Hip stability. Core control.If you own those two positions, you have enough mobility for almost any strength sport, or athletic pursuit.Most adults over 35 don't.This week, I want you to watch the full 4-part playlist. Because it shows the exact rule we use in UMS to fix this.Strength and flexibility in the same workout.No extra sessions. No extra time.▶️ ⁠Watch the playlist: The Strength–Flexibility Pairing Series⁠And, if you want to know what it's like to work with us, → ⁠Click here

In today's episode, we will be discussing corrections of the mid and upper thoracic vertebra on the knee chest table.  It is important to understand the proper technique in order to create a correction and not merely a cavitation. 

Let's talk to you about something that can drastically improve the results of your chiropractic care—your spinal hygiene exercises.Think of these exercises the same way you think about brushing your teeth.You don't brush for an hour once a week.You brush a little every day to protect what you've already gained.Your spine works the same way.

In today's episode, we will begin Chapter 16 on Thoracic Corrections.  We will be covering adjustments on the knee chest table as well as the lower thoracic spine exclusively.

Dr. Edward Mariano, co-chair of ASA's Acute Pain Taskforce, discusses ASA's new guideline on acute postoperative pain management with Dr. Adam Striker. Find out why this new guideline is needed, who the recommendations are for, what's changed, and more. Recorded February 2026. 

Lung cancer is Canada's deadliest cancer—and about one in four cases now occur in people who have never smoked. Toronto father Winhan Wong knows this firsthand: a lingering cough nine years ago led to a stage-four diagnosis. Thoracic surgeon Dr. Christian Finley explains why lung cancer is rising among never-smokers, the stigma around diagnosis, and how a national action plan aims to save lives.

Cancer, Character, and Calling: The Oncologist's Journey, hosted by Girindra Raval, MD, is a podcast highlighting how top oncologists have navigated the field over the course of their careers, the passion that drove them to enter the oncology space, and the ongoing work that will continue to transform cancer care. Each episode, Raval will sit down with a top oncologist to dive into their background, highlight their career achievements, discuss key issues still being addressed in their field, and explore their interests outside of the clinic and lab.In this episode, Raval welcomed Hossein Borghaei, DO, MS, who is the chief of the Division of Thoracic Medical Oncology, the codirector of the Immune Monitoring Facility, the Gloria and Edmund M. Dunn Chair in Thoracic Oncology, and a professor in the Department of Hematology/Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania. Their conversation focused on Borghaei's personal journey into medicine and oncology, highlighting how immigration, mentorship, and scientific curiosity shaped his career and philosophy of patient care.Reflecting on his career, Borghaei described major advances in the field of lung cancer treatment, including targeted therapies and immunotherapy, which he witnessed firsthand. He emphasized that clinical observation and collaboration have driven progress in this area of oncology and will continue to do so. He believes immunotherapy still holds untapped potential and that future breakthroughs will come through continued scientific cooperation.Borghaei advised trainees to persist throughout their careers despite rejection, seek mentorship, and remain committed to improvement. He views artificial intelligence as a powerful tool for research and diagnostics but not a replacement for physicians, emphasizing the irreplaceable value of human connection in patient care. Throughout the interview, he stressed optimism, compassion, and lifelong learning as essential qualities for oncologists, highlighting the profound relationships formed with patients even in the most difficult moments.

If you are attending Cervical Thoracic in the Sedona area, or if you live nearby, I am hosting a free lunch and book signing and you are invited. This is a casual, in person gathering for current students, past students, podcast listeners, and any Myofascial Release therapist who wants to connect in real conversation about business growth, client commitment, and building a fully booked practice. No presentation. No hands on training. No pressure. Just lunch, connection, and meaningful conversation. Event Details: Saturday, February 21 12:30 to 2:30 pm Camp Verde Room Cliff Castle Casino Resort Verde Valley, Arizona I will have signed copies of my books available, and you are welcome to bring a friend. Whether you are fully booked, just getting started, or somewhere in between, you are welcome at the table. If you know another therapist who will be in the area, forward this episode to them and invite them to join us. If you'd like to RSVP please email: clientcare@themfrcoach.com Learn more about working with Heather Hammell, The MFR Coach®: www.themfrcoach.com/foundation Upcoming Webinar: The Real Reason MFR Clients Don't Commit After the First Session Register at: www.themfrcoach.com/reason

🧭 REBEL Rundown 📌 Key Points The 4 Steps of an ED Consult:👋 Introduce yourself and your role🎯 Lead with the outcome (the ask)🧾 Give a focused case summary (why it’s theirs + what you’ve done)🔁 Close the loop (timeline, next steps, contingencies) Click here for Direct Download of the Podcast. 📝 Introduction Today we’re tackling one of the most important (and most under-taught) skills in emergency medicine: how to call a consult in the ED and what to do when a consultant pushes back.To call a consult in the ED, start with a brief introduction, lead with the outcome you need (“the ask”), give a focused decision-relevant summary, and close the loop with timeline and next steps. If the consultant resists, clarify the “why,” restate the ask, offer alternatives, and escalate when patient safety or disposition is at risk.After two decades in emergency medicine and countless consult calls, here’s a simple framework—plus copy/paste scripts—to make your consults faster, clearer, and easier to say “yes” to. 🤔 Why Consult Skills Matter in Emergency Medicine Consults aren’t a formality—they’re a patient-care intervention. Strong consult communication:Reduces delays in time-sensitive careImproves ED throughput and dispositionDecreases conflict and miscommunicationClarifies ownership and next stepsProtects the patient (and the team) when plans are unclear 🪜 The 4-Step ED Consult Framework (Introduction → Ask → Summary → Close the Loop) Most consult friction comes from one of two problems: unclear expectations or excessive noise. This four-step structure solves both.1) Introduce yourself and your roleA simple intro sets a professional tone and removes ambiguity.Script: “Hey, this is Swami, one of the ED attendings. I’m calling for an ortho consult.” 2) Lead with the outcome (the ask)Don’t bury the lede. The consultant wants to know what you need—immediately.Script: “I’m calling about a patient with a suspected septic knee. I need you to evaluate for operative management.” 3) Give a focused, decision-relevant summaryYour summary should answer:Why this is your service’s problemWhat’s already been doneWhat I’m worried about / what decision is needed nowScript: “43-year-old man with no major PMH, 3 days of knee pain and swelling. XR negative. Febrile. Aspiration yielded purulent fluid—cultures sent. We started antibiotics after the tap. He’s hemodynamically stable.” High-yield pearl: Add quick “stability anchors” when relevant:“Airway stable, pain controlled.”“Neurovascularly intact.”“No signs of compartment syndrome.”“No hypotension or escalating oxygen requirement.” 4) Close the loop (timeline + next steps)This prevents the consult from floating in limbo and protects patient flow.Script: “When do you expect to see the patient, and do you want anything done before you arrive—NPO, repeat labs, additional imaging?” 📝 ED Consult Script General ED Consult Script “Hi, this is Dr. ___ in the ED. I’m calling for a ___ consult. The reason is ___. Briefly: ___ year-old with ___. We’ve done ___ and started ___. I’m concerned about ___. Can you see them today, and what’s your preferred next step?” Septic joint / Ortho Example “Hi, this is Swami in the ED. I need an ortho consult for suspected septic arthritis. 43-year-old with 3 days of atraumatic knee swelling and fever. XR negative. Tap produced purulent fluid—cultures sent. Antibiotics started after aspiration. Can you evaluate for operative management, and when can you see the patient?” Neurology example (time-sensitive) “Hi, this is Dr. ___ in the ED. I need neurology for suspected acute stroke. Last known well ___. NIHSS ___. CT/CTA completed (or pending). I’m calling to discuss candidacy for thrombolysis/thrombectomy and next steps. When can you evaluate and what additional workup do you want now?” ⛓️‍💥 Common ED Consult Mistakes (and Fixes) Mistake: Long story before the askFix: Lead with the outcome in the first sentenceMistake: Unfiltered data dumpFix: Provide only decision-relevant detailsMistake: No timelineFix: Ask explicitly when they’ll see the patient and what they need firstMistake: Implicit “ownership”Fix: Clarify who is admitting, who is following, and what happens if the patient worsens ✋ What to Do When a Consultant Pushes Back Even a perfect consult can meet resistance. Your job is to stay calm, keep it professional, and protect the patient.1) Ask “why?”Don’t argue first—diagnose the refusal.Script: “Help me understand your concern about seeing this patient.” Many refusals are based on misunderstanding: wrong service, missing key detail, or incorrect assumption about stability.2) Restate the consult in one sentence, then offer optionsIf the conversation starts spiraling, reset it.Script: “To be clear, I’m concerned this is septic arthritis and needs ortho evaluation. If you don’t feel you’re the right service, who should be—rheum, medicine, or another surgical team?” This keeps you collaborative while preventing dead ends.3) Humanize the decision (use sparingly)This is a “high-voltage” tool. Use it when stakes are high and you’ve already clarified the medical facts.Script: “I’m worried we’re missing something time-sensitive. If this were your family member, what would you want us to do next?” Use it to re-anchor to patient risk—not as a guilt tactic. ⚡️When and How to Escalate a Consult Escalation isn’t personal—it’s a safety mechanism when there’s an impasse that threatens timely care.When to escalateTime-sensitive condition is delayed (e.g., septic joint, cord compression, testicular torsion, GI bleed with instability)No clear disposition plan despite reasonable ED evaluationConsultant refusal blocks needed specialty decision-makingPatient safety or deterioration risk is increasing in the ED How to escalate (lowest to highest intensity)Ask for the consultant’s attending (if speaking to a resident)Call the on-call attending directlyInvolve ED leadership/medical directorEscalate to service chief/department chair (rare, but real)Hospital supervisor/admin escalation for immediate operational impasseScript: “We’re at an impasse and the patient needs a decision. I’m escalating to clarify ownership and ensure timely care.” ️ Documentation Tips for Consult Refusals Documentation should be factual and patient-centered, not punitive.Include:Your clinical concern and why the consult is neededWho you spoke with (name/role)Their stated reason for refusal or delayAlternatives discussedEscalation steps taken and final plan 👉 FAQ: Emergency Medicine Consults What is the best way to call a consult in the ED?Introduce yourself, lead with the specific ask, summarize only decision-relevant details, and close the loop with a clear plan and timeline.What should I say when a consultant refuses to see a patient?Ask why, clarify misunderstandings, restate your concern and the ask, and request an alternative plan or appropriate service.When should I escalate a consult?Escalate when an impasse delays time-sensitive care, threatens patient safety, or prevents appropriate disposition.How do I document a refused consult?Document the clinical concern, who you spoke with, their stated reason, alternatives discussed, and escalation steps taken. 🏁 Conclusion Mastering emergency medicine consults makes you faster, safer, and easier to work with. The goal isn’t to “win” a consult call—it’s to get the patient the right care, with clear ownership and a shared plan. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Associate Editor Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More The post REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback (With Scripts) appeared first on REBEL EM - Emergency Medicine Blog.

In this podcast, experts Aakash Desai, MBBS, MPH; Ibiayi Dagogo-Jack, MD; and Patrick Forde, MBBCh, PhD, discuss how to decode the diagnosis of malignant pleural mesothelioma and review data to optimize frontline and subsequent treatment of this rare malignancy.

In this episode, we'll dive deep into a brand new study exploring the effectiveness of thoracic spine manipulation for managing neck pain. Ever wondered why adjusting the mid back can relieve neck discomfort?Research: Effectiveness of Thoracic Spine Manipulation for the Management of Neck Pain: A Systematic Umbrella Review with Risk of Bias and Methodological and Reporting QualitySpecial Offers for Listeners: Learn more about Diabetes Reversal Group and become a licenseeSave $500 and Get a Free Cart- Learn more at Shockwave Center of America Today!Leander Tables- Save $1,000 on the Series 950 Table using the code EBC2025 — their most advanced flexion-distraction tableNovoPulse OA Recovery Program- learn more herePatient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Long Thoracic Nerve⁠⁠⁠⁠⁠ ⁠from the Orthopedics section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

🧭 REBEL Rundown 📌 Key Points 💨 HFNC met criteria for non-inferiority to BPAP for preventing intubation or death within 7 days in four of the five ARF subgroups.🧪 Bayesian dynamic borrowing increased power across subgroups but created variable certainty, especially in smaller groups such as COPD.🫁 The immunocompromised hypoxemia subgroup did not meet non-inferiority, leading to early trial stopping for futility.️ Rescue BPAP use, subgroup-specific exclusion criteria, and non-standardized BPAP delivery are important contextual factors that influence how subgroup results should be interpreted. Click here for Direct Download of the Podcast. 📝 Introduction Bilevel Positive Airway Pressure (BPAP) has long been a foundational modality in the management of acute respiratory failure (ARF), particularly in COPD exacerbations and cardiogenic pulmonary edema, where it can rapidly reduce work of breathing and improve gas exchange. It remains a core tool in our respiratory support arsenal.High-flow nasal cannula (HFNC), however, has expanded what we can offer patients by delivering many of the same physiologic benefits through a far more comfortable interface. With high flows, modest PEEP, and effective dead-space washout, HFNC can improve oxygenation and decrease work of breathing while preserving the ability to talk, cough, eat, and interact with staff and family. This combination of physiologic support and tolerability makes HFNC especially attractive in patients where comfort, anxiety, or cardiovascular stability are key considerations, and in settings where prolonged noninvasive support may be needed. Rather than competing with BPAP, HFNC broadens our options in ARF and allows us to better match the modality to the patient and their underlying disease process.The RENOVATE trial set out to answer a high-impact question across five distinct etiologic groups: Is HFNC non-inferior to BPAP (NIV) for preventing intubation or death in acute respiratory failure? 🧾 Paper Azoulay É, et al. High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA. 2025 PMID: 39657981 🔙Previously Covered On REBEL: HFNC: Part 1 – How It WorksHFNC: Part 2 – Adult and Pediatric IndicationsFLORALI and AVOID TrialFLORALI-2: NIV vs HFNC as Pre-Oxygenation Prior to IntubationThe Pre-AeRATE Trial – HFNC vs NC for RSI ️ What They Did CLINICAL QUESTION Is HFNC non-inferior to BPAP for rate of endotracheal intubation or death at 7 days in patients with acute respiratory failure due to a variety of causes? STUDY DESIGN Multicenter, randomized non-inferiority trial33 Brazilian hospitalsNov 2019 – Nov 2023Adaptive Bayesian hierarchical modeling with dynamic borrowingOpen label, outcome adjudicators blindedPatients were classified into 5 subgroups SUBGROUPS 1. Non-immunocompromised hypoxemiaSpO₂ < 90% on room air orPaO₂ < 60 mm Hg on room air plusIncreased respiratory effort (accessory muscle use, paradoxical breathing, thoracoabdominal asynchrony) orRespiratory rate > 25 breaths/min2. Immunocompromised hypoxemiaDefined as:Use of immunosuppressive drugs for >3 monthsOR high-dose steroids >0.5 mg/kg/dayOR solid organ transplantOR solid tumors or hematologic malignancies (past 5 years)OR HIV with AIDS / primary immunodeficiency3. COPD exacerbation with acidosisHigh clinical suspicion of COPD as primary diagnosisRR >25 with accessory muscle use, paradoxical breathing, and/or thoracoabdominal asynchronyABG: pH 454. Acute cardiogenic pulmonary edema (ACPE)Sudden onset dyspnea and rales± S3 heart soundNo evidence of aspiration, infection, or pulmonary fibrosisCXR consistent with pulmonary edema5. Hypoxemic COVID-19 (added June 2023)Added due to deviations between expected and observed outcome proportionsAny patient across the other 4 groups with PCR-confirmed SARS-CoV-2 infection in any of the above groups POPULATION Inclusion Criteria:≥18 yrs with ARF* in one of 5 pre-defined subgroups excluding COPD was defined by the following:Hypoxemia with SpO₂

🧭 REBEL Rundown 🗝️ Key Points 💉 Hydrocortisone Saves Lives:The 2023 Cape Cod Trial (NEJM) showed a clear mortality benefit and reduced need for intubation in severe CAP patients treated with hydrocortisone.📊 Guidelines Are Catching Up:The SCCM (2024) and ERS now recommend steroids for severe CAP, while ATS/IDSA updates are still pending.🔥 Redefining “Severe”:Patients requiring high FiO₂ (>50%), noninvasive or mechanical ventilation, or PSI >130 meet criteria for steroid therapy — even outside the ICU.🍬 Main Risk = Hyperglycemia:Elevated glucose was the most consistent adverse effect, but rates of GI bleed and secondary infection were not increased.🧭 Early, Targeted Use Matters:Start hydrocortisone within 24 hours of identifying severity — especially in patients with high CRP (>150) or strong inflammatory response. Click here for Direct Download of the Podcast. 📝 Introduction Corticosteroids have long sparked debate in the treatment of bacterial pneumonia — once viewed with skepticism, now increasingly supported by high-quality evidence. In this episode, Dr. Alex Chapa joins the REBEL Core Cast team to explore how the 2023 Cape Cod Trial (NEJM) reshaped practice and guideline recommendations for severe community-acquired pneumonia (CAP). 📖 Historical Context & Long-Standing Skepticism For decades, the use of steroids in pneumonia was controversial.Early Use: Steroids entered practice in the 1940s and 50s for autoimmune inflammation, but there was immediate hesitation regarding secondary superinfections.Mixed Data: From the 1980s to the 2000s, small studies emerged on severe pneumonia and ARDS, but the data was inconsistent. Different trials used varying definitions of “severe” pneumonia and different C-reactive protein (CRP) cutoffs, making the data “spread” and easy to “cherry pick” to support or deny a benefit.Past Guidelines: This uncertainty was reflected in official guidelines:2007 (ATS/IDSA): The American Thoracic Society and the Infectious Diseases Society of America did not address the topic due to insufficient data.2019 (ATS/IDSA): Pre-COVID, the guidelines recommended against using corticosteroids in severe CAP. They acknowledged no benefit for non-severe pneumonia, but the data for severe pneumonia was considered too weak to endorse.Pre-Trial Consensus: Prior to 2023, the consensus was to avoid steroids in non-severe pneumonia, while severe pneumonia remained a “gray area” with no treatment showing a clear mortality difference. 📜 The Landmark Cape Cod Trial (NEJM 2023) The Cape Cod trial, published in the New England Journal of Medicine in 2023, reignited the discussion by providing robust, positive data.Trial Design: Phase 3, multi-center, double-blind, randomized, controlled trial.Intervention: 800 patients randomized to two groups, Hydrocortisone as a continuous infusion (200mg/day) versus a placebo infusion.Taper: On day 4, clinicians would decide whether to continue the infusion or begin a taper based on clinical response.Population: Patients with severe CAP, defined by meeting at least one of the following criteria:Pneumonia Severity Index (PSI) > 130.O2 by FiO2 ratio < 300.Need for mechanical or non-invasive ventilation (with PEEP ≥ 5).Need for high FiO2 (>50%) via non-rebreather or heated high flow.Primary Outcomes: Death for any cause 6.2% (hydrocortisone) vs 11.9% (placebo)Secondary outcomes:Death from any cause at 90 days 9.3% (hydrocortisone) vs 14.7% (placebo)Endotracheal intubation 18% (hydrocortisone) vs 29% (placebo)Hospital-acquired infections 9.8% (hydrocortisone) vs 11.1% (placebo)Gastrointestinal bleeding 2.3% (hydrocortisone) vs 3.3% (placebo)Vasopressor initiation by day 28 15.3% (hydrocortisone) vs 25.0% (placebo)Key Findings: The trial demonstrated superiority for hydrocortisone 📋 Updated Guidelines & Current Practice The Cape Cod trial, along with subsequent meta-analyses, has begun to change official recommendations.Society of Critical Care Medicine (SCCM): In 2024, an SCCM expert panel, reviewing the Cape Cod trial and 18 others, strongly recommended corticosteroids for severe CAP. They concluded that steroids reduce mortality and the need for mechanical ventilation.Meta-Analysis (Smit et al.): A 2024 meta-analysis in Lancet Respiratory confirmed the 30-day mortality benefit.European Respiratory Society (ERS): The ERS has issued a recommendation to use steroids for severe pneumonia but still urges caution regarding side effects.ATS/IDSA: As of the podcast recording, the ATS/IDSA had not yet updated their 2019 guidelines. 🛠️ Practical Application for Clinicians Defining “Severe” CAP: The key is to identify patients who qualify as “severe”. This can be done using:Scoring Tools: The PSI is the best validated tool for mortality but is cumbersome. Simpler tools like CURB-65 or SMART-COP are practical and acceptable for defining severity. 2023 meta-analysis from by Zaki et al showed both work well, but CURB-65 has better mortality prediction early on.Cape Cod Criteria: Any patient meeting the trial’s inclusion criteria (e.g., high-flow O2, non-invasive ventilation) qualifies, regardless of location (ED, floor, or ICU).Biomarkers: While not required, a CRP level was used in many studies. A CRP > 150 (Cape Cod) or > 204 (Smit meta-analysis) strongly indicates severe inflammation that would benefit from steroids.Clinical Judgment: A patient who looks “sick,” has “soft” blood pressure, or has dense infiltrates and high oxygen needs (e.g., >50% FiO2 on high flow) is a candidate.Adverse Effects:Hyperglycemia: This was the most significant risk identified, with rates between 6-12%. This is a primary concern, especially in patient populations with high BMI.GI Bleed & Secondary Infection: Fears of these side effects, which contributed to historical skepticism, were not borne out in the Cape Cod trial. The data does not support being overly concerned.Other Side Effects: Mood changes, delirium, insomnia, and agitation in the elderly are known side effects of steroids that were not specifically addressed in the trial but remain clinical concerns. 🔄 Clinical Pathway for Steroids in Severe CAP Unanswered Questions & Future Research Possible remaining questions:Biomarkers: Can we find a more precise CRP level to distinguish moderate from severe disease? Could other markers like ferritin or IL-6 be used? Dosing & Tapering: How much immunomodulation is needed, and when is it truly safe to taper?Gender Differences: Early data suggests females may respond better to steroids and experience fewer side effects. The question of female patients with severe CAP require less corticosteroids needs further exploration. 👉 Clinical Bottom Line The current literature, spearheaded by the Cape Cod trial, now supports the use of corticosteroids in severe community-acquired pneumonia. The best evidence currently points to hydrocortisone, started early (within 24 hours) after severity is identified using a validated tool. While hyperglycemia is a risk, the previous fears of GI bleeding and secondary infections were not substantiated in recent, rigorous trials. 📚 References Chapa-Rodriguez A, Abou-Elmagd T, O’Rear C, Narechania S. Do patients with severe community-acquired bacterial pneumonia benefit from systemic corticosteroids?. Cleve Clin J Med. 2025;92(10):600-604. PMID: 41033846Dequin PF, Meziani F, Quenot JP, et al. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023;388(21):1931-1941. PMID: 36942789Chaudhuri D, Nei AM, Rochwerg B, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024;52(5):e219-e233. PMID: 38240492 Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Alex Chapa, MD PGY 5 Pulmonary Critical Care Fellow Cape Fear Valley Medical Center Fayetteville NC 🔎 Your Deep-Dive Starts Here REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia Corticosteroids have long sparked debate in the treatment of bacterial ... Thoracic and Respiratory Read More The post REBEL Core Cast 149: Review of Corticosteroids in Community-Acquired Pneumonia appeared first on REBEL EM - Emergency Medicine Blog.

🧭 REBEL Rundown 🗝️ Key Points 💨 NIV = Support without a tube: CPAP, BiPAP, and HFNC improve oxygenation and reduce the work of breathing.🫁 CPAP = Continuous pressure: Best for hypoxemic patients (e.g., pulmonary edema, OSA).️ BiPAP = Two pressures (IPAP/EPAP): Great for hypercapnic failure (e.g., COPD, obesity hypoventilation).🌬️ HFNC = Heated, humidified high flow: Reduces effort, improves comfort, and enhances oxygen delivery.🩺 Supportive, not definitive: NIV stabilizes patients while the underlying cause is treated. Click here for Direct Download of the Podcast. 📝 Introduction Non-invasive ventilation (NIV) refers to respiratory support provided without endotracheal intubation. The most common modalities include continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula (HFNC). These therapies aim to improve oxygenation, reduce the work of breathing, and potentially prevent invasive mechanical ventilation. 💨 CPAP and BiPAP CPAP delivers a single, continuous pressure during inspiration and expiration. This pressure (commonly 5–10 cm H₂O) helps recruit atelectatic alveoli, reduce shunt, and improve oxygenation. It is commonly used for conditions like pulmonary edema, obstructive sleep apnea, or mild hypoxemia without significant ventilatory failure.BiPAP alternates between two pressures:Inspiratory positive airway pressure (IPAP), augments tidal volume and unloads inspiratory muscles.Expiratory positive airway pressure (EPAP), maintains alveolar recruitment and improves oxygenation.The differential between IPAP and EPAP is critical for reducing hypercapnia in patients with COPD exacerbations or acute hypercapnic respiratory failure.IndicationsCPAP: hypoxemia without major ventilatory failure (e.g., cardiogenic pulmonary edema, atelectasis, OSA).BiPAP: hypercapnia with increased work of breathing (e.g., COPD exacerbation, neuromuscular weakness, obesity hypoventilation).A helpful way to conceptualize CPAP and BiPAP is through the hairdryer analogy. Imagine placing a hairdryer in your mouth: 🩺 Clinical Considerations Masks can be uncomfortable, impair secretion clearance, and limit oral intake.Some patients require sedation to tolerate NIV, but this carries risks in patients with unprotected airways.NIV is thus a high-stakes intervention requiring close monitoring.Common starting dose to understand titration, but start at the level appropriate for your patient:  IPAP 10 cm H₂O / EPAP 5 cm H₂O (“10/5”) and are titrated:Increase IPAP to improve tidal volume and CO₂ clearance.Increase EPAP to recruit alveoli and improve oxygenation.Both may be raised simultaneously if the patient is both hypoxemic and hypercapnic. 🚀 High-Flow Nasal Cannula (HFNC) H: Heated & humidified – improves mucociliary clearance, prevents airway drying, and enhances tolerance. I: Inspiratory flow – high flow meets or exceeds patient demand, reducing respiratory rate and effort.F: Functional residual capacity – modest generation of positive end-expiratory pressure (PEEP), promoting alveolar recruitment.L: Lighter – generally more comfortable and less restrictive than mask-based NIV.O: Oxygen dilution – minimizes entrainment of room air, delivering higher and more predictable FiO₂.W: Washout – flushes anatomical dead space, reducing CO₂ rebreathing.HFNC delivers heated, humidified oxygen at high flow rates (30–60 L/min) through wide-bore nasal prongs. A mnemonic, H-I-F-L-O-W, helps summarize its mechanisms:Indications: Traditionally used for acute hypoxemic respiratory failure (e.g., pneumonia), HFNC is increasingly studied for hypercapnic failure as well, with trials suggesting non-inferiority to BiPAP in select populations. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Syed Moosi Raza, MD PGY 3 Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More The post REBEL Core Cast 148.0–Demystifying Non-Invasive Ventilation & HiFlow appeared first on REBEL EM - Emergency Medicine Blog.

Behind the Knife ABSITE 2026 – Up-to-date and high yield learning to help you DOMINATE the exam. Don't forget to check out our ABSITE Podcast Companion Book available on Amazon: https://www.amazon.com/Behind-Knife-ABSITE-Podcast-Companion/dp/B0CLDQWZG3/ref=monarch_sidesheet Be sure to check out our free study aid, which includes all 32 review episodes, brief written summaries, high yield images, and flash cards. Simply create an account on our iOS or Android app or on our website and you will find the entire course in your Library.  Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Google Play App Store: https://play.google.com/store/apps/details?id=com.btk.app Behind the Knife would like to sincerely thank Medtronic for sponsoring the entire 2026 ABSITE podcast series.  Medtronic has a rich history of supporting surgical education, and we couldn't be happier that they chose to partner with Behind the Knife.  Learn more at https://www.medtronic.com/en-us/index.html If you like the work that Behind the Knife is doing, please leave us a review wherever you listen to podcasts.   Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   Check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Behind the Knife in Español - repaso para el examen de certificación en cirugía general: https://app.behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.You can   Guests: Grant Lewin, MD, PGY4 SLU Postoperative changes of wrist-brachial index following arteriovenous fistula implantation correlate with steal syndrome, a prospective study   Early and late outcomes of patient-specific endografts with retrograde outer branches for complex aortic aneurysms involving cranially oriented target vessels   Early reintervention for hemostasis following open abdominal aortic aneurysm repair using Ifabond surgical glue   Laser fenestration and shape memory polymer embolization of type II endoleaks   Thoracic aortic injury as a complication of spinal surgery: A new case and systematic review (1991-2024)   Benefit of virtual reality during visceral artery aneurysms open and endovascular surgery planning   Bioengineered human blood vessels to treat hospital-acquired vascular complications   Hosts: John Culhane (@JohnCulhaneMD) Follow us @audiblebleeding, @JVS-CIT   Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.   *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

🧭 REBEL Rundown 🗝️ Key Points 💨 Peak vs. Plateau Pressures: PIP reflects total airway resistance and compliance, while Pplat isolates alveolar compliance—elevations in both suggest decreased lung compliance (e.g., ARDS, pulmonary edema, pneumothorax).🧱 PEEP Protects Alveoli: Maintains alveolar recruitment and prevents collapse; typical range 5–8 cmH₂O, but higher levels may benefit moderate–severe ARDS.️ Driving Pressure (ΔP = Pplat − PEEP): Lower ΔP reduces atelectrauma and improves outcomes; optimize by adjusting PEEP thoughtfully.💥 Prevent VILI: Keep Pplat < 30 cmH₂O, use low tidal volumes (6 mL/kg IBW), and monitor for barotrauma, volutrauma, atelectrauma, and biotrauma.📚 Evidence-Based Practice: ARDSNet and subsequent trials confirm that lung-protective ventilation—low Vt, limited pressures, and individualized PEEP—improves survival in ARDS. Click here for Direct Download of the Podcast. 📝 Introduction This episode reviews essential ventilator pressures and how to interpret them during ICU rounds. 🚀 Under Pressure Peak Inspiratory Pressure (PIP)Definition: Total pressure required to deliver a breath.Reflects: Airway resistance + lung/chest wall compliance.Common Causes of ↑ PIP:Mucus pluggingBiting the endotracheal tubeKinked tubing or bronchospasmPlateau Pressure (Pplat)Definition: Alveolar pressure measured after an inspiratory hold.Reflects: Lung compliance (stiffness of lung tissue).When Both PIP & Pplat Are Elevated:→ Indicates poor compliance (e.g., ARDS, pulmonary edema, pneumothorax).Positive End-Expiratory Pressure (PEEP)Definition: Pressure remaining in airways at end-expiration to prevent alveolar collapse.Typical Range: 5–8 cmH₂O but needs to titrated to meet patient requirements Notes:Provides physiologic “glottic” PEEP in intubated patients.Using high PEEP strategy shows mortality benefit only in moderate–severe ARDS in meta-analysis.Driving Pressure (ΔP)Definition: ΔP = Pplat − PEEP.Reflects: Pressure needed to keep alveoli open during the respiratory cycle.Goal: Lower ΔP → less atelectrauma & improved outcomes.Optimize: Increase PEEP to reduce ΔP and alveolar cycling. 📖 Interpreting High PIP/High Pplat ↑ PIP & ↑ PplatInterpretation: ↓ ComplianceCommon Causes: ARDS, pulmonary edema, pleural effusion, pneumothorax↑ PIP & Normal/Low PplatInterpretation: ↑ Airway ResistanceCommon Causes: Mucus plug, bronchospasm, tube obstruction or biting 🤕 Ventilator-Associated Lung Injury (VILI) Barotrauma:Mechanism: Excessive airway pressure damages alveoli.Prevention: Keep Pplat < 30 cmH₂O.Volutrauma:Mechanism: Overdistension from excessive tidal volumes.Prevention: Use low tidal volume ventilation (6 mL/kg ideal body weight).ARDSNet trial: 6 mL/kg → lower mortality compared to 12 mL/kg.Ideal Body Weight: Based on height and sex, not actual weight.Typical patient: Tidal Volume: 6–8 mL/kg IBWARDS: Tidal Volume: 4–6 mL/kg IBWAtelectrauma:Mechanism: Repeated opening/collapse of unstable alveoli.Prevention: Optimize PEEP to keep alveoli open and reduce driving pressure.Biotrauma:Mechanism: Inflammatory cascade (↑ IL-6, TNF-α) from mechanical injury.Effect: Can trigger systemic inflammation & multiorgan dysfunction.Prevention: Minimize all other forms of VILI. Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO) 👤 Show Notes Joel Rios Rodriguez, MD PGY 3 Internal Medicine Resident Cape Fear Valley Internal Medicine Residency Program Fayetteville NC Aspiring Pulmonary Critical Care Fellow 🔎 Your Deep-Dive Starts Here REBEL Core Cast – Pediatric Respiratory Emergencies: Beyond Viral Season Welcome to the Rebel Core Content Blog, where we delve ... Pediatrics Read More REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator When you take the airway, you take the wheel and ... Thoracic and Respiratory Read More REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes Mechanical ventilation can feel overwhelming, especially when faced with a ... Thoracic and Respiratory Read More REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes For many medical residents, the ICU can feel like stepping ... Thoracic and Respiratory Read More REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine The sicker the patient, the more likely an IO line ... Procedures and Skills Read More REBEL Core Cast 139.0: Pneumothorax Decompression On this episode of the Rebel Core Cast, Swami takes ... Procedures and Skills Read More The post REBEL Core Cast 147.0–Ventilators Part 5: Key Mechanical Ventilator Pressures & Definitions Made Simple appeared first on REBEL EM - Emergency Medicine Blog.