Kelsey and our guest discussant Dr. Mark Quinn walk us through a case of heart failure with diagnostic and management tips & tricks.

Links mentioned:
"The Curbsiders" podcast on acute heart failure: https://thecurbsiders.com/podcast/230
JAMA review article on HFrEF: https://jamanetwork.com/journals/jama/fullarticle/2768982

Guest discussants Rachel and Dr. Abebe join us for an awesome discussion filled with practical tips and clinical pearls.

Links mentioned:
NephJC podcast on SGLT-2 inhibitors: http://www.nephjc.com/news/sglt2mechanism
The Curbsiders Fluid Wars episode: https://thecurbsiders.com/podcast/143-nephmadness-fluid-wars
Review article on DKA associated with SGLT-2 inhibitors: https://pubmed-ncbi-nlm-nih-gov.proxy.kumc.edu/32364674/
Review Article Overview article of hyperglycemic crises in adults: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699725/
AAFP Review Article on Management of Diabetic Ketoacidosis: https://www.aafp.org/afp/2013/0301/p337.html
1946 Salt Depletion and Diabetic Acidosis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2601984/

Guest discussants Zach Duarte and Dr. Tahira Zufer help us walk through a classic case with a can't-miss twist.

Links mentioned:
Head-to-head trial of apixaban vs rivoraxaban (studied in A-fib): https://doi-org.proxy.kumc.edu/10.7326/M19-2522
2020 COPD Gold guidelines: https://goldcopd.org/wp-content/uploads/2019/11/GOLD-2020-REPORT-ver1.0wms.pdf

Nausea and vomiting aren't fun for anyone, especially the patient. Treating and diagnosing the cause will not only make you the hero, it'll protect your patient from dangerous consequences and outcomes. Join us for a discussion on how to do just that with first-time discussant Jessica Ferguson and return discussant Dr. Abebe.

Altered Mental Status can be a daunting challenge to diagnose, work up, and treat. But fear not! If you take a step back and keep an open mind, you can help your patient come back to baseline. In this episode, Heather Minchew (MS3 at KUMC) and Dr. John Fritzlen (PGY-3 IM at KUMC) help us to walk through how to approach altered mental status.

Let's face it; diabetes management can get quite complicated. But proper management can make a huge difference in a patient's long-term health. In this episode Dr. Mollyanne Brunkow (PGY-2 Family Medicine resident) helps us to navigate a variety of ways that patients can present to clinic with diabetes, and how to best approach management in an individualized fashion.

Links Referenced:

• American Diabetes Association 2020 Standards of Care: https://clinical.diabetesjournals.org/content/38/1/10

• Reasons for Falsely Elevated or Decreased A1c: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912281/

• Carbohydrate Restriction for T2DM Therapy: https://www.sciencedirect.com/science/article/pii/S0899900714003323

• Post-Meal Exercise Improving Glucose Sensitivity and CV Metabolites: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048462/

Headaches can be very distressing for patients, and daunting for the treatment team. In this episode, In this episode Dr. Jonathan Chandler (PGY-3 Internal Medicine resident at KUMC) and Sara Ohadi-Hamadani (MS3 at KUMC) helps us to walk through a case of severe headache.

Abdominal pain is one of those symptoms in medicine that could be as benign as the patient eating a bit too much... or as life-threatening as an intestinal perforation (and everywhere in between). Join us as we talk through how to approach abdominal pain, when to pull the CT trigger, and how to approach the management of this patient's diagnosis.

Helpful links mentioned in the chat during the live discussion:

• Imaging modality choice for abdominal pathology: https://www.aafp.org/afp/2015/0401/p452.html

• Bilirubinuria breakdown: https://www.ncbi.nlm.nih.gov/books/NBK557439/

An episode of loss of consciousness can mean a lot of things. John, expert discussant Dr. Abebe, and M3 discussant Zach Duarte walk us through a case of LOC with a variety of twists, surprises, and clinical pearls.

Links mentioned in the episode:

• San Francisco Syncope Rule: https://www.mdcalc.com/san-francisco-syncope-rule

• The Curbsiders Hyponatremia: https://thecurbsiders.com/podcast/reboot48

• NEJM article: https://www.nejm.org/doi/full/10.1056/nejm200005253422107

Whether it's "pink lemonade" or "Coca-Cola", whenever a patient is using drinks to describe the color of their urine, you know something is up. Hematuria can have a variety of causes, but one thing for certain is that it's not normal. In this episode, Kelsey and Dr. Kerri Thurmon walk us through how to think about, diagnose, and treat hematuria.

2016 article on AKI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198510/

Severe, acute abdominal pain is distressing for the patient and the care team.
In this episode we have a med-student round-table discussion with Anne Recker (MS3), Jacob Lutgen (MS1)
and Rachel Jenkins (MS3) as they join us on a diagnostic journey that starts with abdominal pain
and touches on all sorts of clinical pearls along the way.

A new or increased oxygen requirement can be one of the first warning signs of a new or worsening clinical condition. In this episode, Dr. Nikki Miller (PGY-3 Internal Medicine resident at KUMC) and Lindsay May (MS3 at KUMC) help us to navigate through this ominous chief complaint with a variety of patient-centered teaching points throughout.

You have a pediatric patient with a likely viral infection, but how do you assess if hospital admission is needed? One big factor to consider is his/her ability to maintain hydration. Children in particular are very prone to dehydration, and fluid resuscitation can be enormously therapeutic.

In this first pediatric edition of Decoding Dx, we explore dehydration and its treatment with our discussants Justin Coogle (PGY-2 Pediatric Neurology resident at Children's Mercy Hospital) and Sara Ohadi-Hamadani (M3 at KUMC).

Chronic diarrhea can be a puzzle to figure out, and becomes even more tricky when the situation is complicated by dementia. In this episode, John and our discussants Sara Ohadi-Hamadani (MS3) & Dr. Stephanie Slimmer (PGY-3 IM resident at KUMC) walk through a case that hits on the workup of chronic diarrhea, goals of care, and how to stay patient-centered in the context of dementia.

The eye can be daunting territory if you're not an ophthalmologist or aspiring to be one. But vision loss can be detrimental to a patient's life, and it could also be a clue into many different disease processes that go much beyond the eye. In this episode we are joined by Dr. Ralph Mohty (PGY-3) and Rachel Jenkins (MS3) to discuss ways to approach vision loss, what pivot points to focus on, how to prioritize your workup, and more.

Myocardial infarction is a big can’t-miss diagnosis with the acute onset of chest pain. But what’s the best workup? If the troponin is elevated, how do you treat acutely? What about post-acute care? Join us for a case of chest pain with return discussant Dr. Mollyanne Brunkow (PGY-2 FM resident) and first-time discussant Katie O-Brien (MS3).

When a patient has a fever, the first thing we usually think is infection, but what if there is no source of infection? There are many possible causes including atypical infections, malignancy, medications, endocrinopathies, and autoimmune diseases. The workup can be daunting, but a systematic approach can enable top-quality care and a comprehensive workup. In this episode, Kelsey walks us through a case of fever of unknown origin with expert discussant Dr. Abebe Abebe and MS3 discussant Dylan McKee.

The first branch point for new onset hypertension is acute vs chronic, then primary vs secondary. In this episode, Rachel (one of our newest members on the team) leads a discussion that starts with an inpatient consult for hypertension but brings us through a variety of clinical tips & management strategies for a common and dangerous cause of secondary hypertension.

In this episode, we go through a case that starts out pretty straight forward, but quickly reveals subtle findings that trigger a re-consideration of our differential diagnosis. We cover a wide scope of ICU logistics including different types of respiratory support, how to evaluate dysphagia, approach to weight loss, ethics of restraints, and when to step back and reconsider your differential. Big thanks to our amazing discussants, Dr. Jonathan Chandler (IM PGY-3) and Jack Nolte (MS3).