Core IM | Internal Medicine Podcast

Dr. Ross Pacher, an intensivist and researcher, dives into the nuanced world of venous congestion and its critical implications. He clarifies the distinction between venous congestion and volume overload, revealing how venous Doppler assessments can illuminate issues like AKI and delirium. Pacher shares practical insights on using the VEXUS score while outlining common pitfalls and the importance of measuring ultrasound markers in acute care. He discusses optimal fluid management strategies and highlights when to reassess congestion during treatment.

Kenneth Pfeiffer, a primary care physician and diabetes clinic co-director at Mount Sinai, defends GLP-1 receptor agonists for diabetes and obesity management. Keri Blum, also from Mount Sinai, highlights SGLT2 inhibitors as beneficial for heart and kidney health. Tracy Rabin, from Yale, emphasizes the practical use of metformin considering cost and tolerability. They delve into the complexities of choosing diabetes medications, weighing factors like A1c reduction, side effects, and patient-specific needs, including obesity and comorbidities.

Marina Serper, a hepatologist at the University of Pennsylvania, shares her expertise on managing hepatorenal syndrome (HRS) and discusses the role of vasoconstrictors like terlipressin and norepinephrine. They explore the complexities of albumin dosing, the safe use of diuretics, and the alarming mortality rates associated with HRS. Marina also emphasizes the importance of evaluating transplant candidacy and discusses when to involve palliative care for patients who aren't transplant candidates.

Dr. Juan Carlos-Velez, a nephrologist from Ochsner Health, dives into the intricacies of hepatorenal syndrome (HRS). He explains how portal hypertension triggers pathophysiological changes in the kidneys and distinguishes HRS from other acute kidney injury causes. The discussion covers the diagnostic challenges posed by serum and urine sodium levels. Dr. Velez also highlights when albumin should be used strategically and how evolving criteria for HRS diagnosis are reshaping clinical practices.

Discover who really faces fracture risks and why most fragility fractures occur in those without osteoporosis. Explore the surprising potential of just one or two IV infusions of zoledronate to prevent fractures for years. Examine the evolution of bisphosphonates in treatment and current debates over their risks. Delve into alternative options like teriparatide and learn about a significant trial showing promising results in a low-risk group. Finally, rethink how to discuss fracture prevention with patients and the public health implications of these findings.

Explore the complexities of managing orthostatic hypotension with insightful discussions on various medications, including midodrine and fludrocortisone. Discover the challenges posed by autonomic failure and how to navigate simultaneous hypertension. Learn about practical strategies for patient care, such as risk stratification and the importance of physical therapy for safe discharge. This conversation prepares healthcare providers to tackle nuanced scenarios in clinical practice effectively.

Discover the intricacies of diagnosing and managing orthostatic hypotension, especially in the elderly. Learn about the importance of multiple blood pressure readings and contextual patient factors. The podcast highlights innovative non-pharmacologic strategies like hydration techniques and the use of compression garments. It also discusses the significance of tailored treatment approaches and encourages listener engagement in sharing their experiences. Tune in for practical insights that prioritize patient functionality over mere blood pressure numbers.

Mihir Parikh, an interventional pulmonologist at BIDMC, dives into the complexities of diagnosing and managing pneumothorax. He breaks down the differences between X-ray, POCUS, and CT for diagnosis and discusses when chest tubes are truly necessary. Parikh also shares insights on effectively explaining pneumothorax to patients and the essential components of pleural drainage systems. Listeners will learn how to monitor air leaks and the best strategies for managing persistent issues, including innovative treatment options.

Join hematologists Jason Fried, Lauren Wirtz, and Eric Poe as they dive into the intricacies of neutropenia. They discuss when neutrophils recover and how to diagnose neutropenic fever quickly. Key insights include the importance of a thorough patient history over lab tests and strategies for managing febrile neutropenia effectively. Learn about the nuances of drug-induced neutropenia and dietary considerations for neutropenic patients. They also tackle timely antibiotic treatment and the complexities of recovery dynamics in cytotoxic therapy.

Dive into heartwarming stories that blend humor and deep reflection. Discover the power of personal narratives in patient care through a touching encounter with a vulnerable patient. Navigate the complexities of leading family meetings with empathy and humility. Explore the emotional toll on healthcare workers during the early COVID-19 pandemic, revealing the stark contrast between patient perceptions and reality. Finally, reflect on the importance of kindness and personal values in medical practice.