Podcasts about Workup

We discuss the injuries sustained from smoke inhalation. Hosts: Sarah Fetterolf, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Smoke_Inhalation.mp3 Download Leave a Comment Tags: Environmental, Toxicology Show Notes Table of Contents 00:37 – Overview of Smoke Inhalation Injury 00:55 – Three Key Pathophysiologic Processes 01:41 – Physical Exam Findings to Watch For 02:12 – Airway Management and Early Intervention 03:23 – Carbon Monoxide Toxicity 04:24 – Workup and Initial Treatment of CO Poisoning 06:14 – Cyanide Toxicity 07:19 – Treatment Options for Cyanide Poisoning 09:12 – Take-Home Points and Clinical Pearls Physiological Effects of Smoke Inhalation: Thermal Injury: Direct upper airway damage from heated air or steam. Leads to swelling, inflammation, and possible airway obstruction. Chemical Irritation: Causes bronchospasm, mucus plugging, and inflammation in the lower airways. Increases capillary permeability, potentially causing pulmonary edema. Systemic Toxicity: Primarily involves carbon monoxide and cyanide poisoning.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Eric Klein, MD With an urgent need to screen for cancer, clinical trials have shown that the multi-cancer early detection (MCED) test Galleri® can screen for more than 50 distinct cancer types in adults 50 and over and predict its origin. Questions have remained regarding the risk of cancer for those patients with a CSD MCED result, followed by a diagnostic evaluation that did not result in a cancer diagnosis and a second MCED test. Recent research was conducted to help address this gap, and now, Dr. Eric Klein joins Dr. Charles Turck to share the real-world outcomes following a Galleri MCED retest. Dr. Klein is a distinguished scientist at Grail and one of the elite investigators on the clinical studies that led to the development of the Galleri MCED test.

Host: Charles Turck, PharmD, BCPS, BCCCP Guest: Eric Klein, MD With an urgent need to screen for cancer, clinical trials have shown that the multi-cancer early detection (MCED) test Galleri® can screen for more than 50 distinct cancer types in adults 50 and over and predict its origin. Questions have remained regarding the risk of cancer for those patients with a CSD MCED result, followed by a diagnostic evaluation that did not result in a cancer diagnosis and a second MCED test. Recent research was conducted to help address this gap, and now, Dr. Eric Klein joins Dr. Charles Turck to share the real-world outcomes following a Galleri MCED retest. Dr. Klein is a distinguished scientist at Grail and one of the elite investigators on the clinical studies that led to the development of the Galleri MCED test.

This week, we kick off a new, highly-anticipated and highly-requested series, covering venous thromboembolism (VTE). In this first episode, we discuss how we make the initial diagnosis and how we approach initial management. As a clinician, you will undoubtedly come across the need to make this decision. This episode and this series will set you up for success!Episode contents:-What is venous thromboembolism?- How do we diagnose patients with VTE?- How do we initially management patients with VTE? - How do we select anticoagulants for VTE? ****This episode is sponsored by our Global Research Partners! Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this episode, Stephen Cantrill, MD, FACEP; Rajesh T. Gandhi, MD; and Payal K. Patel, MD, MPH, FIDSA, discuss: Workup of COVID-19 in the emergency departmentMethods of COVID-19 risk stratification Treatment recommendations for people with severe COVID-19, including how to effectively use antiviral therapy, dexamethasone, and other immunomodulators[CC1] in this population A detailed patient case to illustrate key takeawaysPresenters:Stephen Cantrill, MD, FACEP​Associate Director and Medical Director (Retired) ​ Department of Emergency Medicine​ Denver Health Medical Center​ Associate Professor ​ Department of Emergency Medicine​ University of Colorado Health Sciences Center​ Denver, Colorado Rajesh T. Gandhi, MD​Massachusetts General Hospital​ Professor of Medicine​ Harvard Medical School​ Boston, Massachusetts Payal K. Patel, MD, MPH, FIDSA​Systemwide Director of Antimicrobial Stewardship​ Associate Professor, Division of Infectious Diseases​ Intermountain Health​ Salt Lake City, Utah Link to full program: https://bit.ly/4gu2gcUGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

Dr. Emily Gutowski interviews Dr. Michael Pillinger, NYU rheumatologist and gout expert, about the initial presentation and workup of a patient with this gout. This is the first episode of a two-part series on gout. Join us for the next episode where we'll dive into acute management and long-term outpatient treatment strategies for this chronic condition.

Workup and management of HCC in Radiation Oncology featuring guest Dr Judy Lubas

In this episode of All Things Endurance, host Rick Prince chats with triathlete and serial entrepreneur, Ryan Frankel. A former investor at Goldman Sachs, Ryan has founded multiple companies, and appeared on the hit show, Shark Tank. Rick and Ryan discuss assessing risk, start up financing and mistakes to avoid, among other topics. About Ryan Frankel Ryan Frankel is a serial entrepreneur, triathlete and former investor at Goldman Sachs.  Ryan has founded multiple companies, and appeared on the hit show, Shark Tank. Ryan recently launched his latest start up, Workup (workuphq.com), which aggregates quality and ethical wellness/health companies in an online marketplace format.    Areas covered in this podcast: 1.       Could you tell the listeners a bit about yourself and how you came to be an entrepreneur?2.       Goldman, and perhaps most of the finance industry is known for long hours, high intensity and a collaborative work environment. How did your time at Goldman influence and shape your entrepreneurial journey?3.       Corollary to the prior question, how has your time as a triathlete influenced your experience as an entrepreneur?4.       Let's talk risk. Start-ups and small business in general are often perceived as being very risky as compared to working for someone else. That said, I've had many friends that have lost their ‘9-5' jobs in the last few years. So do you think in today's current economic and work climate, is being self-employed any riskier than working for a company?5.       As someone starting a business, what would be advice for them to reduce the risk commonly associated with a start up?6.       Most coaches are not going to be looking for investors or external capital to start their coaching businesses. Aside from what funds a coach already has in the bank, what are some other creative ways that a coach could raise money to bootstrap their start-up coaching practice?7.       In your time as both working for GS, as well as an entrepreneur, what are some of the most valuable lessons that you have learned that would apply to coaches looking to start and/or scale their business?8.       What are some of the mistakes that you've made that you could share with our listeners with respect to things to be aware of and potentially avoid?Lastly, what was it like being on Shark Tank?

Send Colleen a Text MessageInfertility impacts 1 in 6 couples worldwide. Whether you're in fertility medicine or not, odds are you've worked with or know someone on this frustrating, exhausting journey. But what if there was a way to help patients navigate infertility with more clarity, support, and, yes, even hope? In this episode, we're exploring how a unified, whole-health approach can make a real difference.Join Colleen and fertility PA, Jessica Boone to learn a framework that's straightforward but powerful, designed to address both partners' health and focus on more than just the traditional medical checklist. We'll dive into four foundational pillars to optimize fertility—nutrition, elimination, toxins, and sleep—plus real-life strategies you can use with your patients right away.In this episode we cover: The 4 Pillars of a Unified Fertility Plan: The impact of nutrition, elimination, toxin reduction, and better sleep and actionable tips for each area.Fertility Workup 101: What a complete fertility workup is and why it should include both partnersSupporting Patients Through Tough Emotions: How to guide patients through the frustration, sadness, and confusion that often comes with infertilityWhether you're guiding patients or just want to learn more about this important issue, this episode is packed with insights to empower you as a provider.Resources mentioned:Episode 47: Nutrition and Infertility- Is Your Diagnosis Wrong?Connect with Jessica:Instagram | @fortitudefertilityShared Steps GuideEssential Lab GuideSupport the showConnect with Colleen:InstagramLinkedInSign up for the Nutrition Wrap-Up Newsletter - Nutrition hot-topics and professional growth strategies delivered to your inbox each week. Support the show!If you love the show and want to help me make it even better, buy me a coffee to help me keep going! ☕️Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

Get a second opinion on your uterine fibroid embolization (UFE) technique. Dr. Gary Siskin joins host Dr. Chris Beck for an in-depth discussion on his approach to uterine fibroid embolization, detailing techniques, tools, and embolic agents. Dr. Siskin is an experienced UFE practitioner, professor, and Chair of the Department of Radiology and Chief of the Division of Vascular & Interventional Radiology at Albany Med Health System in New York. --- This podcast is supported by: Merit Embolotherapy https://www.merit.com/solutions/embolotherapy/ --- SYNPOSIS Dr. Siskin shares his journey and evolution of his specialization in GYN-related interventional radiology procedures. The doctors cover various aspects of fibroid embolization, including its effectiveness compared to surgical options like myomectomy and hysterectomy, the referral and evaluation process, and considerations for fertility preservation. Pain management strategies and postoperative care are also explored, emphasizing the importance of patient education and interdisciplinary collaboration to promote less invasive treatments. --- TIMESTAMPS 00:00 - Introduction 04:45 - Building a Fibroid Practice 08:35 - Workup and Consultation 17:01 - Recurrence and Re-Embolization 20:27 - Pre-Procedural Workup and Technique 30:18 - Embolization Endpoint 36:07 - Accessing the Correct Uterine Artery 48:49 - Post-Procedure Patient Care --- RESOURCES List of Publications by Dr. James B. Spies (PubMed): https://pubmed.ncbi.nlm.nih.gov/?sort=jour&term=Spies+JB&cauthor_id=24436560

By now, you know many of the details of these crimes. The place, the time and what was done to Russell and Shirley Dermond. What we still don't know is the why and the who. In the final chapter of our exploration of the Lake Oconee murders, we consult with former members of the FBI's Behavioral Analysis Unit, and put together a profile of that who, and that why. Can we get closer to the actual truth? JOIN OUR PATREON: http://www.deviantpodcast.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Workup and management of Kidney Cancer in Radiation Oncology featuring guest Dr Riche Mohan

Follow along as the great Dr. Senter guides us through the diagnosis, workup, and treatment of an all-star lineup of sport injuries. Part 1 covers concussions, femoroacetabular  impingement (FAI), and the ongoing quest to diagnose Paul's mysterious hip injury.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction  08:43 Case 1 - Concussion  9:39 Approach and Workup of Concussions  18:08 Treatment of Concussions (Return to Activity)  24:10 Consideration of Head Imaging  33:20 Case 2 - Hip Pain (FAI)  34:15 Hip Anatomy and Differential Diagnosis  38:41 Hip Physical Exam  45:41 Hip Imaging  47:28 Treatment of FAI Outro & Take Home Points  Credits Producer and Show Notes: Peter Wikoff MD Writer, Infographic and Cover art: Edison Jyang MD  Reviewer: Sai S Achi MD MBA FACP Hosts and Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP    Technical Production: PodPaste Guest: Dr. Carlin Senter MD Sponsor: ClinicalKey AI ClinicalKey AI is an award-winning solution that combines trusted, evidence-based clinical content with conversational search powered by generative AI. To unlock the power of AI in clinical decision-making with ClinicalKey AI, visit Elsevier.health/AI Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Babbel Get up to 60% off your Babbel subscription - but only for our listeners at Babbel.com/CURB.

In this episode, newlywed Sydney McNabb Dodson shares the aesthetic treatments and procedures she invested in leading up to her wedding so she looked and felt her best on the ...

Workup and management o in Radiation Oncology featuring guest Dr Steven MontalvoWorkup and management of Larynx Cancer in Radiation Oncology featuring guest Dr Beth Neilsen

Host Dr. Sherry Wang summarizes the article Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation. Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation. Flory et al.  RadioGraphics 2024; 44(5):e230121. 

CHP lideri Özgür Özel, asgari ücrete ve emekli maaşlarına zam yapılmazsa erken seçime gidilmesi gerektiğini söyledi. Macar lider Orbán'ın AB'yi kızdıran dünya turu devam ediyor. Bu bölüm Workup hakkında reklam içermektedir. Türkiye İş Bankası tarafından Türkiye'de teknoloji odaklı iş yapış biçimlerinin yaygınlaşmasını sağlamak ve yenilikçi girişimlerin hayata geçmesini desteklemek amacıyla 2017'de başlatılan Workup Girişimcilik Programı, girişimlerin büyümelerinin önündeki engelleri kaldırıyor. Workup Girişimcilik Programı hakkında ayrıntılı bilgiye buradanulaşabilir ve başvuru yapabilirsiniz. Aposto Gündem'e buradan ulaşabilirsiniz.

In this episode: recognition, risk stratification, decision tools, indications for lumbar puncture in the febrile pediatric patient, tips and trick on performing LPs in children, and ED management of pediatric meningitis. We answer such questions as: what are the test characteristics of the various clinical features of meningitis across various ages? How does one differentiate between meningitis and retropharyngeal abscess on physical exam? How do the Canadian and American guidelines on work up of well-appearing febrile infants compare when to it comes to indications for lumbar puncture? Which patients with suspected meningitis require imaging prior to lumbar puncture? How do we best interpret the various CSF tests to help distinguish between viral and bacterial meningitis? What are the indications and timing of administering dexamethasone in the pediatric patient with suspected meningitis? and many more.... EM Cases is Free Open Access; please consider a donation to help ensure that EM Cases remains Free Open Access on our donation page https://emergencymedicinecases.com/donation/

Dr. Dylan Suttle and Dr. Harris Chengazi delve into recent advancements in transjugular intrahepatic portosystemic shunt (TIPS) procedures, highlighting the significant reduction in procedural time and improvements in outcomes due to the introduction of Intracardiac Echo (ICE) and the Scorpion Portal Vein Access Series. --- CHECK OUT OUR SPONSOR Argon Medical http://www.argonmedical.com/ --- SYNPOSIS The doctors share their experiences, techniques, and the evolution of their approaches. They emphasize benefits such as high-resolution imaging, cost-effectiveness, and new technologies that make TIPS cases more approachable. --- TIMESTAMPS 00:00 - Introduction 06:17 - Portal Hypertension Clinics 13:17 - Technical Aspects of TIPS Procedures 35:17 - Challenges in Selecting the Right Hepatic Vein 38:48 - Pre-Procedure Planning 39:36 - Puncture Techniques 50:04 - Stent Deployment and Placement 55:35 - Learning Curve of ICE & Advantages 01:07:58 - The Future of TIPS Procedures --- RESOURCES BackTable VI Episode #123 - TIPS University Freshman Year: Referrals and Pre-op Workup with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/123/tips-university-freshman-year-referrals-pre-op-workup BackTable VI Episode #124 - TIPS University Sophomore Year: Basic Procedure Technique with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/124/tips-university-sophomore-year-basic-procedure-technique BackTable VI Episode #125 - TIPS University Junior Year: Advanced Techniques, ICE, and Splenic Access with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/125/tips-university-junior-year-advanced-techniques-ice-splenic-access BackTable VI Episode #126 - TIPS University Senior Year: Gunsight Technique & Splenic Closure with Dr. Emmett Lynskey: https://www.backtable.com/shows/vi/podcasts/126/tips-university-senior-year-gunsight-technique-splenic-closure Dr. Suttle TIPS Technique Video: https://www.youtube.com/watch?v=jYfr_rWe5Ck TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis: https://www.journal-of-hepatology.eu/article/S0168-8278(23)00314-8/abstract Intracardiac Echocardiography–Guided TIPS: A Primer for New Operators: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540636/

In neurocritical care, the initial evaluation is often fast paced, and assessment and management go hand in hand. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions. In this episode, Aaron Berkowitz, MD, PhD FAAN, speaks with Sarah Wahlster, MD, an author of the article “The Neurocritical Care Examination and Workup,” in the Continuum June 2024 Neurocritical Care issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Wahlster is an associate professor of neurology in the departments of neurology, neurological surgery, and anesthesiology and pain medicine at Harborview Medical Center, University of Washington in Seattle, Washington. Additional Resources Read the article: The Neurocritical Care Examination and Workup Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Guest: @SWahlster Full Episode Transcript Sarah Wahlster, MD   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by clicking on the link in the Show Notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. AAN members: stay tuned after the episode to hear how you can get CME for listening.  Dr Berkowitz: This is Dr Aaron Berkowitz, and today I'm interviewing Dr Sarah Wahlster about her article on examination and workup of the neurocritical care patient, which is part of the June 2024 Continuum issue on neurocritical care. Welcome to the podcast, Dr Wahlster. Can you please introduce yourself to the audience? Dr Wahlster: Thank you very much, Aaron. I'm Sarah Wahlster. I'm a neurologist and neurontensivist at Harborview Medical Center at the University of Washington. Dr Berkowitz: Well, Sarah and I know each other for many, many years. Sarah was my senior resident at Mass General and Brigham and Women's Hospital. Actually, Sarah was at my interview dinner for that program, and I remember meeting her and thinking, “If such brilliant, kind, talented people are in this program, I should try to see if I can find my way here so I can learn from them.” So, I learned a lot from Sarah as a resident, I learned a lot from this article, and excited for all of us to learn from Sarah, today, talking about this important topic. So, to start off, let's take a common scenario that we see often. We're called to the emergency room because a patient is found down, unresponsive, and neurology is called to see the patient. So, what's running through your mind? And then, walk us through your approach as you're getting to the bedside and as you're at the bedside. Dr Wahlster: Yeah, absolutely. This was a fun topic to write about because I think this initial kind of mystery of a patient and the initial approach is something that is one of the puzzles in neurology. And I think, especially if you're thinking about an emergency, the tricky part is that the evaluation and management go hand in hand. The thinking I've adapted as a neurointensivist is really thinking about “column A” (what is likely?) and “column B” (what are must-not-miss things?). It's actually something I learned from Steve Greenberg, who was a mutual mentor of us - but he always talked me through that. There's always things at the back of your head that you just want to rule out. I do think you evaluate the patient having in mind, “What are time-sensitive, critical interventions that this patient might need?” And so, I think that is usually my approach. Those things are usually anything with elevated intracranial pressure: Is the patient at risk of herniating imminently and would need a neurosurgical intervention, such as an EVD or decompression? Is there a neurovascular emergency, such as an acute ischemic stroke, a large-vessel occlusion, a subarachnoid hemorrhage that needs emergent intervention? And then other things you think about are seizures, convulsive/nonconvulsive status, CNS infection, spinal cord compression. But I think, just thinking about these pathologies somewhere and then really approaching the patient by just, very quickly, trying to gather as much possible information through a combination of exam and history. Dr Berkowitz: Great. So, you're thinking about all these not-to-miss diagnoses that would be life-threatening for the patient and you're getting to the bedside. So, how do you approach the exam? Often, this is a different scenario than usual, where the patient's not going to be able to give us a history or maybe necessarily even participate in the exam, and yet, as you said, the stakes are high to determine if there are neurologic conditions playing into this patient's status. So, how do you approach a patient at the bedside? Dr Wahlster: So, I think first step in an ICU setting (especially if the patient has a breathing tube) is you think about any confounders (especially sedation or metabolic confounders) - you want to remove as soon as possible, if able. I think as you do the exam, you try to kind of incorporate snippets of the history and really try to see - you know, localize the problem. And also kind of see, you know, what is the time course of the deterioration, what is the time course of the presentation. And that is something I actually learned from you. I know you've always had this framework of “what is it, where is it?” But I think in terms of just a clinical exam, I would look at localizing signs. I think, in the absence of being able to do the full head-to-toe neuro exam and interact with the patient, you really try to look at the brainstem findings. I always look at the eyes right away and look at, I think, just things like, you know, the gaze (how is it aligned? is there deviation? is there a skew? what do the pupils look like? [pupillary reactivity]). I think that's usually often a first step - that I just look at the patient's eyes. I think other objective findings, such as brainstem reflexes and motor responses, are also helpful. And then you just look whether there's any kind of focality in terms of - you know, is there any difference in size? But I think those are kind of the imminent things I look at quickly. Dr Berkowitz: Fantastic. Most of the time, this evaluation is happening kind of en route to the CT scanner or maybe a CT has already happened. So, let's say you're seeing a patient who's found down, the CT has either happened or you asked for it to happen somewhat quickly after you've done your exam, and let's say it's not particularly revealing early on. What are the sort things on your exam that would then push you to think about an MRI, a lumbar puncture, an EEG? You and I both spend time in large community hospitals, right, where “found down” is one of the most common chief concerns. In many cases, there isn't something to see on the CT or something obvious in the initial labs, and the question always comes up, “Who gets an MRI? Who gets an LP? Who gets an EEG?” - and I'm not sure I have a great framework for this. Obviously, you see focality on your exam, you know you need to look further. But, any factors in the history or exam that, even with a normal CT, raise your suspicion that you need to go further? Dr Wahlster: It's always a challenge, especially at a community hospital, because some of these patients come in at 1 AM where the EEG is not imminently available. But I think - let's say the CT scan is absolutely normal and doesn't give me a cause, but as an acute concerning deterioration, I think both EEG and LP would cross my mind. MRI I kind of see a little bit as a second-day test. I think there's very rare situation where an acute MRI would inform my imminent management. It's very informative, right, because you can see very small-vessel strokes. We had this patient that actually had this really bad vasculitis and we were able to see the small strokes everywhere on the MRI the day later, or sometimes helps you visualize acute brainstem pathology. But I think, even that - if you rule out a large-vessel occlusion on your CTA, there's brainstem pathology that is not imminently visible on the CT - it's nothing you need to go after. So, I do think the CT is a critical part of that initial eval, and whereas I always admire the neurological subspecialties, such as movements, where you just – like, your exam is everything. I think, to determine these acute time-sensitive interventions, the CT is key. And also, seeing a normal CT makes me a little less worried. You always look at these “four H” (they're big hypodensity, hyperdensity, any shift; is there hydrocephalus or herniation). I think if I don't have an explanation, my mind would imminently jump to seizure or CNS infection, or sometimes both. And I think then I would really kind of - to guide those decisions and whether I want to call in the EEG tech at 2 AM - I would, you know, again, look at the history and exam, see if there's any gaze deviation, tongue biting, incontinence - anything leading up towards seizure. I think, though, even if I didn't have any of those, those would strengthen my suspicion. If I really, absolutely don't have an explanation and the patient off sedation is just absolutely altered, I would still advocate for an EEG and maybe, in the meantime, do a small treatment trial. And I think with CNS infection - obviously, there are patients that are high risk for it - I would try to go back and get history about prodromes and, you know, look at things like the white count, fevers, and all of that. But again, I think if there's such a profound alteration in neurologic exam, there's nothing in the CT, and there's no other explanation, I would tend to do these things up front because, again, you don't want to miss them. Dr Berkowitz: Yeah, perfect. So many pearls in there, but one I just want to highlight because I'm not sure I've heard the mnemonic - can you tell us the four Hs again of sort of neurologic emergencies on CT? Dr Wahlster: Yeah. So, it's funny; for ages - I'm actually not sure where that's coming from, and I learned it from one of my fellows, one of our neurocritical care fellows - he's a fantastic teacher and he would teach our EM and anesthesia residents about it and his approach to CT. But yeah, the four H - he was always kind of like, “Look at the CT. Do you see any acute hypodensities, any hyperdensities?” And hypodensities would be involving infarct or edema; hyperdensities would be, most likely, hemorrhage (sometimes calcification or other things). Then, “Do you see hydrocephalus?” (because that needs an intervention). And, “Look at the midline structures and the ventricles.” And then, “Do you see any signs of herniation?” And he would go through the different types of herniation. But I thought that's a very good framework for looking at the “noncon” and just identifying critical pathology that needs some intervention. Dr Berkowitz: Yeah – so, hypodensity, hyperdensity, herniation, hydrocephalus. That's a good one – the four Hs; fantastic. Okay. So, a point that comes up a few times in your article - which I thought was very helpful to walk through and I'd love to pick your brain about a little bit – is, which patients need to be intubated for a neurologic indication? So, often we do consultations in medical, surgical ICUs; patients are intubated for medical respiratory reasons, but sometimes patients are intubated for neurologic reasons. So, can you walk us through your thinking on how to decide who needs to be intubated for the concern of depressed level of consciousness? Dr. Wahlster: It's an excellent question, and I think I would bet there's a lot of variation in practice and difference in opinion. There was actually the 2020 ESICM guidelines kind of commented on it, and those are great guidelines in terms of just intubation, mechanical ventilation of patients, and just acknowledging how there is a lack of really strong evidence. I would say the typical mantra (“GCS 8, intubate”) has been proposed in the trauma literature. And at some point, I actually dug into this to look behind the evidence, and there's actually not as much evidence as it's been put forth in guidelines and that kind of surprised me - that was just recently. I was like, “Actually, let me look this up.” I would say I didn't find a ton of strong evidence for it. I would say, as neurologist – you know, I'm amazed because GCS, I think is a - in some ways, a good tool to track things because it's so widely used across the board. But I would say, as neurologists, we all know that it sometimes doesn't account for some sort of nuances; you know, if a patient is aphasic, if a patient has an eyelid-opening apraxia - it can always be a little confounded. I'm amazed that GCS is still so widely used, to be frank. But I would say there is some literature - some school of thought - that maybe just blindly going by that mantra could be harmful or could not be ideal. I would say – I mean, I look at the two kind of functional things: oxygenation and ventilation. I think, in a neuro patient, you always think about airway protection or the decreased level of consciousness being a major issue (What is truly airway protection? Probably a mix of things). Then there's the issue of respiratory centers and respiratory drive - I think those are two issues you think about. But ultimately, if it leads to insufficient oxygenation - hypoxia early on is bad and that's been shown in several neurologic acute brain injuries. I think you also want to think about ventilation, especially if the mental status is poor to the point that the PCO2 elevates, that could also augment an ICP or exacerbate an ICP crisis. Or sometimes, I think there's just dysregulation of ventilation and there's hyperventilation to the point that the PCO2 is so low that I worry about cerebral vasoconstriction. So, I worry about these markers. I think, the oxygenation, I usually just kind of initially track on the sats. Sometimes, if the patient is profoundly altered, I do look at an arterial blood gas. And then there are things like breathing sounds (stridor, stertor [the work of breathing]). And I think something that also makes me have a lower threshold to intubate is if I'm worried and I want to scan, and I'm worried that the patient can't tolerate it - I want an imminent scan to just see why the patient is altered, or seizing, or presenting a certain way. Dr Berkowitz: All great pearls for how to think through this. Yeah - it's hard to think of hard and fast rules, and you can get to eight on the GCS in many different ways, as you said, some of which may not involve the respiratory mechanics at all. So, that's a helpful way of thinking about it that involves both the mental state, kind of the tracheal apparatus and how it's being managed by the neurologic system, and also the oxygen and carbon dioxide (sort of, respiratory parameters) – so, linking all those together; that's very helpful. And, related question – so, that's sort of for that patient with central nervous system pathology, who we're thinking about whether they need to be intubated for a primary neurologic indication. What about from the acute neuromuscular perspective (so, patients with Guillain-Barré syndrome or myasthenic crisis); how do you think about when to intubate those patients? Dr Wahlster: Yeah, absolutely - I think that's a really important one. And I think especially in a patient that is rapidly progressing, you always kind of think about that, and you want them in a supervised setting, either the ER or the ICU. I mean, there's some scores - I think there's the EGRIS score; there's some kind of models that predict it. I would say, the factors within that model, and based on my experience, often the pace of progression of reflex motor syndrome. I often see things like, kind of, changes in voice. You know, myasthenia, you look at things like head extension, flexion - those are the kind of factors. I would say there's this “20/30/40 rule” about various measures of, like, NIF and vital capacities, which is great. I would say in practice, I sometimes see that sometimes the participation in how the NIF is obtained is a little bit funky, so I wouldn't always blindly go by these numbers but sometimes it's helpful to track them. If you get a reliable kind of sixty and suddenly it drops to twenty, that makes me very concerned. But I would say, in general, it's really a little bit the work of breathing - looking at how the patient looks like. There's also (at some point) ABG abnormalities, but we always say, once those happen, you're kind of later in the game, so you should really - I think anyone that is in respiratory distress, you should think about it and have a low threshold to do it, and, at a minimum, monitor very closely. Dr Berkowitz: Yeah, we have those numbers, but so often, our patients who are weak, from a neuromuscular perspective, often have facial and other bulbar weakness and can't make a seal on the device that is used to check these numbers, and it can look very concerning when the patient may not, or can be a little bit difficult to interpret. So, I appreciate you giving us sort of the protocol and then the pearls of the caveats of how to interpret them and going sort of back to basics. So, just looking at the patient at the bedside and how hard they are working to breathe, or how difficult it is for them to clear their secretions from bulbar weakness. Moving on to another topic, you have a really wonderful section in your article on detecting clinical deterioration in patients in the neuro ICU. Many patients in the neuro ICU - for example, due to head trauma or large ischemic stroke or intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus - they can't communicate with us to tell us something is getting worse, and they can't (in many cases) participate in the examination. They may be intubated, as you said, sedated or maybe even not sedated, and there's not necessarily much to follow on the exam to begin with if the GCS is very low. So, I'd love to hear your thoughts and your pearls, as someone who rounds in the neuro-ICU almost every day. What are you looking for at the bedside to try to detect sort of covert deterioration, if you will, in patients who already have major neurologic deficits, major neurologic injury or disease that we're aware of? I'm trying to see if there is some type of difference at the bedside that would lead you to be concerned for some underlying change and go back to the scanner or repeat EEG, LP, et cetera. Dr Wahlster: Yeah. I think that's an excellent question because that's a lot of what we do in the neuro ICU, right? And when you read your Clans, your residency, like, “Ah, QNR neuro checks, [IG1]  ” right? We often do that in many patients. But I think in the right patient, it can really be life or death a matter, and it is the exam that really then drives a whole cascade of changes in management and detects the need for lifesaving procedure. I would say it depends very much on the process and what you anticipate, right? If you have, for example, someone with a large ischemic stroke, large MCA stroke, especially, right, then there's sometimes conversations about doing a surgical procedure before they herniate. But let's say, kind of watch them and are worried that they will, you do worry about uncal herniation, and you pay attention to the pupil, because often, if the inferior division is infarcted, you know, you can see that kind of temporal tickling the uncus already. And so, I think those are patients that I torture with those NPi checks and checking the pupil very vigilantly. I would say, if it's a cerebellar stroke, for example, right, then you think about, you know, hydrocephalus. And often patients with cerebellar stroke - you know, the beauty of it is that if you detect it early, those patients can do so well, but they can die, and will die if they develop hydrocephalus start swelling. But I think, often something I always like to teach trainees is looking at the eye movements in upgaze and downgaze because, often, as the aqueduct, the third ventricle gets compressed and there's pressure on the colliculi – you kind of see vertical gaze get worse. But I would say I think it's always good to know what the process is and then what deterioration would look like. For example, in subarachnoid hemorrhage, where you talk about vasospasm - it's funny - I think a really good, experienced nurse is actually the best tool in this, but they will sometimes come to you and say, “I see this flavor,” and it's actually a constellation of symptoms, especially in the anterior ACA (ACom) aneurysms. You sometimes see patients suddenly, like, making funky jokes or saying really weird things. And then you see that in combination with, sometimes, a sodium drop, a little bit of subfebrile temperature; blood pressure shoot up sometimes, and that is a way the brain is sometimes regulating. But it's often a constellation of things, and I think it depends a little on the process that you're worried about. Dr Berkowitz: Yeah, that's very helpful. You just gave us some pearls for detecting deterioration related to vasospasm and subarachnoid hemorrhage; some pearls for detecting malignant edema in an MCA stroke or fourth ventricular compression in a large cerebellar stroke. Patients I find often very challenging to get a sense of what's going on and often get scanned over and over and back on EEG, not necessarily find something: patients with large intracerebral hemorrhage (particularly, in my experience, if the thalamus is involved) just can fluctuate a lot, and it's not clear to me actually what the fluctuation is. But you're looking for whether they're developing hydrocephalus from third ventricular compression with a thalamic hemorrhage (probably shouldn't be seizing from the thalamus, but if it's a large hemorrhage and cortical networks are disrupted and it's beyond sort of the subcortical gray matter, or has the hemorrhage expanded or ruptured it into the ventricular system?) And yet, you scan these patients over and over, sometimes, and just see it's the same thalamic hemorrhage and there's some, probably, just fluctuation level of arousal from the thalamic lesion. How do you, as someone who sees a lot of these patients, decide which patients with intracerebral hemorrhage - what are you looking for as far as deterioration? How do you decide who to keep scanning when you're seeing the same fluctuations? I find it so challenging - I'm curious to hear your perspective. Dr Wahlster: Yeah, no - that is a very tricky one. I mean, unfortunately, in patients with deeper hemorrhages or deeper lesions - you know, thalamic or then affecting brainstem - I think those are the ones that ultimately don't have good, consistent airway protection and do end up needing a trach, just because there's so much fluctuation. But I agree - it's so tricky, and I don't think I can give a perfect answer. I would say, a little bit I lean on the imaging. And for example - let's say there's a thalamic hemorrhage. We recently actually had a patient - I was on service last week - we had a thalamic hemorrhage with a fair amount of edema on it that was also kind of pressing on the aqueduct and didn't have a lot of IVH, right? But it was, like, from the outside pushing on it and where we ended up getting more scans. And I have to say, that patient actually just did fine and actually got the drain out and didn't need a shunt or anything, and actually never drained. We put an EVD and actually drained very little. So, I think we're still bad at gauging those. But I think, in general, my index of suspicion or threshold to scan would be lower if there was something, like, you know, a lot of IVH associated, if, you know, just kind of push on the aqueduct. It's very hard to say, I think. Sometimes, as you get to know your patients, you can get a little bit of a flavor of what is within normal fluctuation. I think it's probably true for every patient, right? - that there's always some fluctuation within the realm of like, “that's what he does,” and then there's something more profound. Yeah, sorry - I wish I could give a better answer, but I would say it's very tricky and requires experience and, ideally, you really taking the time to examine the patient yourself (ideally, several times). Sometimes, we see the patient - we get really worried. Or the typical thing we see the ICU is that the neurosurgeons walk around at 5 AM and say, like, “She's altered, she's different, she's changed.” And then the nurse will tell you at 8 AM, like, “No, they woke up and they ate their breakfast.” So, I think really working with your nurse and examining the patient yourself and just getting a flavor for what the realm of fluctuation is. Dr Berkowitz: Yeah - that's helpful to hear how challenging it is, even for a neurocritical care expert. I'm often taking care of these patients when they come out of the ICU and I'm thinking, “Am I scanning these patients too much?” Because I just don't sort of see the initial stage, and then, you know, you realize, “If I'm concerned and this is not fitting, then I should get a CT scan,” and sometimes you can't sort it out of the bedside. So, far from apologizing for your answer, it's reassuring, right, that sometimes you really can't tell at the bedside, as much as we value our exam. And the stakes are quite high if this patient's developed intraventricular hemorrhage or hydrocephalus, and these would change the management. Sometimes you have these patients the first few days in the ICU (for us, when they come out of the ICU) are getting scanned more often than you would like to. But then you get a sense of, “Oh, yeah - these times of day, they're hard to arouse,” or, “They're hard to arouse, but they are arousable this way,” and then, “When they are aroused, this is what they can do, and that's kind of what we saw yesterday.” And yet, as you said, if anyone on the team (the resident, the nurse, the student, our neurosurgery colleague) says, “I don't think this is how they were yesterday,” then, very low threshold to just go back and get a CT and make sure we're not missing something. Dr. Wahlster: Exactly. Yeah. I would say the other thing is also certain time intervals, right? If I'm seeing a patient that may be in vasospasm kind of around the days seven to ten, for the first fourteen day, I would be a little bit more nervous. Or with swelling - acute ischemic stroke says that could peak swelling, when knowing which [IG2]  , I would just be more anxious or have a lower threshold to scan. Yeah. Dr Berkowitz: Yeah - very helpful. Well, thank you so much for joining me today on Continuum Audio. Dr Wahlster: Thank you very much, Aaron. Dr Berkowitz: Again, today we've been interviewing Dr Sarah Wahlster, whose article, “Examination and Workup of the Neurocritical Care Patient” appears in the most recent issue of Continuum, on neurocritical care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice. And right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024 or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. AAN members: go to the link in the episode notes and complete the evaluation to get CME. Thank you for listening to Continuum Audio.

In 2011, Congress passed a resolution naming June "National CMV Awareness Month," to raise awareness about the most common congenital infection in the US, affecting 1 of 200 live births. It is the leading VIRAL cause of IUFD & miscarriage & the leading cause of neonatal hearing loss, second only to genetic causes. Furthermore, cCMV is more common than many other neonatal conditions, such as spina bifida and fetal alcohol syndrome. Neonates affected by the virus can experience a wide array of symptoms, from none to severe neurodevelopmental disability, & even death. However, public and healthcare provider awareness remains low. In this episode, which is part 1, we will cover the presentation, transmission, and work up of CMV in pregnancy.

Workup and management of Medulloblastoma in Radiation Oncology featuring guest Dr Steven Montalvo

Workup and management of LGG in Radiation Oncology featuring guest Dr Nancy Zhou

Anton is joined by the world's leading EM researcher in subarachnoid hemorrhage diagnosis Dr. Jeff Perry and EM-Stroke team clinician Dr. Katie Lin for a deep dive into why we still miss this life-threatening diagnosis, the key clinical clues, proper use of decision tools, indications for CT, indications for CTA, indications for LP and CSF interpretation for the sometimes elusive diagnosis of subarachnoid hemorrhage... Help support EM Cases by making a donation: https://emergencymedicinecases.com/donation/ The post Ep 194 Subarachnoid Hemorrhage – Recognition, Workup and Diagnosis Deep Dive appeared first on Emergency Medicine Cases.

Workup and management of GBM in Radiation Oncology featuring guest Dr Qian Zhang

On this episode of the BackTable MSK podcast, co-hosts Dr. Chris Beck and Dr. Aaron Fritts review the basics of bone lesion biopsy, including patient selection, imaging modalities, and procedural steps. They begin with summarizing indications for bone lesions, which are most common in the setting of metastatic disease. Patients usually get referred for biopsy when a bone lesion is caught on CT imaging of the chest, abdomen, and pelvis. The doctors emphasize that imaging multiple areas is needed to find the most easily accessible lesion, which is sometimes located within a solid organ, rather than within bone. While PET imaging can be useful for confirmation of sclerotic bone lesions, patients usually cannot receive PET scans without an established cancer diagnosis. Dr. Beck highlights the fact that lytic lesions with soft tissue components are technically easier to access than sclerotic lesions and result in higher yield. He occasionally uses a soft tissue biopsy needle for these lesions. For sclerotic lesions, he prefers the OnControl or Stryker bone biopsy coaxial systems. With the coaxial system, it can be hard to adjust the biopsy tract after you have already started drilling, but he recommends obtaining multiple cores at different angles of approach. He also advises listeners to choose the shortest needle possible, since this makes it easier to control and image the needle within the lesion.The doctors also discuss biopsy of tricky locations. Sternal lesions carry the risk of lung injury and pneumothorax, so when faced with these, Dr. Beck picks an oblique tract that has a longer trajectory. For lesions located in proximal extremities, he secures the limb to minimize movement. Next, disc biopsies are discussed. Patients usually present with discitis osteomyelitis from prior back surgery, IV drug use, or idiopathic causes. It is important to distinguish between infection of the disc space versus chronic degenerative disc disease, which can be identified by comparison with prior imaging and lab workup. For the lumbar spine disc biopsy, fluoroscopy is Dr. Beck's preferred imaging modality, and he reviews imaging landmarks. Dr. Fritts usually biopsies both bone and disc. Finally, they discuss post-procedural complications to watch for, such as chest x-rays in checking for lung injury and neurological exams to assess for new deficits. --- CHECK OUT OUR SPONSOR Stryker Interventional Spine https://www.strykerivs.com --- SHOW NOTES 00:00 - Introduction 03:12 - Referrals and Imaging Techniques for Bone Lesion Biopsy 07:09 - Procedural Steps of Bone Lesion Biopsy 12:32 - Choosing Biopsy Tools 23:22 - Approach to Tricky Biopsy Locations 28:19 - Workup and Indications for Disc Biopsy 32:08 - Fluoroscopy vs. CT for Disc Biopsy 40:15 - Handling Biopsy Samples 48:03 - Post-Procedure Care and Complications --- RESOURCES Arrow OnControl Powered Bone Biopsy System: https://irc.teleflex.com/oncontrolsystem/ Stryker Bone Biopsy Coaxial System: https://www.stryker.com/us/en/interventional-spine/products/bone-biopsy.html BD Trek Powered Bone Biopsy System: https://www.bd.com/en-us/products-and-solutions/products/product-families/bd-trek-powered-bone-biopsy-system Jamshidi Evolve Bone Marrow Needle: https://www.bd.com/en-us/products-and-solutions/products/product-families/jamshidi-evolve-bone-marrow-needle BD Illinois Sternal/Iliac Bone Marrow Aspiration Needles: https://www.bd.com/en-ca/products-and-solutions/products/product-families/illinois-sternal-iliac-bone-marrow-aspiration-needles BD Mission Disposable Core Biopsy Instrument: https://www.bd.com/en-us/products-and-solutions/products/product-families/mission-disposable-core-biopsy-instrument Disc Biopsy Visualization Website: https://www.pediatricir.com/disc-aspiration-for-discitis.html

Radiology read to you! Frank reads our spontaneous intracranial hypotension article to neuroradiologist and CSF leak expert Lalani Carlton Jones. Workup and management of CSF leaks has evolved rapidly over recent years so this will be a much needed update for many listeners.  Radiopaedia's spontaneous intracranial hypotension article  ► https://radiopaedia.org/articles/spontaneous-intracranial-hypotension-2 Radiopaedia's CSF venous fistula article ► https://radiopaedia.org/articles/csf-venous-fistula Radiopaedia 2024 Virtual Conference ► https://radiopaedia.org/courses/radiopaedia-2024-virtual-conference Become a supporter ► https://radiopaedia.org/supporters Get an All-Access Pass ► https://radiopaedia.org/courses/all-access-course-pass Andrew's X ► https://twitter.com/drandrewdixon Frank's X ► https://twitter.com/frankgaillard Ideas and Feedback ► podcast@radiopaedia.org   The Reading Room is a radiology podcast intended primarily for radiologists, radiology registrars and residents. 

Ongoing healthcare workforce shortages have prompted hospitals and health systems to expand educational and internship programs to better engage young people in pursuing careers in healthcare. For the past two weeks, Gist Healthcare Daily has highlighted initiatives underway at University Hospitals in Cleveland, Ohio to attract high school students to the healthcare industry. Today, host J. Carlisle Larsen speaks with Zach Fleitman, founder and CEO of Workup Health, to learn more about how the talent pipeline management platform works with health systems– including University Hospitals– to help them track and evaluate the impact of their youth outreach programs. You can find JC's two-part conversation with Celina Cunanan of University Hospitals at the links below:How University Hospitals in Cleveland Engages with Youth in its Communities to Build its Talent Pipeline (March 4, 2024)Continuing the Conversation: Celina Cunanan of University Hospital about the importance of talent pipeline development, diversifying the provider workforce (March 12, 2024) Hosted on Acast. See acast.com/privacy for more information.

You get called to see a consult in the middle of the night. It is a middle-aged woman with a bariatric history, and she says her stomach is smaller but doesn't know the name of the operation. She developed worsening abdominal pain after dinner and it's been getting worse. She's not peritonitic, but she's clearly in discomfort. Is it cholecystitis, diverticulitis, pancreatitis, marginal ulcer, or an internal hernia? What do you do? Join Drs. Matthew Martin, Adrian Dan, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias.  Show Hosts: Matthew Martin Adrian Dan Paul Wisniowski Show Notes 1.     Initial Evaluation a.     Focused history and physical, labs, and imaging                                       i.     Presenting symptoms may vary and include: nausea, emesis, and abdominal pain ranging from vague to severe.                                        ii.     A basic lab panel can aid in developing the diagnosis and guide resuscitation.                                     iii.     CT of the abdomen and pelvis with IV and oral contrast can assist in identifying intra-abdominal pathology                                     iv.     Reviewing the previous operative report is beneficial to have a framework of the anatomy, i.e. type of bariatric surgery, and configuration of small bowel limbs (ante- vs retro-gastric and ante- vs retro-colic). 1.     According to a 2019 study, 40-60% of closed defects had reopened at time of re-exploration                                       v.     If the patient is peritonitic with abdominal pain, they should be treated similarly to any patient with an acute abdomen with emergent exploration. b.     CT Imaging                                        i.     A mesenteric swirl sign with twisting of the soft tissue and mesenteric vessels with surrounding fat attenuation has been shown to have a sensitivity of 78-100% and specificity of 80-90%. Other findings include: a Bird's beak, dilation of roux or biliopancreatic limbs, SMV narrowing, and displacement of JJ limb to the RUQ and can be used to support the diagnosis of internal hernia                                      ii.     An experienced radiologist familiar with bariatric anatomy has been shown to have a positive predictive value to 81% and negative predictive value to 96% at radiologically diagnosing internal hernia.                                      iii.     A CT scan can provide insight for a suspected diagnosis but it cannot rule out internal hernia c.      Nasogastric/Esophageal Tube                                       i.     Use judiciously based on patient's presenting symptoms                                      ii.     Placement should be done by the surgical team                                      iii.     This may mitigate the risk of aspiration during intubation. 2.     Operative Management a.     Entry should be dependent on the comfort of the operating surgeon.                                        i.     Veress entry into the abdomen with dilated bowels may lead to increased injuries.                                       ii.     Optiview allows for direct visualization of each layer of the abdominal wall. Focusing on twisting the trochar and limiting perpendicular pressure.                                      iii.     Hasson entry also allows for direct visualization but may be limiting in bariatric patients with thick abdominal walls b.     Exploration – a systematic approach                                       i.     Start with evaluation of the gastric pouch and run the roux limb to the jejunojejunostomy, and examine Petersen's and mesojejunal defects.                                       ii.     Follow the biliopancreatic limb to the ligament of Treitz                                     iii.     Lastly, identify the terminal ileum at the sail of Treves and run backwards to the jejunojejunostomy                                     iv.     This will allow for examination of all possible defect and possible intussusception at the jejunostomy c.      Defect Management                                       i.     All defects should be closed, with studies demonstrating reduced rates of internal hernia when defects are closed with a running suture. There is no strong evidence to support the use of a specific suture material. 1.     The use of suture is superior to other methods of closure such as metallic clips, fibrin glue, mesh, or abrasive pads. 2.     A barbed suture can be considered. d.     In a patient with unfavorable anatomy or those unable to tolerate pneumoperitoneum surgeons should consider early conversion to open exploration  3.     Postoperative Care a.     Patients are started on ERAS protocol with limited narcotic use, same day mobilization, early oral nutrition with advancement, and no nasogastric tubes or foley catheters b.     Patients with bowel resection and those with suspected postoperative ileus may benefit from judicious advancement of diet. 4.     Pregnancy a.     Pregnant patients with history of anastomotic bariatric surgery are at increased risk of internal hernia especially in 3rd trimester due to loss of intra-abdominal space b.     Evaluation of a pregnant patient should include abdominal imaging.                                        i.     In a non-acute setting, an MRI abd/pelvis can be considered.                                       ii.     Patients with abdominal pain presenting to the Emergency Department should undergo CT imaging.                                     iii.     The risk of radiation to a fetus, especially beyond the 1st trimester, is limited. Based on the CDC guidelines, a human embryo and fetus are sensitive to ionizing radiation at doses greater than 0.1Gray. The amount of radiation from a typical CT range from 0.015 to 0.034Gray depending if it is multiphasic or not; well below the guideline level. c.      It is important to discuss with women of child bearing age the risk of internal hernia during pregnancy with anastomotic bariatric surgery 5.     Outpatient Presentation a.     Half of patients with internal hernia will present in outpatient setting often >6 months after initial operation with complaints of intermittent nausea, vomiting, and abdominal pain b.     Workup includes: CT abd/pelvis with IV and oral contrast, Upper GI series, EGD, and a RUQ ultrasound based on their symptoms c.      If diagnostic testing is equivocal, proceed with diagnostic laparoscopy to mitigate the risk of internal hernia with bowel ischemia. **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen

Welcome back to another enlightening episode with Hormones Demystified! In this eagerly anticipated Round 2, we delve into one of the most misunderstood aspects of health and weight loss: thyroid and thyroid testing. If you missed our first episode (Episode 11), make sure to catch up for a profound exploration of functional and integrative medicine. Key Highlights: Symptoms and Workup of Hypothyroidism: Briefly explaining hypothyroidism symptoms and when seeking medical advice is crucial. Unpacking the intricacies of thyroid blood testing and understanding the half-lives of T3 and T4 hormones. Reliability of TSH Measurement: Discussing the reliability of TSH measurement in diagnosing hypothyroidism. Differences in Testing Approaches: Contrasting conventional thyroid testing with alternative medicine clinician approaches. Reverse T3 Testing: Exploring the reasons behind ordering a reverse T3 test. Endocrinological Treatment of Hypothyroidism: Insights into how Endocrinologists treat hypothyroidism and the recommended medications. Alternative Medicine Approaches: Understanding alternative medicine providers' treatments and the use of pig thyroid vs. levothyroxine. BOVINE Thyroid in Products: Examining potential effects of products containing bovine thyroid. Usage of Pig Thyroid by Clinicians: Discussing why some clinicians prescribe pig thyroid and its potential benefits. T3 Replacement Benefits: Exploring the benefits of T3 replacement and its impact on subsequent laboratory tests. Endocrinologists and T3 Replacement: Unraveling situations where Endocrinologists might consider T3 replacement. Refuting Alternative Medicine Claims: Debunking the claim that escalating doses of T3 are necessary for persistent hypothyroid symptoms. Optimizing Thyroid Health through Lifestyle: Advice for patients interested in optimizing thyroid health through diet and lifestyle choices. Impact of Nutrients on Thyroid Function: Discussing the role of nutrients like selenium and zinc on thyroid function. Subclinical Thyroid Diagnosis: Unpacking subclinical thyroid diagnosis and lifestyle/dietary changes before medication considerations. Join us in this comprehensive exploration as we demystify the complexities of thyroid testing, offering valuable insights and debunking common misconceptions. Get ready for another informative journey into the world of hormones! Coach VinnyEmail: vinny@balancedbodies.ioInstagram: vinnyrusso_balancedbodiesFacebook: Vinny Russo Dr. ErynEmail: dr.eryn@balancedbodies.ioInstagram: dr.eryn_balancedbodiesFacebook: Eryn Stansfield Hormones DemystifiedWebsite / Blog: https://hormonesdemystified.com/ LEGION 20% OFF CODEGo to https://legionathletics.com/ and use the code RUSSO for 20% off your order!

Episode 119. Hear about my lab results from my first appointment with my midwife and what testing was recommended for my irregular periods. I also mention which fertility supplements were recommended to me and which ones I found to be beneficial. Editing Service for Pre-Med and Medical Students (CV, personal statement, applications): ⁠https://www.fiverr.com/firstlinepod⁠  Visit First Line's website and blog: ⁠https://poddcaststudios.wixsite.com/firstlinepodcast⁠ For a discount off your TrueLearn subscription use link: ⁠https://truelearn.referralrock.com/l/firstline/⁠ and code: firstline Instagram: @firstlinepodcast Facebook: ⁠www.facebook.com/firstlinepodcast⁠ Email: firstlinepodcast@yahoo.com Content on First Line is for educational and informational purposes only, not as medical advice. Views expressed are my own and do not represent any organizations I am associated with.

In this episode, Dr. Sujana Chandrashekar, neurotologist with New York City's ENT and Allergy Associates, joins host Dr. Ashley Agan to discuss labyrinthitis. The podcast begins by reviewing the clinical presentation of labyrinthitis, drawing on Dr. Agan's personal experience with the condition. Then, Dr. Chandrashekar explains in-depth the physical exam of the dizzy patient, focusing on differentiating central vestibular lesions (such as strokes) from peripheral ones (such as labyrinthitis). While labyrinthitis is a self-limited condition, Dr. Chandrashekar shares strategies to mitigate the associated nausea, imbalance, and hearing loss patients find debilitating. Finally, the surgeons discuss how vestibular physical therapy and adequate rest enable prompt recovery. --- SHOW NOTES 00:00 - Introduction 01:22 - Discussion of and Personal Experience with Labyrinthitis 08:14 - Recovery and Treatment of Labyrinthitis 11:01 - Examination and Workup of Labyrinthitis 16:11 - Understanding Nystagmus in Labyrinthitis 20:29 - Further Testing and Examination for Labyrinthitis 33:49 - Treatment for Labyrinthitis 40:53 - The Role of Physical Therapy 43:12 - Follow-up and Recovery --- RESOURCES Dr. Chandrashekar's ENT and Allergy Associates Profile: https://www.entandallergy.com/find-a-doctor/sujana-s-chandrasekhar-md-facs/ Backtable ENT Ep. 87 – “Sudden Sensorineural Hearing Loss with Dr. Sujana Chandrashekar:” https://www.backtable.com/shows/ent/podcasts/87/sudden-sensorineural-hearing-loss “The Ten-Minute Examination of the Dizzy Patient,” J.A. Goebel: https://pubmed.ncbi.nlm.nih.gov/11774054/ “She's On Call” Podcast featuring Dr. Sujana Chandrashekar and Dr. Maurina Kurian: https://podcasts.apple.com/us/podcast/shes-on-call-weekly-medical-show/id1582727930 “Otolaryngologic Clinics” Podcast hosted by Consulting Editor Sujana S. Chandrasekhar, features in-depth discussions and commentary on the articles in each issue by the guest editors themselves. Otolaryngologic Clinics (Elsevier) on Apple Podcasts

In this podcast, expert clinicians will discuss current guidelines for clinical assessment of IRDs and the importance of interprofessional collaborative care.

In this episode, host Dr. Ashley Agan discusses management of synkinesis with Dr. Shiayin (Shi) Yang, facial plastic surgeon at Vanderbilt University Medical Center. The surgeons begin by defining synkinesis, a condition in which voluntary facial muscle movement triggers involuntary contraction of other facial muscles. Though the pathophysiology of synkinesis remains incompletely understood, damage to and aberrant “rewiring” of the facial nerve is thought to trigger these symptoms. Causes of synkinesis include Bell's Palsy, facial tumors, and intra-operative injury. Dr. Yang explains the importance of appropriate patient counseling, especially given the misperception that synkinesis is a “disease of vanity.” The discussion then transitions to treatment options, including physical therapy, Botox injections, and surgical intervention (including myectomy and selective neurectomy). The podcast finishes with Dr. Yang's insights into the mental health impact of synkinesis. --- SHOW NOTES 00:00 – Introduction 02:26 – Understanding Synkinesis 05:08 – Common Patient Presentations 06:11 – Importance of Early Treatment and Patient Education 07:48 – Referral and Timeliness of Treatment 09:35 – Pathophysiology of Nerve Rewiring 12:11 – Workup and Diagnosis 17:57 – Treatment Options: Botox Therapy 25:51 – Treatment Options: Surgical Interventions 30:31 – Long-term Management and Expectations 33:27 – Eye Protection in Facial Paralysis 37:16 – Mental Health Impact of Synkinesis 38:27 – Conclusion and Contact Information --- RESOURCES Dr. Yang's Vanderbilt University Medical Center profile: https://search.vanderbilthealth.com/doctors/yang-shiayin

Asavari and Rachel review three patient cases and the infertility workup for each case with Dr. Moravek. 00:38: Dr. Moravek Bio 01:43: Infertility Introduction and Definitions 03:24 Case 1: 29yo G0 woman with irregular periods, acne, and weight gain 11:26 Case 2: 32yo G0 woman with a history of a sexually transmitted infection 18:22 Case 3: 38yo G2P2 woman with difficulty becoming pregnant  Transcript: https://bit.ly/ultrasounds_infertility References: ACOG committee opinion, number 781: Infertility workup for the women's health specialist AAFP Diagnosis and Treatment of Polycystic Ovarian Syndrome AAFP Polycystic Ovarian Syndrome Common Questions and Answers AAFP Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention ASRM Ovarian Reserve (predicting fertility potential in women) Michigan Medicine OB/GYN Infections Guidelines The Normal Menstrual Cycle and the Control of Ovulation Khan Academy Ovarian Cycle Video Additional Resources for LGBTQ+ Health and Infertility: ACOG committee opinion no. 749: Marriage and Family building Equality for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Gender Nonconforming Individuals ASRM Access to Fertility Services by Transgender and Nonbinary persons: an Ethics Committee Opinion Since this podcast was recorded, ASRM has expanded the definition of infertility to be more inclusive. Infertility includes any of the following factors: 1) the inability to achieve a successful pregnancy based on a patient's medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors OR 2) the need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner, OR 3) in patients having regular, unprotected intercourse and without any known etiology for either partner suggestive of impaired reproductive ability, evaluation should be initiated at 12 months when the female partner is under 35 years of age and at 6 months when the female partner is 35 years of age or older.

This week on BackTable Urology, Dr. Jose Silva and Dr. David Sas, a pediatric nephrologist at the Mayo Clinic-Rochester, discuss clinical presentation and prevention of kidney stones in children as well as workup of metabolic diseases. --- SHOW NOTES First, David explains how laboratory and genetic tests can be useful when determining the cause of kidney stones. Obtaining a 24-hour urine sample and analyzing stone composition are important for understanding the causes of stone formation in teenagers. Environmental and genetic factors can also contribute to the formation of stones. For example, CYP24A1 mutation a gene can cause a hypersensitivity to vitamin D and calcium in the diet. Next, David and Jose discuss lifestyle modifications for preventing stones in teenagers. They talk about how to limit sodium intake, the use of thiazide diuretics, and supplementing potassium citrate for calcium oxalate stones. Furthermore, they delve into the causes of hyperoxaluria, which are genetic primary hyperoxaluria and enteric hyperoxaluria. Additionally, they discuss the rare monosodium urate stones, which are usually associated with metabolic acidosis but can be caused by chronic diarrhea or eating a lot of protein. The doctors end by discussing the challenges of transitioning pediatric management to adult management. Lastly, they discuss the potential causes of why more kids are forming stones, such as increasing sweet juices and fast food in the diet.

Dr. Ami Kapadia leads us in a discussion about the step by step thought process in working up a fatigue GI patient. In this episode we discuss: Fatigue and sleep Sleep hygiene and fatigue Lifestyle hygiene for fatigue Blood sugar's relationship to fatigue Intermittent fasting and fatigue Alcohol and fatigue Caffeine and fatigue Anti-histamines that can affect fatigue Supplements that can affect fatigue Ami Kapadia, MD, ABFM, ABIHM” - ⁠⁠⁠https://www.amikapadia.com/⁠⁠⁠ Rebecca Sand ND, LAc, MSOM - ⁠⁠https://www.drrebeccasand.com/⁠⁠ Ilana Gurevich ND, FABNG, LAc, MSOM - ⁠https://www.naturopathicgastro.com/⁠

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. 00:00:07 - Historical Background and Definitions 00:01:56 - Admitting a Patient with Sepsis 00:05:29 - Plan for Workup and Management of Sepsis 00:07:41 - Clinical Pearls 00:16:07 - If You Remember Nothing Else

In this episode, Dr. Mark Hoffman invites Dr. Ted Lee, an OBGYN specializing in MIGS and professor of OBGYN at University of Pittsburgh Medical Center, about the ambulatory workup of endometriosis patients. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/bT7a9b --- SHOW NOTES The episode begins with the physicians discussing the difficulties of diagnosing endometriosis, including: the stigma of pelvic pain/not believing women's pain, recognition that pelvic pain is not normal, the discomfort of physicians asking the appropriate questions for pelvic pain, and the hesitancy towards surgery by physicians and patients all play a role. Many patients have been having pain for years that may have been covered up by OCP use or misdiagnosed as IBS or interstitial cystitis. Ted emphasizes the importance of a thorough history in diagnosing endometriosis. Essential information includes age of onset of symptoms, gravidity and parity, prior C-section (abdominal wall endometriosis) and the “3 D's” of dyspareunia, dyschezia, and most importantly dysmenorrhea. A quality physical exam can also elucidate endometriosis. Ted starts by palpating the anterior vaginal wall, then the levator ani muscles and cervix, and finally the rectovaginal exam. Palpation of the uterosacral ligament and posterior cul-de-sac in endometriosis patients causes a visceral reaction, and advanced disease may also have nodules felt. The majority of patients don't require additional imaging since ultrasound is insensitive for stage 1 and 2 endometriosis. Indications for MRI include endometrioma, nodularities felt on exam, and abdominal wall endometriosis. When it comes to surgery, both doctors emphasize the importance of having other surgeons on your team, including colorectal surgery, general surgery, and urology. Ted dives into some surgical tips and techniques from his years of experience. Finally, the physicians end by discussing the future of endometriosis diagnosis. A Japanese study has recently found fusobacterium in the uterine microbiome in endometriosis patients more often than those without. Also, a French study has taken saliva samples and found signature microRNAs for endometriosis. It will be interesting to see how studies like these change the future of endometriosis diagnosis and if it will bring new challenges, such as overtreatment and overdiagnosis. --- RESOURCES Muraoka, A., Suzuki, M., Hamaguchi, T., Watanabe, S., Iijima, K., Murofushi, Y., Shinjo, K., Osuka, S., Hariyama, Y., Ito, M., Ohno, K., Kiyono, T., Kyo, S., Iwase, A., Kikkawa, F., Kajiyama, H., & Kondo, Y. (2023). Fusobacterium infection facilitates the development of endometriosis through the phenotypic transition of endometrial fibroblasts. Science translational medicine, 15(700), eadd1531. https://doi.org/10.1126/scitranslmed.add1531 Bendifallah, S., Suisse, S., Puchar, A., Delbos, L., Poilblanc, M., Descamps, P., Golfier, F., Jornea, L., Bouteiller, D., Touboul, C., Dabi, Y., & Daraï, E. (2022). Salivary MicroRNA Signature for Diagnosis of Endometriosis. Journal of clinical medicine, 11(3), 612. https://doi.org/10.3390/jcm11030612

We discuss the diagnosis and management of septic arthritis in the pediatric population. Hosts: Brian Gilberti, MD Ellen Duncan, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Septic_Joint_in_Children.mp3 Download 2 Comments Tags: Infectious Diseases, Pediatrics Show Notes General Pain in joint for pediatric patient has a broad differential, including transient synovitis and septic arthritis Transient synovitis, also known as toxic synovitis, is a common condition affecting kids aged 3-10 and often occurs after a viral infection. It is typically self-limiting and not considered a serious condition. Septic arthritis is an infection in the joint space, typically affecting only one joint. It is often difficult to diagnose due to the fact that many patients, particularly under the age of 3, may not be able to localize their pain to a specific joint. Workup Diagnostic work-up for septic arthritis begins with blood work, which includes a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood cultures. Lyme disease studies may also be necessary since Lyme disease can cause joint pain.

Join our panel of experts, Dr. Neal Shore, Dr. Ben Lowentritt, Dr. Ted Schaefer, and Dr. Jonathan Tward, as they discuss the various components and utility of a full workup for localized prostate cancer. They explore the importance of germline testing and how it has significant implications for personalized treatment choices. They will also discuss and examine the use of traditional biomarkers like PSA, PSA density, kinetics, and the Gleason grade system, as well as newer advancements in molecular markers and the potential use of artificial intelligence. Tune in as our experts share their insights, experiences, and expectations for the future of prostate cancer care.

Full article: https://www.ajronline.org/doi/10.2214/AJR.23.29340  Wenhui Zhou, MD, PhD reviews a recent AJR article that explored the feasibility of pulmonary MRA for evaluating pulmonary embolism during a contrast media shortage in 2022. The results of this study highlight the value of pulmonary MRA as a practical alternative to pulmonary CTA, especially in emergency settings. 

In this episode, host Dr. Mark Dubin speaks with Dr. Jose Mattos and Dr. Spencer Payne. They discuss their recently published article: Evaluation and workup of immunodeficiencies in recurrent acute rhinosinusitis: A scoping review. Please note that an unedited version of this episode posted in error earlier this month. Wiley sincerely apologizes for this error. […]

Workup and management of Seminoma in Radiation Oncology featuring guest Dr Rachel Shenker

The fundamentals of what you need for your patient encounters and board exams. In this episode we'll discuss a little epidemiology and pathophys, but focus heavily on the clinical presentation and workup. Part 2 will come out soon and focus on the management of systemic sclerosis. Thank you for taking a couple minutes to do the survey :) Survey link here: https://docs.google.com/forms/d/e/1FAIpQLSd6QbrO0kJDzRE8t4fZPIFw1CA9nTw6Qk3Z1FVmCRpt8EdLSg/viewform?usp=sf_link

The workup and management of breast cancer is complex! In this next series, we will dissect this topic inside and out. We will are so excited to be kicking off this series with special guest, Dr. Yasha Gupta to shed light on the role of our friendly breast radiologists and the very important role they/their team plays in the initial diagnosis and workup for a patient with a breast mass.Content:- Fundamentals of breast cancer screening- Difference between screening and diagnostic mammogram- What is "BI-RADS"?- Workup of a concerning breast mass - What are marker clips? How do we use these clinically? - Role of tomosynthesis - How are the axillary lymph nodes assessed? ** About our Guest: A huge thank you to Dr. Yasha Gupta from Memorial Sloan Kettering for joining us! ** Help us as we continue to grow our show by filling out this BRIEF survey! Link: https://forms.gle/KBhDRTGBqRJ1CgnK7Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Depending on the underlying cause of a neck mass, treatment may involve antibiotics, anti-inflammatory medications, surgical removal, or other interventions as needed. Early detection and prompt neck mass treatment can help prevent complications and improve patient outcomes. What is the best approach for neck masses? How do you refer a patient after a workup and diagnosis? Here to help guide us through the steps is Dr. Ben Hechler, an oral maxillofacial surgeon practicing in North Carolina. In our conversation, Dr. Hechler walks us through the basics of diagnosing and treating neck masses, and the best approach for referring patients. We discuss the leading causes of neck masses, the symptoms of neck masses, and how to approach treatment. Learn what the best imaging tools for evaluation are, whether ultrasound can be used to evaluate a neck mass, the different ways of performing a biopsy, the likelihood of neck masses with no associated symptoms, how to deal with patient expectations, why it is crucial to assume a cyst is cancer, and more. To learn everything you need to know about neck masses and how to treat them, tune in now. Key Points From This Episode:Why every dentist should have a basic understanding of neck masses.An outline of the major causes of neck masses. The difference between how neck masses manifest in adults and children.How to best perform a physical exam and identify any problems.Describing neck masses effectively to other doctors and patients.Find out how Dr. Hechler characterizes a neoplastic mass.Symptoms in the neck that are helpful for diagnosis.What to keep in mind when diagnosing and treating patients.Our guest us about the ideal imaging modalities to further evaluate neck masses.The steps involved for definitely diagnosing a neck mass and performing a biopsy.Dr. Hechler explains what type of biopsy requires anesthesia.We review the different types of lesions and how to treat them.We briefly discuss salivary gland tumors that present as neck masses.How to effectively diagnose and treat developmental cysts.Essential aspects to remember when referring patients.Links Mentioned in Today's Episode:Ben Hechler on LinkedIn — https://www.linkedin.com/in/ben-hechler/Duke University Health System — https://www.dukehealth.org/Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059KLS Martin promo code EOSExo22 — https://www.klsmartin.com/ 

DM “FAT LOSS” to @‌COLOSSUSFIT to lose 20+lbs of fat in 90 days.In today's episode we are going to give you 10 easy tips to drop body-fat fast. Track Your Macros - Otherwise you're guessing. Hope cannot be a plan.80-90% of your food should be whole food/ micronutrient dense high quality food, the other 10% can be anything to help you have balance, not be restricted and maintain your deficitAim for 25-40g of fiber (Most adults eat less than 15g a day.Workup to 1g of protein for the bodyweight you want to be. It can be more complicated than this but this is a great starting point.Cut out the cheat meals and win the weekends.Carbs and fats are pretty interchangeable at this point, eat what you're comfortable with.5x quality training sessionsFind a realistic solution to scaling cardio. I recommend avoiding huge sessions, instead start with step goals, moderate sessions 3-5x a week and scale from there. Often times you can either avoid cardio and eat less, or do more cardio and eat more. Know what you're comfortable with. Saying so, cardio should never been a punishment.Adapt - This will work, but you will have to continue to make adjustments.Stay consistent, accept progress isn't a linear line, it's a spiral with ups and downs, push through them.Notice we didn't say anything about supplements, waist trainers or any other gimmicks. These tips aren't sexy but they are proven.“Day one, or one day.” - You decide.Listed points:Thanks for listening! We genuinely appreciate every single one of you listening.➢Follow us on instagram @‌colossusfit➢Apply to get your Polished Physique: https://colossusfitness.com/Support the show

My guest this week is Dr. Amie Hornaman also deemed, “The Thyroid-Fixer”. In this episode, Dr. Amie and I discuss functional medicine workup and protocols for thyroid imbalances. First, we talk about the conglomeration of symptoms those with thyroid imbalances may be experiencing, how the autoimmune switch gets turned on & possible underlying causes of thyroid issues, what role gluten plays in thyroid health, as well as the various thyroid hormones, especially T2.  Dr. Amie shares how to get into “optimization land”; starting with the one question all physicians need to be asking and often don't, what thyroid labs you need to ask your physician for, why we need Iodine and how to supplement (pool swimmers, listen up!), and tips for weight loss, fasting, cold therapy, and more.   Learn more about Dr. Aime and her thyroid support products at here and use code NAT10 for 10% off.     ------     Follow Dr. Amie: Website Facebook Instagram YouTube     ------     Episode Sponsors Oxford HealthSpan brings us Primeadine, which upregulates autophagy and mitophagy, helps the immune system to rejuvenate plus it protects DNA and supports deep sleep, hair skin and nails!  It's a staple in my supplement stack! If you haven't tried it yet, go to Primeadine's website to learn more and use promo code BIONAT15 to save 15%.   Mitopure from Timeline Nutrition is a scientific breakthrough for our cells. Ten years of research has led to the discovery of Urolithin A; a mitochondrial powerhouse that assists in mitophagy, protecting cells from cellular decline. Mitopure is clinically proven to enhance muscle health and performance. It comes in a powder, capsules or a berry powder (it tastes good!). There is a 3-month trial so you can try them all! To learn more, visit www.timelinenutrition.com and use code NAT10 for 10% discount!     ------     Episode Takeways [06:50] Let's talk about thyroid & what symptoms to look out for?… [09:50] Why are so many people having thyroid issues?.. [12:30] Is gluten bad for the thyroid?.. [17:30] What are the basic thyroid tests people need?.. [30:50] The importance of being in a functional lab value range… [32:00] What should we be looking for as far as ideal lab ranges?.. [35:28] How to help your thyroid with food, thyroid replacement and supplements… [52:30] Fasting and thyroid… [57:10] Dr. Amie's unique thyroid support supplement line…     ------     Follow Nat Facebook Facebook Group  Instagram Work with Nat: Book Your 20 Minute Optimization Consult

In this main episode podcast on ED risk stratification and workup of the febrile infant, recorded at the CAEP 2022 Conference in Quebec City with Dr. Brett Burstein and Dr. Gary Joubert, we answer such questions as: Which febrile infants require lumbar puncture? How accurate is procalcitonin in identifying low risk febrile infants? What is the difference between serious bacterial infection (SBI) and invasive bacterial infection (IBI) and why is this important in the work up of the febrile infant? How do the PECARN, Step-by-Step and Aronson decision tools for identifying febrile infants at low risk for IBI and SBI? Can EM Cases incorporate all these decision tools and the upcoming Canadian Pediatric Society position statement on febrile infants recommendations into one concise algorithm? and many more... The post Ep 173 Febrile Infant – Risk Stratification and Workup appeared first on Emergency Medicine Cases.