Core IM | Internal Medicine Podcast

Arthi Rao, a cardiology fellow, and Eric Sosemsky, a vascular medicine cardiologist, dive deep into the complexities of peripheral arterial disease (PAD). They discuss when to suspect PAD and the critical role of the Ankle-Brachial Index (ABI) in diagnosis. The conversation highlights non-surgical management strategies, emphasizing lifestyle changes, medications like cilostazol, and cardiovascular risk management. They also outline when revascularization may be necessary and explore therapy options that can significantly improve patient quality of life.

Explore the essentials of parenteral nutrition, distinguishing between Total Parenteral Nutrition (TPN) and Peripheral Parenteral Nutrition (PPN). Discover when to use each type and the common complications, including myths surrounding TPN's effects on bowel movements. Dive into hydration management, emphasizing the need for personalized regimens and understanding the significance of tube feeds. Learn about the role of nutrition and pharmacy teams in enhancing patient care for those needing critical nutrition support.

Dr. Michael Insa, a primary care and addiction medicine physician at the University of Utah, teams up with Dr. Heather Stieglitz, a clinical analytical toxicologist at The Ohio State University. They dive into the intricacies of urine drug screening, including common false positives and negatives. The conversation emphasizes the importance of confirmatory tests and patient-centered approaches. They also discuss the sensitive nature of screenings, advocating for empathetic communication and motivating patients to engage in open discussions about substance use.

Dr. Harry Han, a palliative care expert, dives into the nuances of hospice care, discussing the practicalities clinicians face when transitioning patients to hospice services. He addresses critical issues like managing medications, navigating financial concerns, and the surprising reasons patients may return to the hospital while on hospice. The conversation also highlights the emotional challenges of opting for hospice and encourages a shift in perception to focus on celebrating life, rather than just the end.

The podcast dives into the groundbreaking MINT trial, exploring its potential to reshape anemia treatment in acute myocardial infarction. It contrasts liberal and restrictive transfusion strategies, underscoring how past studies like TRIC have informed current practices. The discussion highlights the risks of increased transfusions and calls for careful anemia management. Insights shed light on personalized approaches to transfusion thresholds, emphasizing the importance of nuanced patient assessments over one-size-fits-all guidelines.

Dive into the complex world of moral distress in healthcare. Experts share strategies to support healthcare professionals facing ethical dilemmas. Discover the significance of open communication and collaborative solutions among teams. Learn about the role of mentorship in easing the transition from training to practice. The importance of community becomes clear as listeners share their own experiences, fostering connection and resilience. This discussion shines a light on the need for systemic change in advocating for patient care and professional well-being.

Explore the distinctions between moral distress, moral residue, and moral injury as they affect healthcare professionals. The discussion highlights the ethical dilemmas faced in high-pressure environments, particularly in neonatal care. Experts delve into the systemic challenges that lead to emotional turmoil, including cumbersome workflows and the disconnect between administrative demands and patient care. Understanding these issues is crucial for fostering open communication and improving both clinician well-being and patient outcomes.

Explore the intricacies of diuretic resistance with three compelling cardiorenal case studies. Discover how intra-abdominal hypertension and low cardiac output challenge effective diuretic use. Learn the importance of renal perfusion and hemodynamic assessments in managing fluid issues, particularly in critically ill patients. Uncover key interventions and decision-making strategies that can improve patient outcomes in complex scenarios involving heart and kidney complications.

Explore the art of patient handoffs with memorable stories and five essential questions to enhance communication. Discover the weight of delivering complete information about patient goals and their prognosis to night teams, especially for critically ill individuals. Navigate the complexities of emergency situations where consent and language barriers come into play. Uncover the importance of effective communication during overnight shifts to ensure continuity of care, ultimately impacting patient outcomes.

Explore the philosophy of hospice care and who qualifies for it. Learn about the hospice team composition and payment options. Understand the different levels of care available and limitations of Medicare benefits. Dive into the importance of caregiver support and the value of hospice care in enhancing end-of-life experiences.