Medgeeks with Andrew Reid

Today, I'd like to introduce Eric Gordon PA-C. He's the newest member of the Medgeeks team and is a physician assistant practicing emergency medicine in Fort Worth, Texas. He graduated from the University of North Texas Health Science Center in 2016. Eric developed a passion for teaching while working as a zipline and ecotour guide in Austin, Texas. He has also taught standardized test prep classe...

Last week we discussed some scoring systems regarding neuro, cardiac, and respiratory. This week, I want to go over GI, renal, endocrinology, infectious disease, and hematology. Let's get started! - Our goal at Medgeeks is to help you live the life  you  want to live as you navigate a career in medicine. This looks different to everyone, which is why we take such a personalized approach.  Whether...

Over the next couple weeks, I want to take a break from the normal disease based podcasts. Instead, I want to shift our focus and discuss some high yield useful scoring, equations, and algorithms, such as the NEXUS C-Spine rule, PERC rule, calcium correction for albumin, FENA, free water deficit for hyponatremia, etc. There are a ton to know. But, I want to touch on the ones I use day in and day o...

So, you scroll to the next patient on your list and see the chief complaint of "eye problem". This can be anything. From a simple hordeolum to an emergency situation like a retrobulbar hematoma. So, let's go over some common eye problems you might see in the emergency department, urgent care, or primary care office. Enjoy! - Our goal at Medgeeks is to help you live the life  you  want to live as y...

Today, we're going to talk about toxic shock syndrome.  You're probably thinking this is the disease associated with tampons and menstrual cycles. Well, let me tell you it's not just menstrual cycle related. In fact, half of the reported case are not menstrual related. Regardless, when you hear toxic shock syndrome, get concerned and get worried. Hopefully, you won't ever have to make this diagnos...

You have a 54 year old male patient with a past medical history of schizophrenia, ETOH abuse, drug abuse (crack cocaine), hypertension, hyperlipidemia, and diabetes. He was brought in by police for aggressive behavior in public. The patient was roaming the street, yelling and banging on restaurant windows.  Upon police arrival, the patient was awake and alert. However, he wasn't calm or cooperativ...

So, today's podcast topic is not a common one, but definitely an emergency when it walks through the door. I actually recently admitted a patient with tumor lysis syndrome to the ICU. This was a very interesting case because it was spontaneous and not following chemotherapy treatment. So, I thought it would be appropriate to touch on this and break the case down in today's podcast.  - Our goal at...

As I pick up more per diem shifts in the ER, I've been seeing more and more complaints of the dreaded vaginal bleeding. At first, I avoided these patients as much as I could, because this isn't your every day complaint in the ICU. I had no idea how to approach these patients - I mean the last time I did a speculum exam was when I was a student. So, I challenged myself to see more of these patients...

Lately, I've been seeing a ton of patient's coming into the ER with a chief complaint of syncope. Today, I want to discuss an approach to the syncopal patient. I also want to get into: Identifying the red flag emergencies Common causes of syncope What diagnostics need to be ordered Today, we have a 75 year old female with a past medical history of hypertension, hyperlipidemia, aortic stenosis, and...

Today, we're going to discuss the last topic of the toxicology series and that's going to be serotonin syndrome. We have a 32 year old male with a past medical history of depression who presents with an intentional overdose of Zoloft.  Per the family, the patient was found in his bedroom acting abnormal, and an empty bottle of Zoloft was found on the floor. His last known normal was when he got ho...

Today, we're going to discuss anticholinergic toxicity. This is an important one as there are a ton of medications out there that have anticholinergic properties.  We have a 75 year old female with a past medical history of Parkinsons, COPD, hypertension, and hyperlipidemia.  She presents from a skilled nursing facility with altered mental status. Per the SNF, the patients baseline is alert and or...

We have an 18 year old male with a past medical history of depression and anxiety who presents with remorse following an intentional ingestion of anything he could find in his parents medicine cabinet. He believes he took about a handful of tylenol tablets and thinks they were about 10 pills of 500 mg extended release tablets. It's the most commonly used fever reducing and pain control agent on th...

Over the next few weeks, I want to do a mini toxicology series. With the amount of new drugs and the amount of overdoses which are occurring, I think it's important for providers to know... The clinical presentation Diagnosis Differential Diagnosis Workup Management ...for these critical patients. Today, we'll be discussing the acute opioid overdose. We'll go over a case, break it down by intro, e...

We have a 32 year old male with a past medical history of ETOH abuse (1 pint of vodka daily), ETOH related seizures, and hypertension. He presents with a complaint of severe epigastric pain and tenderness which started about a day ago and has progressively worsened over the day. The patient said he attempted to eat and drink this morning, but became nauseous and had one episode of non-bloody vomit...

Today, we have a 35 year old African American female with a past medical history of hypertension, who presents to the emergency department. He has a two week history of a viral upper respiratory symptoms, including a low grade fever, cough, nasal congestion, rhinorrhea, sore throat, decreased oral intake - followed by a persistent nose bleed. The nose bleed began over the last couple days and isn'...

Today, I want to talk about a specific topic, that I've seen about 5 times total in my career: Ace inhibitor induced angioedema The first question we should ask is, why do we care (aside from it being fatal)? Well, many patient's have hypertension, and many of them are placed on an ACE inhibitor. This makes ACE inhibitors the number one cause of drug induced angioedema in the United States. The mo...

As you start your shift, your first patient comes in with a chief complaint of headache. A 38 year old female comes in with a two day history of headache. She describes 8/10 pain on the left side of her head and is pulsating in quality. She denies any radiation and states the pain started while she was at work and continued to worsen. She took Motrin with minimal improvement. As soon as she got of...

This week, I want to do a quick rapid review of OSA (obstructive sleep apnea). It's a topic on the blueprint and one you should know about, because it puts patient's at risk for many complications. OSA is one of the most common sleep disorders and occurs due to decreased airflow through the upper airway due to soft tissue collapse. This occurs during sleep and leads to derangement of the oxygen-ca...

Sepsis is an ever changing syndrome that has evolving definitions, scoring systems, and management. You might have heard about the surviving sepsis campaign. It's a joint collaboration between the Society of Critical Care Medicine and the European Society of Critical Care Medicine, which offers evidence based guidelines aimed at reducing sepsis related mortality and morbidity. Guidelines have been...

Today, I'd like to talk about pulmonary hypertension. Most find this quite dull and boring. But, I find this topic interesting, and actually wrote a PA school paper on the topic.  Before you skip this podcast, reconsider... ...I mean this topic is on the boards. Can you really say you know all the groups of pulmonary hypertension without looking them up? If not, then let's dive right in! We'll cov...

The next patient on your list is a 35 year old male with a past medical history of IV drug and alcohol abuse. He's been sober for the last 7 years.  He presents to the ER after a mechanical fall at home. The nursing triage notes states the patient was in his normal state of health, until about two days prior. He may have hit his head, but is unsure. The patient had a loss of consciousness. No neur...

Today, I want to review the evaluation and management of an acute COPD exacerbation.  We have a 65 year old obese male who's a former smoker of 30 years (1 pack/day), but quit 5 years ago.  He has a past medical history of COPD on 3L nasal canula, coronary artery disease, GERD, and type 2 DM. He's presenting with a 3 day history of subjective fever, increasing cough, increasing sputum production,...

Last week, we reviewed the different types of anticoagulation medications.  Today, I want to review what to do when things go bad aka what are the reversal agents. There are 4 basic questions you should consider when thinking about anticoagulation reversal: Is the patient actively bleeding aka do I have to take action immediately? What anticoagulant is the patient on? When was their last dose? Wha...

Today, we're going to change gears.  No case today and no systematic review. Instead, I want to review anticoagulation pharmacology...any medication that inhibits one or more steps of that coagulation cascade.  We're going to review the new and old agents, including: Mechanism of action Indications Precautions Adverse effects Monitoring Dosing We'll also quickly review and simplify the intrinsic a...

I was doing some moonlighting the other week, and I had a textbook case walk through the door. However, it's a case that doesn't walk through the door all too often. I had a 63 year old male with a history of hypertension and type 2 DM who presented with sore throat x 5 days. He denies shortness of breath and chest pain. Vitals revealed normal temperature, HR 95, BP 145/80, and O2 sat 98% RA.  At...