The Curbsiders Internal Medicine Podcast

#485: Things We Do For No Reason™Live from SHM #Converge2025

62 snips
Jun 2, 2025
Guest
Tony Breu
Guest
Lenny Feldman
Join Dr. Lenny Feldman, a trailblazer in urban health from Johns Hopkins, and Dr. Tony Breu, Harvard's resident education director, as they dissect high-value care decisions. They challenge the effectiveness of lactate-guided resuscitation in sepsis, question the routine discontinuation of beta-blockers in cocaine users, and debate the risks of anticoagulation in fall-prone patients. Plus, discover the implications of pushing for hospital discharges before noon. It's a mix of insightful medical discourse and engaging anecdotes!
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INSIGHT

Lactate Indicates Beta-2 Activation

  • Elevated lactate often reflects beta-2 adrenergic activation, not tissue hypoperfusion.
  • Hypoxemia alone rarely causes significant lactate elevation in shock or sepsis.
ADVICE

Don't Over-Treat with Fluids

  • Avoid basing fluid resuscitation solely on lactate levels to prevent fluid overload, especially in heart failure.
  • Consider alternative causes for elevated lactate such as alcohol use or catecholamine excess before treating.
INSIGHT

Beta Blockers Safe With Cocaine Use

  • The original caution against beta blockers with cocaine comes from a small, flawed study with intracoronary propranolol.
  • Subsequent data show selective beta blockers like metoprolol or labetalol are safe in cocaine users with other indications.
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