Barbell Medicine Podcast Episode #372: Smells Like Teen Spirit
Oct 28, 2025
Dr. Austin Baraki, an internist and clinical educator, joins to unravel a medical mystery involving a 38-year-old man with severe chest pain and shortness of breath. They delve into differential diagnoses for chest pain, focusing on cardiac and pulmonary emergencies. A surprising diagnosis of methemoglobinemia emerges, linked to inhalants. Dr. Baraki clarifies the mechanics of oxygen binding issues, highlighting important diagnostic steps. The conversation wraps with management strategies and a prognosis for this rare condition.
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Anatomy-First Diagnostic Framework
- Organize chest pain differentials by anatomy and symptom overlap to prioritize life-threatening causes.
- Focusing on heart and lungs first narrows diagnostics and guides urgent testing like EKG and imaging.
Act Fast On Suspected ACS
- Rule out acute coronary syndrome immediately when EKG or symptoms suggest it, and arrange urgent cath lab evaluation.
- If cath shows no culprit lesion, broaden the differential to other causes like spasm, dissection, or noncardiac mimics.
Cyanosis Is A Red Flag
- Persistent cyanosis despite apparent cardiac concern suggests alternative mechanisms like severe hypoxemia or hemoglobin issues.
- Cyanosis uncommon in routine MI signals the need to reassess diagnostic direction.