The Point of Care Podcast

Explore asterixis, often called the 'liver flap,' a critical neurological sign indicating toxic-metabolic encephalopathy. Learn why this 'negative myoclonus' isn't a tremor, how to spot its distinctive 'flapping' motion, and its diverse etiologies, from liver and kidney disease to hypoglycemia and medications. We demystify its strong historical link to hepatic issues and emphasize why this finding is key to a complete diagnostic assessment. Subscribe to our Substack: https://substack.com/@rokeefemd

Navigating hepatic encephalopathy can be complex, and the role of ammonia levels is often misunderstood. In this concise episode, we clarify why hepatic encephalopathy is fundamentally a clinical diagnosis, not one based solely on lab values, and reveal the crucial limitations of ammonia testing. Learn when ammonia levels are genuinely helpful - specifically in acute liver failure - and why relying on them for routine diagnosis or trending can lead clinicians astray, diverting focus from essential clinical assessment. Subscribe to our Substack: https://substack.com/@rokeefemd

Hepatic encephalopathy (HE) can feel like it comes out of nowhere: one day a patient is baseline, the next they’re confused after “just” constipation, a little dehydration, or a routine diuretic tweak. In this episode, we unpack why seemingly benign stressors can flip a fragile gut–liver–brain system past its tipping point. Subscribe to the Point of Care Medicine Substack.

In this episode, we break down why lactulose and rifaximin work specifically for HE: lactulose acidifies the colon to “trap” ammonia as ammonium (NH4⁺) and rapidly clears nitrogen substrates via catharsis, while rifaximin reshapes the gut microbiome and dampens gut-derived inflammatory signaling - benefits that don’t always correlate with serum ammonia levels. We also cover why other antibiotics fell out of favor, where polyethylene glycol fits, and how to think mechanistically about the best risk–reward strategy for preventing and treating HE. Subscribe to the Point of Care Medicine Substack

A comprehensive guide on how to complete a thorough history and physical (H+P) for patients presenting to the hospital with opioid withdrawal. 00:15 Admission Checklist for Opioid Withdrawal 00:40 Triage and Chart Check 02:01 Critical Considerations and Admission Orders 03:10 Initial Treatment Options for Opioid Withdrawal 05:32 Detailed HPI Intake Questions 07:33 Physical Exam Notes 08:35 Key Takeaways and Conclusion Subscribe to our Substack to receive updates and IM/Hospital Medicine recaps directly to your inbox. POCM Opioid Withdrawal Inpatient Admission POCM Opioid Use Disorder and Withdrawal Clinical Review 13 Essential Facts for Managing Opioid Withdrawal in 2025

This is a text-to-speech (TTS) AI reading of our most recent blog post: 6 Facts Every Clinician Needs to Know About Tumor Lysis Syndrome. https://www.pointofcaremedicine.com/blog-post/6-facts-every-clinician-needs-to-know-about-tumor-lysis-syndrome-2025 Tumor Lysis Syndrome (NEJM, 2025) Bociek RG, Lunning M. Tumor Lysis Syndrome. N Engl J Med . 2025;393(11):1104-1116. doi:10.1056/NEJMra2300923 ‍Related Content Tumor Lysis Syndrome Admission Template

Many patients with hypertension have primary aldosteronism, but most at-risk patients are never tested. Learn who needs screening, how to order an ARR without unnecessary washouts, and why timely diagnosis prevents heart, vessel, and kidney damage. Based on “Things We Do For No Reason – Failing to Consider Primary Aldosteronism in Hypertension” (Journal of Hospital Medicine). Source: https://pubmed.ncbi.nlm.nih.gov/40113595/ Subscribe to our Substack: https://rokeefemd.substack.com/

Today's episode is an AI text-to-speech (TTS) reading of our most recent blog post: 12 Key Principles for Diagnosing and Managing Vertigo and Dizziness. Read along here: https://www.pointofcaremedicine.com/blog-post/12-key-principles-for-diagnosing-and-managing-vertigo-and-dizziness Related Content Dizziness and Vertigo Admission Template https://www.pointofcaremedicine.com/inpatient-admission/dizziness-and-vertigo Dizziness and Vertigo Clinical Review https://www.pointofcaremedicine.com/review-article/dizziness-and-vertigo

Today's quick admit episode is a rapid review on the evaluation of vertigo and dizziness in a hospital setting. Visit https://www.pointofcaremedicine.com/inpatient-admission/dizziness-and-vertigo to see the online admission template and follow along. Timestamps 00:00 - Intro and Summary 02:13 - Admission Checklist 02:51 - HPI Intake 06:54 - Focused Physical Exam 09:06 - Differential Diagnosis 09:49 - Initial Workup 10:22 - Treatment Related Content Dizziness and Vertigo Clinical Review https://www.pointofcaremedicine.com/review-article/dizziness-and-vertigo 12 Key Principles for Diagnosing and Managing Dizziness and Vertigo https://www.pointofcaremedicine.com/blog-post/12-key-principles-for-diagnosing-and-managing-vertigo-and-dizziness

AFib with RVR: Quick Admit This Quick Admit episode on AFib with RVR will focus on only the highest yield information you need when admitting a patient to the hospital. To take your understanding of the disease to the next level, check out the full-length episode for more information including a discussion of the most important clinical pearls and literature. Visit https://www.pointofcaremedicine.com/inpatient-admission/atrial-fibrillation to see the admission template discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Timestamps 00:00 Introduction to AFib Management 00:24 Initial Assessment and Triage 01:06 Reviewing Patient History 01:59 Admission Orders and Labs 02:29 Initial Treatment Considerations 03:41 History of Present Illness (HPI) 04:30 Physical Examination 04:58 Etiology and Causes 05:33 If You Remember Nothing Else 06:49 Conclusion and Follow-Up Disclaimer: The content of this video and any associated media is meant for educational and information purposes only. RMO Medical Education does not provide medical advice, diagnosis, or treatment.

Atrial Fibrillation: Clinical Review This full-length clinical review episode on atrial fibrillations is designed to help take your fund of knowledge to the next level! Visit https://www.pointofcaremedicine.com/review-article/atrial-fibrillation to see the online Clinical Review Article. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Timestamps 00:00 Introduction to Atrial Fibrillation 00:12 Key Takeaways 01:13 Definitions 02:17 Etiologies 04:22 Pathophysiology 07:28: Physical Exam 08:18 Diagnostic Workup 10:25 Treatment - Stroke Prevention 14:17 Treatment - Rate Control 16:13 Treatment - Rhythm Control 19:05 Treatment - Risk Modification 20:10 Clinical Pearls 29:54 Review of Clinical Trials 34:11 Additional Resources and Conclusion Show Notes Review Articles Atrial Fibrillation A Review Direct Oral Anticoagulants in Patients with ESRD Catheter ablation for atrial fibrillation: indications and future perspective Related Content Afib with RVR Admission Template 20 Atrial Fibrillation Facts Every Physician Needs to Know in 2025 10 Key Facts About Ablation for Atrial Fibrillation CKD and Atrial Fibrillation: Navigating the Anticoagulation Maze Disclaimer: The content of this video and any associated media is meant for educational and information purposes only. RMO Medical Education does not provide medical advice, diagnosis, or treatment.

This Quick-Admit episode on acute pancreatitis will focus on only the highest-yield information you need when admitting a patient to the hospital. To take your understanding of the disease to the next level, check out the full-length episode for more information including a discussion of the most important clinical pearls and literature. Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia.

This full-length episode on the inpatient management of acute pancreatitis includes not only the admission framework, but also key clinical pearls on the background, pathophysiology, etiologies, presentation, diagnosis, treatment, and complications associated with the disease to help take your understanding to the next level! Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Timestamps 00:00:00 - Background and Epidemiology 00:01:13 - A Note on Chronic Pancreatitis 00:01:31 - Admission Checklist 00:03:49 - HPI Intake 00:04:33 - Physical Exam 00:05:20 - Etiology and Differential 00:06:20 - Plan - Work Up 00:07:30 - Plan - Treatment 00:09:31 - If You Remember Nothing Else 00:10:04 - Pearls - Pathophysiology 00:11:15 - Pearls - Etiology and Risk Factors 00:12:56 - Pearls - Presentation and Diagnosis 00:15:56 - Pearls - Treatment 00:18:08 - Pearls – Complications Show Notes Reviews Acute Pancreatitis: A Review ⁠(JAMA, 2021)⁠ Acute Pancreatitis ⁠(NEJM, 2016) Trials WATERFALL Trial - Aggressive (20 ml/kg bolus + 3 ml/kg/hr) vs Non-Aggressive (10 ml/kg bolus + 1.5 ml/kg/hr) fluid resuscitation in acute pancreatitis - fluid overload resulted in 20.5% vs 6.3% of patients but no difference in the development of moderately severe or severe pancreatitis ⁠(NEJM, 2022) Other Literature Enteral versus parenteral nutrition for acute pancreatitis ⁠(Cochrane, 2010)⁠ A Critical Evaluation of Laboratory Tests in Acute Pancreatitis ⁠(Am J Gastroenterol, 2002) Blogs and Summaries Clinical Problem Solvers - Acute Pancreatitis Illness Script Internet Book of Critical Care - Pancreatitis Radiopaedia - Imaging Findings in Acute Pancreatitis Pathway Guidelines Summary - Acute Pancreatitis

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Timestamps : 00:00:07 - Background and Epidemiology 00:00:42 - Pathophysiology 00:02:29 - Admission Checklist 00:04:29 - HPI Intake 00:05:15 - To Note on Exam 00:05:25 - Etiology and Differential 00:06:10 - Plan - Treatment 00:07:56 - If You Remember Nothing Else 00:08:40 - Pearls - Etiology 00:09:44 - Pearls - Presentation and Diagnosis 00:12:03 - Pearls - Treatment Trials and Literature Clinical Management of Hyperkalemia (Mayo Clin Proc, 2021) An Integrated View of Potassium Homeostasis (NEJM, 2015) Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age (JAMA, 2019) - Kayexalate is associated with serious GI adverse events over 30 days (0.2% of people who take vs. 0.1% who don’t) - NNH is 1000; intestinal ischemia is the most common Sodium zirconium cyclosilicate in hyperkalemia (NEJM 2015) - reduces K over placebo Other Resources: Clinical Problem Solvers - Hyperkalemia Schema Core EM - Hyperkalemia (good EKG change images) Life in the Fastlane - EKG Features of Hyperkalemia

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care without getting bogged down by unnecessary details or trivia. Timestamps 00:00:08 – Background 00:01:12 – Pathophysiology 00:01:55 – Admission Checklist 00:03:29 – HPI Intake 00:04:19 – To Note on Exam 00:04:58 – Plan: Workup 00:05:40 – Plan: Treatment 00:07:28 – If You Remember Nothing Else 00:08:28 – Pearls 00:10:43 – Literature Literature IWGDF/IDSA Guidelines on Diagnosis and Treatment of Diabetes-Related Foot Infections (Diabetes Metab Res Rev, 2023) Diabetic Foot Ulcers and Their Recurrence (NEJM, 2017) Diabetic Foot Ulcers: A Review (JAMA, 2023)

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Time Stamps: 00:00:08 - Background and Definitions 00:01:39 - Pathophysiology 00:03:22 - Admission Checklist 00:04:25 - HPI Intake 00:05:51 - Physical Exam 00:06:06 - Differential Diagnosis 00:06:38 - Plan - Workup and Treatment 00:08:54 - If You Remember Nothing Else 00:10:14 - Pearls - Etiology 00:11:00 - Pearls - Presentation and Diagnosis 00:13:07 - Pearls - Treatment 00:15:20 - Literature and Trials 00:15:56 - Wrap Up Show Notes: Gout Review (NEJM, 2022) STOP Gout Trial (NEJM, 2022) - allopurinol non-inferior to febuxostat for preventing flares and for reaching target urate concentrations at 48 weeks CARES Trial (NEJM, 2018) suggested an increased risk of mortality in febuxostat from cardiac events, but a follow-up FAST Trial (Lancet, 2020) showed no difference compared to allopurinol - FDA still has a black box warning Calcium Pyrophosphate Deposition Disease (CPPD) Review (NEJM, 2016)

Today's episode is on the inpatient workup and management of Community-Acquired Pneumonia featuring an admission checklist, HPI intake, differential, plan, and high-yield clinical pearls. Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care without getting bogged down by unnecessary details or trivia. Show Notes: 00:00:08 - Background and Definitions 00:01:13 - Etiology and Pathophysiology 00:02:49 - Admission Checklist 00:05:16 - HPI Intake 00:06:38 - Physical Exam Findings 00:07:30 - Differential 00:08:48 - Treatment Plan 00:10:15 - If You Remember Nothing Else 00:11:47 - Clinical Pearls - Etiology 00:13:47 - Clinical Pearls - Presentation and Diagnosis 00:16:53 - Clinical Pearls - Treatment 00:19:52 - Clinical Pearls - Complications

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. 00:00:07 - Historical Background and Definitions 00:01:56 - Admitting a Patient with Sepsis 00:05:29 - Plan for Workup and Management of Sepsis 00:07:41 - Clinical Pearls 00:16:07 - If You Remember Nothing Else

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Show Notes: 00:00:15 - Introduction and Terminology 00:01:51 - Beta Blockers 00:02:47 - ACE/ARB/ARNI 00:04:30 - MRA's 00:05:28 - SGLT2i's 00:06:12 - Nitrates and Hydralazine 00:08:41 - Loop Diuretics 00:09:25 - Initiating and Titrating GDMT 00:11:18 - Barriers and Other Considerations 00:13:44 - Resources for Use at the Point of Care Other Resources and References: GDMT for Everyone – https://www.gdmt.org/HFrEF.php Table of all the Sacubitril/Valsartan Trials Published to Date (2023) - https://twitter.com/jaycvance/status/1660732176999108623 An elegant graphic showing how the hazard ratios with confidence intervals for all-cause mortality improve based on adding on each extra GDMT medication; brought to my attention by a tweet from Dr. Scott Cameron - ⁠https://twitter.com/2Scottish/status/1556798319996932096⁠ Heart Failure with Reduced Ejection Fraction: A Review (JAMA, 2020) - https://pubmed.ncbi.nlm.nih.gov/32749493/ A Systematic Review and Network Meta-Analysis of Pharmacological Treatment of Heart Failure With Reduced Ejection Fraction (JACC, 2022) - ⁠https://www.jacc.org/doi/full/10.1016/j.jchf.2021.09.004

Visit pointofcaremedicine.com to see the templates, pearls, literature, and other resources discussed in this episode. Our mission is to create accessible and easy-to-use digital resources that help healthcare professionals tackle common clinical presentations at the point of care, without getting bogged down by unnecessary details or trivia. Show Notes: 00:00:38 - Background and terminology 00:02:22 - Checklist for Admitting a Patient with ADHF 00:05:40 - Crafting your Assessment 00:08:56 - Creating a Plan for ADHF - Diuresis and GDMT 00:13:12 - Clinical Pearls 00:16:48 - A note on HFpEF 00:17:15 - If you remember nothing else