Medgeeks with Andrew Reid

It's that time of year ago and our little viral friend is quickly gracing us with it's presence.  As of November 2nd, the CDC informed the community that influenza activity is low, however there have been small increases of activity seen over the prior week. So, it's coming... The three main strains seen are influenza A H1N1, influenza A H3N2, and influenza B. We'll do a quick review in just 5 min...

Hyperparathyroidism is one of those topics that is confusing, as it has primary, secondary, or tertiary causes.  There are PTH, phosphate, calcium, and vitamin D levels.  To be honest, it can get confusing. But, if you can understand the pathophysiology behind it all, then it will help you understand the labs and will help you come to the diagnosis. So, let's dive right in!  - Our goal at Medgeeks...

Today, we're going to do a quick systematic review of hyponatremia. If you're one of the few who know all the causes and correlating serum osmolality, urine osmolality, urine sodium values, and corresponding treatments - then this podcast is not for you lol. But, for those who struggle with hyponatremia, like I do at times, then have a listen as I break this down this complicated topic for you. Af...

It's Monday morning and your first patient on your schedule comes in with one day of shortness of breath. The MA checks the vitals and says, "the patient's blood pressure is a little high at 220/110". The patient is a 55 year old male with a history of hypertension, hyperlipidemia, and heart failure with a preserved EF. So, what would be your next step? Today, we're going to talk hypertensive urge...

Today, we are going to do a quick systematic review of lymphomas: Hodgkin and non-Hodgkin lymphomas. I'm pretty sure after school, all I knew about this topic was that reed sternberg cells were associated with Hodgkin lymphoma. Maybe you're in the same boat. But, hopefully after todays podcast, you'll feel much more comfortable with this. - Our goal at Medgeeks is to help you live the life  you  w...

One of the most common issues I face are patients who have pain, anxiety, agitation, and delirium; sometimes all of them at once. Let's say we have a 75 year old female patient with a past medical history of dementia, chronic back pain with radiculopathy, CAD status post CABG, heart failure with a reduced EF, and ESRD on hemodialysis. She's on opiates, as well as on a neuropathic pain medication. ...

Lets talk about the approach to the patient that presents to the hospital with altered mental status.  This is a very common presentation that I see often - whether I'm in the emergency room, step down, or ICU. The etiologies can be endless. But, the goal after today's podcast, is to arm you with an algorithm to narrow in on that etiology.  Enjoy! - Our goal at Medgeeks is to help you live the lif...

You're asked to see a 22 year old female with a past medical history of asthma who presents to the emergency room with increasing shortness of breath, chest tightness, and wheezing. Over the past 24 hours she's been non-responsive to her home nebulizer treatment every 4 hours.  A quick chart review allows you to see the patient has required ICU admission and mechanical ventilation last year due to...

Last week we presented a patient presenting with signs and symptoms of a PE and CTA confirmed saddle pulmonary embolism.  So, now the questions is, what type of PE is this? Massive Submassive Non-massive (low risk) It's important we separate patients into different categories, because each category will have different adverse outcomes, and more importantly, differences in mortality risk. Therefore...

As you're working in the emergency room, you're asked to see a 62 year old female. She has a past medical history significant for morbid obesity (BMI 43). She fell three weeks ago and fractured her right tibia, which required a cast, and has been not been mobile since.  She developed shortness of breath two weeks ago which has worsened to the point where she can't even put her clothes on without b...

Today, we'll be introducing Katelyn Reeve to the team who will be starting her emergency medicine fellowship November 2018. Prior to PA school she played D1 soccer at Clemson University, was elected as captain for 2 years, and ended her time there as in the Academic Hall of Fame as an All-American. She then attended the Medical University of South Carolina (MUSC) in Charleston, SC and graduated in...

Prior to PA school, Zach was a clinical research coordinator at Mass General Hospital. He was lucky enough to work with some of the worlds leading researchers in cardiac imaging. One thing he learned was how to approach a medical paper... This skill is usually overlooked and most simply read the abstract of the paper. But, there's a lot more that we need to know, as research drives medicine.  It's...

This is the final lecture in our ABG mini series. Today, we're going to finish it all off with metabolic alkalosis. This has the potential for some really bad complications: seizures, arrhythmias, electrolyte abnormalities, and death.  The patients with alkalosis should definitely scare you most. So, let's dive right in! - Our goal at Medgeeks is to help you live the life  you  want to live as you...

This acid base disorder requires multiple steps! So, make sure to pay close attention to this one.  But, what are common metabolic acidosis disorders? Well, everyone jumps to MUDPILES. The first step, however, is to determine if there's an increased anion gap or not. Remember, the body already has a normal anion gap (difference between anions and cations). Clinical pearl for all you Medgeeks : the...

Today, we'll be going over part 2 of 4 of the acid base disorders.  As a recap, what is normal?  Well, a normal pH is 7.35 - 7.45 If the pH is 7.45 then we have alkalemia. A normal bicarbonate is 22-26 and a normal pCO2 is 35-45.  In today's podcast we are going to tackle respiratory acidosis, partial vs complete compensation, and we'll show you what to look for to see if there is a co-existing ac...

Over the next 4 weeks we will be going over ABGs. We're going to break them down into 4 parts, as they all require different approaches. This will be our schedule for the next few weeks: Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Today, we will be talking respiratory acidosis. Zach sees acid/base disorders on a daily basis and does an amazing job teaching thi...

Today, we're going to talk about the patient, who makes you want to go home and have your own drink.  You get a page from the ER about a new admission. It's a 35 year old male patient with a past medical history of heavy alcohol abuse - he presents to the hospital asking for detox. For every ETOH patient that walks through the door, Zach normally has a set of questions he likes to ask, depending o...

In last weeks episode, we discussed the differences between DKA and HHS. Today, we'll be sharing how to manage these two diseases. If you missed last weeks episode, you can listen to that here:  https://medgeeks.co/podcast/ We had that 35 year old female with type 1 DM on insulin complaining of burning with urination, followed by a few days of nausea, vomiting, abdominal pain, and poor PO intake. ...

Today, we're going to talk about the evaluation of your diabetic patient who walks into your clinical with a glucose which is unable to be read (>500). A 35 year old female with type 1 DM on insulin arrives to the ER for evaluation after being referred by her PCP. The patient complains of burning with urination x3 days, followed by nausea, vomiting, and abdominal pain with poor PO intake. Because...

​As you start to review your patients - you get your first page.  So, you call stat, and on the other end, you hear a frantic nurse saying, "Bed 45. Heart rate 150s with an irregular rhythm."  Your first thought should be AFIB with RVR until proven otherwise. Today, Zach will give you the run down on what to do with these patients... Click here to learn about the acute AFIB patient  Zach drops a ...

​You're on the rapid response team and are called over to a patient presenting with hypotension.  Per nursing, the patient is a 58 year old male with a PMH of: ​ETOH abuse (1 pint of vodka daily) Cirrhosis While in the room, the patient vomits a large amount of bright red blood, followed by a drop in the systolic blood pressure to the 70s.​ The patient looks lethargic, unresponsive to verbal stimu...

Today, we have a 60 year old male patient, with a past medical history of: Osteoarthritis COPD Atrial fibrillation Hypertension Hyperlipidemia Diverticulosis Rectal cancer Chief complaint: 1 day rectal bleeding (episodes every hour) causing them to spend the entire day in the bathroom. The patient states he's had a similar episode like this years ago. Before we see the patient, we should be asking...

Over the next three weeks we are going to dive into the GI bleed patient. We're going to divide these lectures into: upper GI bleed (above the ligament of treitz), lower GI bleed (below the ligament of treitz), and the scary liver patient who has a GI bleed.  Today, let's work through an upper GI bleed case presentation as we touch on the background, evaluation, and management of the patient.  Tod...

A 65 year old female presents to your ER with difficulty breathing over the past 3 days, despite increasing her home oxygen tank to 3 liters. Her husband called 9-11 because she wasn't really acting herself.  EMS arrived and found her sats in the 70s and put her on a non-rebreather mask and had an improvement in her sats to the low 90s. They also reported some wheezing on exam, so they gave her on...

I just got off a long stretch of working 7 days in a row in the ER. Every time I finish a shift I like to replay in my mind every patient I saw and I ask myself: 1. is there anything I could have done better? 2. were there any gaps in knowledge regarding any disease processes? 3. was I able to make a positive impact in my patients life? Working in emergency medicine, we often feel like we make the...