The Point of Care Podcast
By RMO Medical Education
The Point of Care PodcastJan 22, 2023
Acute Pancreatitis - Quick Admit
This Quick-Admit episode on acute pancreatitis will focus on only the highest-yield information you need when admitting a patient to the hospital.
To take your understanding of the disease to the next level, check out the full-length episode for more information including a discussion of the most important clinical pearls and literature.
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.
Acute Pancreatitis (Inpatient) - Full Episode
This full-length episode on the inpatient management of acute pancreatitis includes not only the admission framework, but also key clinical pearls on the background, pathophysiology, etiologies, presentation, diagnosis, treatment, and complications associated with the disease to help take your understanding to the next level!
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.
Timestamps
00:00:00 - Background and Epidemiology
00:01:13 - A Note on Chronic Pancreatitis
00:01:31 - Admission Checklist
00:03:49 - HPI Intake
00:04:33 - Physical Exam
00:05:20 - Etiology and Differential
00:06:20 - Plan - Work Up
00:07:30 - Plan - Treatment
00:09:31 - If You Remember Nothing Else
00:10:04 - Pearls - Pathophysiology
00:11:15 - Pearls - Etiology and Risk Factors
00:12:56 - Pearls - Presentation and Diagnosis
00:15:56 - Pearls - Treatment
00:18:08 - Pearls – Complications
Show Notes
Reviews
- Acute Pancreatitis: A Review (JAMA, 2021)
- Acute Pancreatitis (NEJM, 2016)
Trials
- WATERFALL Trial - Aggressive (20 ml/kg bolus + 3 ml/kg/hr) vs Non-Aggressive (10 ml/kg bolus + 1.5 ml/kg/hr) fluid resuscitation in acute pancreatitis - fluid overload resulted in 20.5% vs 6.3% of patients but no difference in the development of moderately severe or severe pancreatitis (NEJM, 2022)
Other Literature
- Enteral versus parenteral nutrition for acute pancreatitis (Cochrane, 2010)
- A Critical Evaluation of Laboratory Tests in Acute Pancreatitis (Am J Gastroenterol, 2002)
Blogs and Summaries
- Clinical Problem Solvers - Acute Pancreatitis Illness Script
- Internet Book of Critical Care - Pancreatitis
- Radiopaedia - Imaging Findings in Acute Pancreatitis
- Pathway Guidelines Summary - Acute Pancreatitis
Hyperkalemia (Inpatient)
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.
Timestamps:
00:00:07 - Background and Epidemiology
00:00:42 - Pathophysiology
00:02:29 - Admission Checklist
00:04:29 - HPI Intake
00:05:15 - To Note on Exam
00:05:25 - Etiology and Differential
00:06:10 - Plan - Treatment
00:07:56 - If You Remember Nothing Else
00:08:40 - Pearls - Etiology
00:09:44 - Pearls - Presentation and Diagnosis
00:12:03 - Pearls - Treatment
Trials and Literature Clinical Management of Hyperkalemia (Mayo Clin Proc, 2021) An Integrated View of Potassium Homeostasis (NEJM, 2015) Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age (JAMA, 2019) - Kayexalate is associated with serious GI adverse events over 30 days (0.2% of people who take vs. 0.1% who don’t) - NNH is 1000; intestinal ischemia is the most common Sodium zirconium cyclosilicate in hyperkalemia (NEJM 2015) - reduces K over placebo Other Resources: Clinical Problem Solvers - Hyperkalemia Schema Core EM - Hyperkalemia (good EKG change images)
Life in the Fastlane - EKG Features of Hyperkalemia
Diabetic Foot Wound (Inpatient)
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.
Timestamps
00:00:08 – Background
00:01:12 – Pathophysiology
00:01:55 – Admission Checklist
00:03:29 – HPI Intake
00:04:19 – To Note on Exam
00:04:58 – Plan: Workup
00:05:40 – Plan: Treatment
00:07:28 – If You Remember Nothing Else
00:08:28 – Pearls
00:10:43 – Literature
Literature
IWGDF/IDSA Guidelines on Diagnosis and Treatment of Diabetes-Related Foot Infections (Diabetes Metab Res Rev, 2023)
Diabetic Foot Ulcers and Their Recurrence (NEJM, 2017)
Diabetic Foot Ulcers: A Review (JAMA, 2023)
Acute Gout Flare (Inpatient)
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.
Time Stamps:
00:00:08 - Background and Definitions
00:01:39 - Pathophysiology
00:03:22 - Admission Checklist
00:04:25 - HPI Intake
00:05:51 - Physical Exam
00:06:06 - Differential Diagnosis
00:06:38 - Plan - Workup and Treatment
00:08:54 - If You Remember Nothing Else
00:10:14 - Pearls - Etiology
00:11:00 - Pearls - Presentation and Diagnosis
00:13:07 - Pearls - Treatment
00:15:20 - Literature and Trials
00:15:56 - Wrap Up
Show Notes:
Gout Review (NEJM, 2022)STOP Gout Trial (NEJM, 2022) - allopurinol non-inferior to febuxostat for preventing flares and for reaching target urate concentrations at 48 weeks CARES Trial (NEJM, 2018) suggested an increased risk of mortality in febuxostat from cardiac events, but a follow-up FAST Trial (Lancet, 2020) showed no difference compared to allopurinol - FDA still has a black box warning Calcium Pyrophosphate Deposition Disease (CPPD) Review (NEJM, 2016)
Community-Acquired Pneumonia (Inpatient)
Today's episode is on the inpatient workup and management of Community-Acquired Pneumonia featuring an admission checklist, HPI intake, differential, plan, and high-yield clinical pearls.
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.
Show Notes:
00:00:08 - Background and Definitions
00:01:13 - Etiology and Pathophysiology
00:02:49 - Admission Checklist
00:05:16 - HPI Intake
00:06:38 - Physical Exam Findings
00:07:30 - Differential
00:08:48 - Treatment Plan
00:10:15 - If You Remember Nothing Else
00:11:47 - Clinical Pearls - Etiology
00:13:47 - Clinical Pearls - Presentation and Diagnosis
00:16:53 - Clinical Pearls - Treatment
00:19:52 - Clinical Pearls - Complications
Sepsis and Septic Shock
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
GDMT For Heart Failure: A Practical Guide
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.
Show Notes:
00:00:15 - Introduction and Terminology
00:01:51 - Beta Blockers
00:02:47 - ACE/ARB/ARNI
00:04:30 - MRA's
00:05:28 - SGLT2i's
00:06:12 - Nitrates and Hydralazine
00:08:41 - Loop Diuretics
00:09:25 - Initiating and Titrating GDMT
00:11:18 - Barriers and Other Considerations
00:13:44 - Resources for Use at the Point of Care
Other Resources and References:
GDMT for Everyone – https://www.gdmt.org/HFrEF.php
Table of all the Sacubitril/Valsartan Trials Published to Date (2023) - https://twitter.com/jaycvance/status/1660732176999108623
An elegant graphic showing how the hazard ratios with confidence intervals for all-cause mortality improve based on adding on each extra GDMT medication; brought to my attention by a tweet from Dr. Scott Cameron - https://twitter.com/2Scottish/status/1556798319996932096
Heart Failure with Reduced Ejection Fraction: A Review (JAMA, 2020) - https://pubmed.ncbi.nlm.nih.gov/32749493/
A Systematic Review and Network Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction (JACC, 2022) - https://www.jacc.org/doi/full/10.1016/j.jchf.2021.09.004
Acute Decompensated Heart Failure (Inpatient)
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.
Show Notes:
00:00:38 - Background and terminology
00:02:22 - Checklist for Admitting a Patient with ADHF
00:05:40 - Crafting your Assessment
00:08:56 - Creating a Plan for ADHF - Diuresis and GDMT
00:13:12 - Clinical Pearls
00:16:48 - A note on HFpEF
00:17:15 - If you remember nothing else
Diuresis (Inpatient)
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.
Show Notes:
00:00:00 First steps and communicating with the ED
00:01:05 - Following up after dosing
00:02:02 - Troubleshooting resistance - drips, other loops, thiazides
00:03:35 - Monitoring while diuresis - labs and exam
00:06:09 - Switching to PO and guidance for discharge
00:07:19 - Presenting patients who are being diuresed
00:08:12 - If you remember nothing else
Post Cardiac Arrest Care and Targeted Temperature Management (TTM)
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.
00:00:00 - First Things First
00:01:01 - Assessment of post-cardiac arrest patients, including the likely etiology, duration of CPR, and relevant medical tests.
00:01:46 - Plan for working up and treating post-arrest patients.
00:04:00 - Pearls for post-cardiac arrest care, including treating shivering, aspirational pneumonia prophylaxis, and looking for complications.
00:06:11 - Trials and literature related to post-cardiac arrest care
00:06:58 - If you remember nothing else
ACLS (Running a Code)
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.
Timestamps:
00:00:00 - Initial Steps and Delegation: Starting chest compressions, confirming code status, calling for help, delegating tasks, and gathering data. (Includes information on rhythm and pulse check, patient access, labs, and involving family members.)
00:02:21 - ACLS Protocol and Rhythm-Specific Interventions: Explains the procedure for rhythm checks, pulse checks, use of POCUS, intubation, and treatment based on shockable and non-shockable rhythms. Discusses medications and adjuncts for different rhythms and scenarios.
00:05:28 - Reversible Causes and Post-Cardiac Arrest Care: Covers the differential for reversible causes of arrest (H's and T's), treatment options, and considerations for post-cardiac arrest care. Includes targeted temperature management and decision-making based on patient condition.
Transfusion Reactions (Inpatient)
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.
Diabetes Management (Inpatient)
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.
Preparing for Intubation (Rapid Response)
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.
Tachyarrhythmias (Rapid Response)
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.
Hypertensive Urgency and Emergency (Inpatient)
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.
Hypotension (Rapid Response)
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.
Altered Mental Status (Rapid Response)
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.
Respiratory Distress (Rapid Response)
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.
COPD Exacerbation (Inpatient)
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.
Persistent Inpatient Fevers (Schema)
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.
Cellulitis and SSTI (Inpatient)
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.
Hyponatremia (Inpatient)
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.
Acute Kidney Injury (Inpatient)
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.
Neutropenic Fever (Inpatient)
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.
Hypercalcemia (Inpatient)
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.
Syncope and Loss of Consciousness (Inpatient)
Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode.
At Point of Care Medicine, 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.