A cool ID case, a stupid joke and a factoid you can use. What more do you need?
Rank #1: A Gobbet o' Pus 808: Belize Boil.
Adventures of a Pus Whisperer.
Rank #2: A Gobbet o' Pus 1018: What is worse: Candida on a valve or in the esophagus..
Adventures of a Pus Whisperer.
The Infectious Diseases Society of America's Guideline Update presents concise summaries of IDSA guidelines. For details of the guidelines, please go to www.idsociety.org .Host: Neil S. Skolnik, M.D., Professor of Family and Community Medicine, Temple University School of Medicine, Associate Director, Family Medicine Residency Program, Abington Memorial Hospital.
Rank #1: Skin and Soft Tissue Infections 2014 - IDSA Guideline Update.
The Infectious Diseases Society of America's Guideline Update presents concise summaries of important IDSA guidelines. This podcast discusses the IDSA Clinical Practice Guideline for Diagnosis and Management of Skin and Soft Tissue Infections: 2014 . For details of the guidelines presented, please go to www.idsociety.org . Presented by: Neil S. Skolnik, M.D., Professor of Family and Community Medicine, Temple University School of Medicine, Associate Director, Family Medicine Residency Program, Abington Memorial Hospital. Dr. Dennis L. Stevens, Chief, Infectious Diseases Section, VA Medical Center, Boise, ID.
Rank #2: Streptococcal Pharyngitis - IDSA Guideline Update.
The Infectious Diseases Society of America's Guideline Update presents concise summaries of important IDSA guidelines. This podcast discusses the IDSA Clinical Practice Guideline for Diagnosis and Management of Group A Streptococcal Pharyngitis. For details of the guidelines presented, please go to www.idsociety.org .Presented by: Neil S. Skolnik, M.D., Professor of Family and Community Medicine, Temple University School of Medicine, Associate Director, Family Medicine Residency Program, Abington Memorial Hospital. Standord T. Shulman, MDChief, Division of Infectious Diseases Ann & Robert H. Lurie Childrens's Hospital of ChicagoVirginia H. Rogers Professor of Pediatric Infectious DiseasesNowthwestern University Feinberg School of Medicine
A podcast highlighting key articles in the current issue of Emerging Infectious Diseases, a journal from the Centers for Disease Control and Prevention (CDC).
Rank #1: The Mother of All Pandemics.
Dr. David Morens, of the National Institute of Allergy and Infectious Diseases, discusses the 1918 influenza pandemic.
Rank #2: Ethics of Infection Control.
Dr. Babette Rump, an infectious disease physician and doctoral candidate at the RIVM National Institute of Public Health and the Environment in the Netherlands, discusses ethical issues around infection control for antimicrobial resistance.
Intended for the medical professional who enjoys learning for the sake of it. Dr. Porat is a practicing Colorado Hospitalist and Board Certified in Internal Medicine.
Rank #1: Pneumonia - Part 1.
Does the patient really have pneumonia? Differential diagnosis and mimics are considered in this common clinical problem. Dive deeper into how microbes and the immune system interact in lower respiratory infections.
Rank #2: Pulmonary Embolism - part 1.
The topics covered are D-Dimer testing, false positive over-diagnosis of PE on CT scanning, the ADJUST-PE study, and clinical signs and symptoms of a pulmonary embolism.
Bedside Rounds is a storytelling podcast about medical history and medicine’s intersections with society and culture. Host Adam Rodman seeks to tell a few of these weird, wonderful, and intensely human stories that have made modern medicine.
Rank #1: 3 - Dark Winter.
In episode 3 of Bedside Rounds, I talk about the human triumph of small pox vaccination, and discuss the government exercise called Dark Winter which simulated a bioterrorism attack on the United States.
Rank #2: 45 - The French Disease at 500.
In 1495, a mysterious and deadly plague struck the city of Naples. Over the next 500 years, the medical attempts to understand and treat this new disease -- syphilis -- would mold and shape medicine in surprising ways. In this episode, Tony Breu and I will perform an historical and physiological biography of syphilis, covering the development of germ theory, epic poetry, mercury saunas, intentionally infecting patients with malaria, magic bullets, and lots and lots of experiments on poor rabbits. This presentation was performed live at the American College of Physicians’ national meeting in Philadelphia on April 11, 2019. Sources (WARNING -- LONG LIST): Swain, K. ‘Extraordinarily arduous and fraught with danger’: syphilis, Salvarsan, and general paresis of the insane. Lancet Psychiatry 5, (2018). Kępa, M. et al. Analysis of mercury levels in historical bone material from syphilitic subjects – pilot studies (short report). Kępa Małgorzata 69, 367-377(11) (2012). Forrai, J. Syphilis - Recognition, Description and Diagnosis. (2011). doi:10.5772/24205 Parascandola, J. From mercury to miracle drugs: syphilis therapy over the centuries. Pharm Hist 51, 14–23 (2009). Eisler, C. Who Is Dürer’s ‘Syphilitic Man’? Perspect Biol Med 52, 48–60 (2009). Rothschild, B. M. History of Syphilis. Clin Infect Dis 40, 1454–1463 (2005). Schwartz, R. S. Paul Ehrlich’s Magic Bullets. New Engl J Medicine 350, 1079–1080 (2004). Fee, E. The wages of sin. Lancet 354, SIV61 (1999). O’Shea, J. ‘Two Minutes with Venus, Two Years with Mercury’-Mercury as an Antisyphilitic Chemotherapeutic Agent. J Roy Soc Med 83, 392–395 (1989). Mahoney, J., Arnold, R., Sterner, B. L., Harris, A. & Zwally, M. Penicillin Treatment of Early Syphilis: II. Jama 251, 2005–2010 (1984). Waugh, M. Role played by Italy in the history of syphilis. Sex Transm Infect 58, 92–95 (1982). Thorburn, A. Fritz Richard Schaudinn, 1871-1906: protozoologist of syphilis. Sex Transm Infect 47, 459–461 (1971). CROSBY, A. W. The Early History of Syphilis: A Reappraisal. Am Anthropol 71, 218–227 (1969). Clark, E. G. & Danbolt, N. The Oslo study of the natural history of untreated syphilis An epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material a review and appraisal. J Chron Dis 2, 311–344 (1955). MUNGER, R. S. Guaiacum, the Holy Wood from the New World. J Hist Med All Sci IV, 196–229 (1949). Thomas, E. & r, W. Rapid Treatment of Early Syphilis with Multiple Injections of Mapharsen. J Nerv Ment Dis 99, 88 (1944). WIEDER, L., FOERSTER, O. & FOERSTER, H. MAPHARSEN IN THE TREATMENT OF SYPHILIS: FURTHER EXPERIENCES. Arch Dermatol Syph 35, 402–413 (1937). THON, L. SHOULD THE INTERNIST KNOW SYPHILIS? J Amer Med Assoc 97, 994–996 (1931). Sarton, G. The Earliest Printed Literature on Syphilis, being Ten Tractates from the Years 1495-1498. Karl Sudhoff , Charles Singer , Henry E. Sigerist. Isis 8, 351–354 (1926). COLE, H., GERICKE, A. & SOLLMANN, T. THE TREATMENT OF SYPHILIS BY MERCURY INHALATIONS: HISTORY, METHOD AND RESULTS. Arch Dermatol Syph 5, 18–33 (1922). Mason, U. Observation: Use and Abuse of Salvarsan. J Natl Med Assoc 3, 340–3 (1911). Fleming, A. & Colebrook, L. ON THE USE OF SALVARSAN IN THE TREATMENT OF SYPHILIS. Lancet 177, 1631–1634 (1911). Evans, A. The Treatment of Syphilis by Salvarsan (Dioxy-diamido-arseno-benzol). Brit Med J 1, 617 (1911). Boeck, W. History, Theory and Practice of Syphilisation. New Engl J Medicine 73, 20–25 (1865). Veale, H. Remarks on Syphilis and Its Treatment. Edinb Medical J 10, 10–26 (1864). LaFond RE and Lukehart SA, Biological Basis for Syphilis. Clinical Microbiology Reviews 2006. Secher L et al, Treponema pallidum in peripheral nerve tissue of syphilitic chancres. Acta dermato-venereologica 1982. Hollander DH, Turner TB, The role of temperature in experimental treponemal infection. American journal of syphilis, gonorrhea, and venereal diseases, 1954 Eagle H, et al. The effect of hyperpyrexia on the therapeutic efficacy of penicillin in experimental syphilis. American journal of syphilis, gonorrhea, and venereal diseases, 1947. Kampmeier RH, Syphilis therapy: an historical perspective. Journal of the American Venereal Disease Association 1976. Pachner AR, Spirochetal Diseases of the CNS. Neurologic clinics, 1986. Sell S et al, Experimental syphilitic orchitis in rabbits: ultrastructural appearance of Treponema pallidum during phagocytosis and dissolution by macrophages in vivo. Laboratory investigation; a journal of technical methods and pathology, 1982. Taylor SH, Diuretics in cardiovascular therapy. Perusing the past, practising in the present, preparing for the future. Zeitschrift für Kardiologie, 1985. Ovchinnikov NM, [Treponema pallidum in peripheral nerves of rabbit syphiloma]. Vestnik dermatologii i venerologii, 1975. Cheek DB, Wu F, The Effect of Calomel on Plasma Epinephrine in the Rat and the Relationship to Mechanisms in Pink Disease, Archives of Disease in Childhood, 1959 Vogl A, The discovery of the organic mercurial diuretics, American Heart Journal, 1950 Schwemlein GX et al, Penicillin and fever therapy in early syphilis, Journal of the American Medical Association, 1948. Stringham JS, On the Diuretic Effects of Mercury in a Case of Syphilis. The Medical and physical journal, 1807 Evanson RL et al, Effect of mercurial diuretics on tubular sodium and potassium transport in the dog. The American journal of physiology, 1972 Sell S and Salman J, Demonstration of Treponema pallidum in Axons of Cutaneous Nerves in Experimental Chancres of Rabbits, Sexually Transmitted Diseases, 1992 Penn CW, Avoidance of Host Defences by Treponema pallidum in Situ and on Extraction from Infected Rabbit Testes, Microbiology 1981. Beutler B and Munford RS, Tumor Necrosis Factor and the Jarisch–Herxheimer Reaction, The New England Journal of Medicine 1996. Radolf JD et al, Treponema pallidum: doing a remarkable job with what it's got. Trends in Microbiology, 1999 Tight RR, Perkins RL, Treponema pallidum infection in subcutaneous polyethylene chambers in rabbits. Infection and immunity, 1976 Salazar JC et al, Treponema pallidum Elicits Innate and Adaptive Cellular Immune Responses in Skin and Blood during Secondary Syphilis: A Flow-Cytometric Analysis. The Journal of Infectious Diseases, 2007 Azevedo BF et al, Toxic Effects of Mercury on the Cardiovascular and Central Nervous Systems. Journal of Biomedicine and Biotechnology 2012, Clarkson TW and Magos L, The Toxicology of Mercury and Its Chemical Compounds, Critical Reviews in Toxicology 2008. Fitzgerald TJ, The Th1/Th2-like switch in syphilitic infection: is it detrimental? Infection and immunity, 1992 Batterman RC et al, THE SUBCUTANEOUS ADMINISTRATION OF MERCAPTOMERIN (THIOMERIN®): Effective Mercurial Diuretic for the Treatment of Congestive Heart Failure. Journal of the American Medical Association, 1949 Batterman RC, The status of mercurial diuretics for the treatment of congestive heart failure. American Heart Journal, 1951 Bleich HL et al, The Role of Regional Body Temperature in the Pathogenesis of Disease, The New England Journal of Medicine, 1981 Vander Veer JB et al, The Prolonged Use of an Oral Mercurial Diuretic in Ambulatory Patients with Congestive Heart Failure. Circulation 1950 Cox DL et al, The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infection and immunity, 1992. Fildes P, The Mechanism of the Anti-bacterial Action of Mercury. Br J Exp Pathol, 1940 Clarkson TW, THE MECHANISM OF ACTION OF MERCURIAL DIURETICS IN RATS; THE METABOLISM OF 203Hg‐LABELLED CHLORMERODRIN. British Journal of Pharmacology and Chemotherapy, 1965 Engelkens HJ et al, The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws. Genitourinary Medicine, 1993 Belum GR et al, The Jarisch–Herxheimer reaction: Revisited. Travel Medicine and Infectious Disease, 2013 Arando M et al, The Jarisch–Herxheimer reaction in syphilis: could molecular typing help to understand it better? Journal of the European Academy of Dermatology and Venereology, 2018. Butler T, The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. The American Journal of Tropical Medicine and Hygiene, 2016 Carlson JA et al, The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity. The American Journal of Dermatopathology 2011. Aronson IK and Soltani K, The enigma of the pathogenesis of the Jarisch-Herxheimer reaction. The British Journal of Venereal Diseases, 1976 Sellato TJ et al, The Cutaneous Response in Humans to Treponema pallidum Lipoprotein Analogues Involves Cellular Elements of Both Innate and Adaptive Immunity, The Journal of Immunology 2001 Spiller HA, Rethinking mercury: the role of selenium in the pathophysiology of mercury toxicity. Clinical Toxicology 2017 Sell S et al, Reinfection of chancre-immune rabbits with Treponema pallidum. I. Light and immunofluorescence studies. The American journal of pathology 1985. Grant SS and Hung DT, Persistent bacterial infections, antibiotic tolerance, and the oxidative stress response, Virulence 2013 Lant AF, Modern diuretics and the kidney. Journal of Clinical Pathology, 1981 Kamath SU et al, Mercury-based traditional herbo-metallic preparations: a toxicological perspective, Archives of Toxicology 2012. Yeter et al, Mercury Promotes Catecholamines Which Potentiate Mercurial Autoimmunity and Vasodilation: Implications for Inositol 1,4,5-Triphosphate 3-Kinase C Susceptibility in Kawasaki Syndrome. Korean Circulation Journal 2013 Wöβmann W et al, Mercury intoxication presenting with hypertension and tachycardia. Archives of Disease in Childhood, 1999 Giacani L et al, Identification of the Treponema pallidum subsp. pallidum TP0092 (RpoE) Regulon and Its Implications for Pathogen Persistence in the Host and Syphilis Pathogenesis. Journal of Bacteriology 2013. Edwards AM, From tooth to hoof: treponemes in tissue‐destructive diseases. Journal of Applied Microbiology, 2003 Wolgemuth CW, Flagellar motility of the pathogenic spirochetes. Seminars in Cell & Developmental Biology 2015. Solomon HC and Kopp I, Fever Therapy. The New England Journal of Medicine 1937. Rice KM et al, Environmental Mercury and Its Toxic Effects. Journal of Preventive Medicine and Public Health 2014. Drusin LM, Electron microscopy of Treponema pallidum occurring in a human primary lesion. Journal of bacteriology 1969. McNeely MC et al, Cutaneous secondary syphilis: Preliminary immunohistopathologic support for a role for immune complexes in lesion pathogenesis. Journal of the American Academy of Dermatology 1986. Borenstein LA et al, Contribution of rabbit leukocyte defensins to the host response in experimental syphilis. Infection and immunity 1991. Cabot RC et al, Case 51-1976 — Bicentennial CPC — Syphilis, Diarrhea and Death in the 1820's. The New England Journal of Medicine 1976. Hobman JL and Crossman LC, Bacterial antimicrobial metal ion resistance. Journal of Medical Microbiology 2015 Gelpi A and Tucker JD, After Venus, mercury: syphilis treatment in the UK before Salvarsan. Sexually Transmitted Infections 2015. MacHaffie et al, A study of the effectiveness of mercurial diuretics in treatment of cardiac decompensation. The American Journal of Cardiology 1958 Aberer W et al, Ammoniated mercury ointment: outdated but still in use. Contact Dermatitis 1990 Farhi D, Dupin N, Origins of syphilis and management in the immunocompetent patient: Facts and controversies. Clinics in Dermatology (2010) 28, 533–538 Frith J, “Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins,” Journal of Military and Veterans’ Health, 20(4), retrieved online at: http://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/ Howes OD et al, “Julius Wagner-Jauregg, 1857-1940,” American Journal of Psychiatry, April 2009 Volume 166 Number 4, Volume 166, Issue 4, April, 2009, pp. 409-409. Karamanou M et al, “Julius Wagner-Jauregg (1857-1940): Introducing fever therapy in the treatment of neurosyphilis.” Psychiatriki. 2013 Jul-Sep;24(3):208-12. Simpson WM, “Artificial fever therapy of syphilis,” JAMA. 1935;105(26):2132-2140. Tsay CJ, “Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane,” Yale J Biol Med. 2013;86(2): 245–254 Wagner-Jauregg J, “The history of malaria treatment of general paralysis.” Am J Psychiatry. 1946;02: 577-582 Shafer JK et al, Untreated syphilis in the male Negro: A prospective study of the effect on life expectancy. Public Health Rep. 1954 Jul; 69(7): 684–690. Abara WE et al, Syphilis Trends among Men Who Have Sex with Men in the United States and Western Europe: A Systematic Review of Trend Studies Published between 2004 and 2015. PLoS One. 2016; 11(7): e0159309. Nutton V, The Reception of Fracastoro's Theory of Contagion: The Seed That Fell among Thorns? Osiris, Vol. 6, Renaissance Medical Learning: Evolution of a Tradition (1990) Tsaraklis A, Preventing syphilis in the 16th century: the distinguished Italian anatomist Gabriele Falloppio (1523-1562) and the invention of the condom. Le Infezioni in Medicina, n. 4, 395-398, 2017.
A podcast dedicated to the teaching of critical care. The focus audience is physicians, residents, medical students, nurses, therapists, and paramedics. These are topics that arise while on teaching rounds in the Burn ICU at Vanderbilt Medical Center. A broad scope of critical care and prehospital topics are presented as well as recent journal articles and medical news.
Rank #1: Metabolic Acidosis in the ICU.
A common problem in the ill or injured patient is a metabolic acidosis. In this episode we will review the common etiology of a metabolic acidosis as well as some lesser known causes.
Rank #2: Arterial Blood Gases.
This episode is a discussion about how to approach an arterial blood gas result.
Internal medicine lectures focused on clinically and board relevant topics from faculty and guest lecturers with the University of Louisville Internal Medicine Department.
Rank #1: Hypertensive Crisis with Dr. Lorrel Brown.
Dr. Lorrel Brown discusses the Hypertensive Crisis by first defining hypertension. She then defines hypertensive crisis as having severely elevated blood pressure with end-organ damage. After, she discusses the pathophysiology of end organ damage along with the different treatment approaches for hypertensive crisis. Finally, she finishes her presentation with a few case reports. Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page.Disclaimers©2016 LouisvilleLectures.org
Rank #2: Sepsis with Dr. Sally Suliman.
Dr. Sally Suliman defines Sepsis and its history. She then presents the guidelines for surviving sepsis as well as the updates in literature. After, she discusses the recognition and diagnosis of sepsis as well as treatment. And finally, bundles and compliance. Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers ©2016 LouisvilleLectures.org
Core Internal Medicine via following segments:5 Pearls || Clinically relevant pearls on IM topics!Mind the Gap || Why do we do what we do?Hoofbeats || Dissecting clinical reasoning!
Rank #1: #49 Smoking Cessation: 5 Pearls Segment.
Practical tips on smoking cessation! Get CME Credit with ACP! Full Transcript with References and Show Notes Time Stamps 04:50 What questions are important to ask after a patient who contemplative about quitting tobacco? 07:00 Is quitting abruptly on a quit date or gradual cessation to a quit date better? 08:10 How can technology help support patients who are trying to quit? 08:49 How should we prepare patients who quit smoking and are worried about weight gain? 11:06 How can we try to convince patients to use medication as assistance to quit smoking? 11:50 What is the most effective nicotine replacement approach? 13:54 What are the potential side effects of the nicotine patch? 15:00 What should we prescribe for patients who smoke <5 cigarettes a day? 16:28 How can we determine how severe a patient’s nicotine dependence is? 18:26 When is the ideal frequency of nicotine gum or lozenge? 21:45 How does varenicline work? 25:05 Can you start varenicline in patients who have had psychiatric history? 27:15 What major side effect is seen in patients taking bupropion? 29:15 How do e-cigarettes work? 31:18 How should we approach adding e-cigarettes into a patient’s plan for quitting? 31:42 How should we discuss e-cigarette use with our patients? 33:47 Recap 39:54 Screening for Barrett’s Esophagus
Rank #2: 5 Pearls Ep2: Iron Deficiency Anemia.
Solidify your knowledge on iron deficiency anemia! Quiz yourself on the 5 Pearls we will be covering: Should patients be screened for iron deficiency? If so, who and how often? (1:40) What are the indications for diagnostic endoscopy in iron deficient patients? (3:23) How should you advice patients to take oral iron? (5:53) What is optimal dosing for oral iron? In which patients would you consider IV iron? What are the risks? (11:41) Throwback Question: What is a medication-overuse HA? (14:44)For full shownotes: https://www.coreimpodcast.com/2017/11/15/5-pearls-on-iron-deficiency-anemia/
The Elective Rotation - the number 1 ranked Hospital Pharmacy podcast - is created for YOU Pharmacy Nation! If you are a Pharmacy Student, Resident, Pharmacist, Nurse, Physician, or Critical Care Practitioner in a hospital, intensive care unit (ICU) or emergency department looking to improve your practice, The Elective Rotation delivers unbiased critical care and hospital pharmacy content from a Board Certified Pharmacotherapy Specialist. Episodes are published every Monday and Thursday at 3AM EST. Find the show notes at pharmacyjoe.com.
Rank #1: 342: Three drug interactions every critical care pharmacist should know how to manage.
Show notes at pharmacyjoe.com/episode342. In this episode, I’ll discuss three drug interactions every critical care pharmacist should know how to manage: 1. Linezolid and fentanyl (serotonin syndrome) 2. Metoclopramide and olanzapine (neuroleptic malignant syndrome) 3. Levofloxacin and sotalol (torsades) The post 342: Three drug interactions every critical care pharmacist should know how to manage appeared first on Pharmacy Joe.
Rank #2: 263: What makes ketamine different from other sedatives & analgesics used in critical care?.
In this episode, I ll discuss what makes ketamine different from other sedatives & analgesics used in critical care. The post 263: What makes ketamine different from other sedatives & analgesics used in critical care? appeared first on Pharmacy Joe.
The Best Science (BS) Medicine Podcast is a weekly presentation where practitioners can get evidence-based drug therapy content that is practical, entertaining and promotes healthy scepticism. In essence, we are the Medication Mythbusters. We present information that is useful and relevant to physicians, pharmacists, nurses, physician assistants and other health professionals, and that can easily be incorporated into day-to-day practice. The podcast is presented by Dr. James McCormack, Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia and Dr Michael Allan, Associate Professor in the Department of Family Practice at the University of Alberta. For more about us and to get the show notes for each episode, visit our website at www.bsmedicine.com or www.medicationmythbusters.com
Rank #1: Episode 432: All the evidence for all the medications for a failing heart – PART III.
In episode 432, James and Mike finish their review of the evidence around medications for systolic heart failure. In this episode our goal was to try to make sense of the process by adding as much art as possible to the evidence and also use a modicum of common sense. Let us know if we achieved our goal.Show notes
Rank #2: Episode 439: Taking a hard look at the evidence: PDE5 inhibitors in erectile dysfunction.
In episode 439, Mike and James invite Adrienne to take us through the impressively large amount of evidence for the PDE5 inhibitors for erectile dysfunction. We find that the NNTs are 2-3 for the not clearly defined endpoint of successful intercourse. There is a 20% absolute increase in adverse effects but almost no one stops using these medications because of these effects. Go figure.
UpToDate® is the premier evidence-based clinical decision support resource, trusted worldwide by healthcare practitioners to help them make the right decisions at the point of care. It is proven to change the way clinicians practice medicine, and is the only resource of its kind associated with improved outcomes.Support for UpToDate Talk is provided by UpToDate, Wolters Kluwer. UpToDate is entirely funded by the subscriptions of its users and does not accept advertising or funding unrelated to subscriptions. The opinions in such podcasts are entirely those of the discussants, and these discussants are authors and editors for UpToDate. View UpToDate’s conflict of interest policy: http://www.uptodate.com/home/conflict-interest-policy.Please note that we are no longer producing new clinical podcasts.
Rank #1: Vaccination to prevent herpes zoster.
This episode features Dr. Kenneth Schmader discussing new guidelines from the Advisory Committee on Immunization Practices regarding the herpes zoster vaccines. Dr. Sadhna Vora hosts.Dr. Schmader is a Professor of Medicine and Chief of the Division of Geriatrics at Duke University. He is Section Editor in Primary Care and Editor-in-Chief of the Geriatrics specialty at UpToDate. Reference: Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018; 67:103.Contributor Disclosure: Grant/Research/Clinical Trial Support: Merck [Herpes zoster (Zoster vaccine)]; GlaxoSmithKline [Herpes zoster (Zoster vaccine)].
Rank #2: Choice of basal insulin for management of diabetes; Evaluation of children with febrile seizures.
In this episode, Dr. David Nathan discusses choice of basal insulin for management of type 1 and type 2 diabetes, and Dr. Douglas Nordli, Jr., discusses evaluation of children with febrile seizures. Dr. Nancy Sokol hosts.
Issue highlights and interviews from Annals of Internal Medicine.
Rank #1: Atrial fibrillation.
Contemporary management of atrial fibrillation; interview with Tristram Bahnson, MD, of Duke University Medical Center; plus a summary of all the issue's articles.
Rank #2: Issue Summary November 19, 2019.
Highlights of new articles published in Annals of Internal Medicine
Author interviews that explore the latest clinical reviews.
Rank #1: COPD: All You Need to Know in 20 Minutes.
COPD is common enough that it is responsible for 3% of all clinic visits in the United States. Clinicians will undoubtedly deal with this disease in their practice. How to diagnose and manage it is reviewed by Frank C. Sciurba, MD, a professor of medicine from the University of Pittsburgh, Pennsylvania.
Rank #2: Management of Heart Failure in 2019-2020, Part 1.
JAMA Deputy Editor Ed Livingston, MD, interviews Akshay Desai, MD, at the European Society of Cardiology's 2019 conference in Paris, France.
A short, focused discussion of emergency medicine topics with perspectives from emergency physicians as well as other specialties. Here's the problem: When I listen to a 45 minute lecture that goes through about 15 different studies and has 50 slides, I come out feeling like a genius. An hour later, I have forgotten 95% of it. Here's the solution: ercast. We cover a single issue and try to tease out all the relevant elements without overstuffing your frontal cortex. It's for physicians and anyone interested in a bare bones look at emergency care.
Rank #1: ZDoggMD.
Zubin Damania (ZDoggMD) is an internist and founder of Turntable Health, an innovative healthcare startup that was part of an urban revitalization movement in Las Vegas. During a decade-long hospitalist career at Stanford, he experienced our dysfunctional health care system firsthand leading to burnout and depression. He created videos under the pseudonym ZDoggMD as an outlet to find his voice. This launched a grassroots movement — half a billion youtube views and a passionate tribe dedicated to improving health care for everyone. ERcast 2.0 Launches May 1 Click hereto learn more Or hereto sign up and skip the details In this interview we cover a wide range of topics including Underwear How ZDogg went from hospitalist to rapper to Medicine 3.0evanaglist Meditation The Mind Illuminated The roots of anxiety Mental preparation before giving a talk ZDogg's response to criticism, antipathy, and negative feedback from the anti-vaccine movement Nurse practitioners A Smattering of Performance Improvement, Stress Management, and Wellness Episodes Finding the Joyin Your Job Performance Coach Jason Brooks Making Order Out of Chaos How to Not Freak Out When Consultants Give Bad Advice Beating Stress and the Hot Offload Mastering the Storm Full Video Interview Below https://www.youtube.com/watch?v=bujZmXEtuHA My Favorite Zdogg Song https://www.youtube.com/watch?v=NAlnRHicgWs
Rank #2: How to Use the Pulse Ox Like a Boss.
From Essentials of Emergency Medicine NYC 2017, Reuben Strayer explains how the pulse ox might be the most useful bit of tech in the ED. Pearls: The pulse ox waveform is an excellent indicator of mechanical heart rate and peripheral perfusion. For patients breathing room air, pulse oximetry can be used to monitor for hypoventilation. Nail polish has minimal impact on the accuracy of pulse oximetry. If you are unable to get a good pulse ox waveform by adjusting or repositioning the probe, be concerned that the patient is poorly perfused. “The respiratory rate is the most vital of the vital signs.” Experienced doctors look at a patient who seems well, but understands that they’re not truly well, because they subconsciously notice tachypnea. Subconsciously is the only way to notice tachypnea, because respiratory rate is often not measured accurately. Since we don’t always have access to reliable respiratory rate, Strayer’s go-to vital sign is the oxygen saturation. “Reusable pulse oximeter probes are gross.” One study found that even when these probes are cleaned by standard procedure, ⅔ had bacteria cultured from them. Strayer recommends using single use probes in your department. Wilkins MC. Residual bacterial contamination on reusable pulse oximetrysensors. Respir Care. 1993 Nov;38(11):1155-60. PubMed PMID: 10145923. Data is conflicting about the effect of nail polish on pulse oximetry readings, but overall it is felt that the impact is minimal. Earlier data suggested that nail polish decreased sat readings by 2-10%, but more recent studies found minimal effect. If it seems that the waveform is affected by nail polish, you can remedy the situation by turning the probe 90 degrees, so it goes sideways through the finger. Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. PubMed PMID: 18957149. As long as a patient is breathing room air, pulse ox can monitor ventilation and function as a hypoventilation alarm. Significantly hypercapnic patients saturate less than 95% when they’re breathing room air. So if you need to monitor a patient for hypoventilation, such as due to intoxication or procedural sedation, the pulse ox will do a great job of telling you if the patient is still breathing. If you need to give supplemental oxygen, then use capnography to monitor respirations. The pulse oximeter does so much more than provide oxygen saturation. It provides the photoplethysmogram (PPG) which is a waveform that tells you the “mechanical” heart rate. While telemetry gives the electrical heart rate, what really matters to your organs is the mechanical rate. This can be especially helpful during transvenous or transcutaneous pacing. When you have reliable tracing, the pulse ox heart rate is more reliable than the telemetry heart rate. The pulse ox can measure the peripheral perfusion index which is a more sensitive and earlier indicator of hypoperfusion than blood pressure. This is a numerical value which indicates the strength of the pulsations read by the pulse oximeter. It is based on the amplitude of the pulse ox waveform and expressed as a number between 1 (low) and 10 (high). The perfusion index dips before the stroke volume drops and long before the heart rate rises. Many monitors will report the perfusion index in tiny print after the word PERF. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med.2002 Jun;30(6):1210-3. PubMed PMID: 12072670. van Genderen ME, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013 Feb;116(2):351-6. PubMed PMID: 23302972. What if you don’t have a reliable pulse ox tracing? Most of the time this is because the probe is poorly positioned, the patient is moving too much, or there’s a lot of ambient light. If you’ve corrected for these problems and you still don’t have a good tracing, you should be concerned that the patient is poorly perfused. One study of 20,000 anesthesia cases showed that pulse ox failure was directly related to worsening physical status. Moller JT, et al. Randomized evaluation of pulse oximetry in 20,802 patients: I. Design, demography, pulse oximetry failure rate, and overall complication rate. Anesthesiology. 1993 Mar;78(3):436-44. PubMed PMID: 8457044. How does the pulse ox measure oxygen saturation and what is the best way to position the oximeter probe on the finger? One side of the pulse ox puts emits visible (red) light and infrared light. On the other side is the detector. The percent oxygen saturation is calculated based on the different way in which oxyhemoglobin absorbs visible and infrared light compared with deoxyhemoglobin. The pulse ox measures carboxyhemoglobin as if it were oxyhemoglobin, giving a falsely elevated pulse ox reading for a victim of carbon monoxide poisoning. The best spot for a peripheral pulse ox is a place with a lot of capillaries and arterioles, like the fingertips, earlobes, nose, or forehead. Functionally, it doesn’t seem to matter whether the emitter is on the dorsum, volar aspect, or even side of the finger. For convenience sake, most find it ergonomically superior to have the cord and emitter on the dorsum of the finger. Mannheimer PD. The light-tissue interaction of pulse oximetry. Anesth Analg.2007 Dec;105(6 Suppl):S10-7. Review. PubMed PMID: 18048891 Vegfors M, Lennmarken C. Carboxyhaemoglobinaemia and pulse oximetry. Br JAnaesth. 1991 May;66(5):625-6. PubMed PMID: 2031826 DeMeulenaere, Susan. "Pulse oximetry: uses and limitations." The Journal for Nurse Practitioners 3.5 (2007): 312-317. Link. Chan ED, et al. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99. PMID: 23490227
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