#203 POCUS for AKI & Dialysis | Real Cases That Changed Management

A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?🔹Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/See here for Neph Madness details See here for the POCUS region of NephMaddnessVOTE here to build your bracket!🔹Transcript and Shownotes:00:52 | What is NephMadness?02:19 | Detecting post-renal obstruction in a patient who reported normal urination11:26 | POCUS for discharge or continue diurese 17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis lineAlong the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUSFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Most clinicians see dementia medications on the med rec, but many of us aren’t sure how much they actually help. In this episode we break down donepezil, memantine, and the new anti-amyloid drugs, and when to stop them.• Do cholinesterase inhibitors really work?• What should clinicians know about lecanemab and donanemab before referring patients?• How much benefit should we expect and for how long?• When should you deprescribe dementia medications?🔹Sponsor: Caraway’s cookware set is a favorite for a reason.For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.🔹Transcript and Shownotes02:27 | Deep Dive 1: How do we deliver the news of a diagnosis of dementia?09:41 | Deep Dive 2: Prescribing medications for cognitive decline29:30 | Deep Dive 3: Patient-centered management for a patient with cognitive decline35:46 | Deep Dive 4: Planning for an uncertain futureTags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Cognitive decline is tough for all parties. What are the high-yield questions to ask? What should you add to your one-liner? When do you stop using MOCA and try to clearly describe their functional status? Do all patients with cognitive decline need an MRI?🔹Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com🔹Transcript & Shownotes:01:12 | Cognitive Concerns During a Routine Follow-Up03:41 | Deep Dive 1: How do you pivot when you recognize unexpected memory issues?15:08 | Deep Dive 2: What tools should we use to characterize and stage cognitive decline?31:09 | Deep Dive 3: How do we determine the etiology of cognitive decline?Tags: CoreIM, Internal Medicine, Medical Education, Cognitive Screening, primary care, nurse practitioner, physician assistantFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

From metformin to basal insulin to overlooked older medications, this episode reviews the T2D medication toolkit clinicians use every day. We then dive into new evidence on once-weekly insulin to help you individualize therapy while reducing treatment burden.🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/🔹Transcript and Shownotes:00.58 | Insulin Hx & Types06:00 | Indications for Insulin and the Burden on Patients08:26 | What is the QWINT-1 Trial?16:18 | DiscussionTags: CoreIM, Internal Medicine, Evidence-Based Medicine, Insulin Resistance, Clinical Reasoning, Hospital Medicine, Medical Education, Endocrine, EndocrinologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Is patient confidentiality absolute or conditional? When does protecting privacy put others at risk? Can you follow a former patient in the EHR for learning? Should you post a compelling case online even if it’s “de-identified”? And when does the law force you to betray patient trust? In this episode of At the Bedside, learn how clinicians should act when ethics, law, and trust collide.🔹 Sponsor: DoxGPT by Doximity - an AI assistant built with practicing clinicians to deliver bottom-line clinical answers, chart summaries, secure calls, and faxing directly inside the Doximity app. See how fast it is and how easy to read at DoxGPT.com🔹Transcript and Shownotes:03:51 | What is the difference between Privacy and Confidentiality?05:50 | Guidelines and laws10:06 | Limits/appropriate breaches (competing principles/obligations) 22:03 | Privacy vs education35:34 | ConclusionFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Baby alligators  - those betrayals of purpose , or, death by a thousand paper cuts !Check out our latest episode, where Dr. Eileen Barrett walks us through how to tackle baby alligators with:Regulated curiosityStrategic empathySmall, well-chosen moves......and change that is big enough to matter, and small enough to win!🔹 Sponsor: Caraway’s cookware set is a favorite for a reason.For 10% off, go to Carawayhome.com/CoreIM or use code CoreIM at checkout.🔹 Transcript & Shownotes00:00 | What are “baby alligators” in medicine?02:24 | Rifaximin & Workflow Fixes14:17 | Verbal Orders Policy18:39 | Micro Skills for Change25:12 | Key Takeaways#PhysicianBurnout #DoctorLife #HealthcareEfficiency, CoreIM, Internal Medicine, Career Development, Quality Improvement, QIFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Gray zones of VTE management! How to approach anticoagulation duration in unprovoked, provoked-irreversible, and provoked-reversible clots?When dose-reduced DOACs make sense for long-term secondary prevention? What truly constitutes DOAC failure? We also devle into how APLAS a critical do-not-miss diagnosis that changes management entirely.🔹 Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/🔹 Transcript & Shownotes(2:56) - (13:15) | PEARL 1: Managing clots in the “unprovoked”/provoked-irreversible patient(13:21) - (18:10) | PEARL 2: Managing provoked, “reversible” clots(18:14) - (25:14) | PEARL 3: DOAC failure: time to step it up?(25:20) - (37:25) | PEARL 4: APLAS: the exception to everythingTags: CoreIM, Internal Medicine, ClinicalPearls, Medical Education, IMCore, hospitalist, physician assistant, nurse practitioner, medical student, internal medicine, hematologyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

We hope these stories resonate with anyone who has felt pulled between professional purpose and personal life, and remind you that you’re not alone in wanting both.🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and Shownotes(1:09) | How the Horn Award Opened the Door to Growth in Dr. Tyra Fainstad’s Career and Life(10:28) | How Dr. Carol Ward Created the Horn Award and Honored Mary Horn’s Legacy(14:16) | Dr. Hilit Mechaber’s Story of Courage, Vision, and Impact Beyond the Award(17:55) | Why does the Horn Award Matter?Tags: CoreIM, Internal Medicine, Career Development Award, Mary O'Flaherty Horn Award, Clinical Care, Scholarship, Teaching, Leadership, Wellness and Care, Family ResponsibilitiesFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Antibiotic duration for bacteremia is something most of us learned by habit, not by trial data. In this episode, we walk through the BALANCE trial and use it as a lens to revisit how 1) host, 2) organism, and 3) source should guide treatment. When shorter really is enough, and when it isn’t?🔹 Sponsor: Oakstone CMEUse the code "CORE30" for 30% off: https://www.coreimpodcast.com/MKSAP 🔹 Transcript and ShownotesTimestamp(02:58) | Host, Organism, Source: The Core Framework Behind Duration(09:02) | How Evidence Shifted Practice(11:27) | The BALANCE Trial: Short-Course vs Standard-Course Therapy(18:55) | Where does this leave us?Tags: CoreIM, Internal Medicine, Infectious disease, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical EducationFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do you start with why and when?🔹 Transcript and Shownotes(03:19) | Lipoprotein Lipase and Why Triglycerides Fluctuate Fast(05:27) | Triglycerides as a Cardiovascular Risk Marker(09:28) | Acute Management For Pancreatitis induced by Triglycerides(14:34) | Lifestyle Counseling(17:31) | Medications That Lower Triglycerides(25:29) | How to Choose the Right Triglyceride Therapy(27:56) | Genetic Causes and When to Suspect Familial DisordersTags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary careFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Our Sponsors:* Check out FIGS and use our code FIGSRX for a great deal: https://wearfigs.comAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy