The Point of Care Podcast

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.

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

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

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)

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)

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

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

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

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

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

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

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.

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.

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.

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.

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.

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.

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.

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.

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.