The High-Yield Podcast

Following the SOAP approach, we review Subjective, Objective, Assessment & Plan for Ascites & Peritonitis.

Exudative versus Transudative classification compared to new SAAG-based classification are discussed for differential diagnosis.

Values of SAAG in relation to Protein content, Cell count, LDH and Glucose and pH values as well as major risk factors are discussed to differentiate primary (spontaneous) versus 2ndary bacterial peritonitis. and management guidelines provided.

Needs some mathematical understanding of SAAG formula and couple exceptions to the rules (as discussed).

Following our SOAP format we have a question-based discussion of Subjective (epidemiology, risk factors, patients complaints), Objective (PhEx findings, lab assessment results), Assessment (of possible etiologic differential diagnosis) and Plan for management of cirrhosis.

Question-based review of Acute liver failure, staging of hepatic encephalopathy (per clinical & EEG criteria), management of ALF with understanding of the severity criteria, Stage-based management of hepatic encephalopathy, Indications & Eligibility requirement for Liver transplantation, and a brief discussion on acetaminophen toxicity at the end.

After an important question-based assessment of structural versus functional components of hepatocyte markers, we discuss high-yield cases of Hepatitic, cholestatic and mixed-pattern LFT abnormalities. This is prerequisite to entire liver & hepatobiliary system discussions.

Case-Based Review of Respiratory Failure Management.

Please make sure you understand the indications & contraindications for supplemental versus active (invasive & non-invasive) modes of ventilatory support before going through cases.

Indications and contra-indications for common methods of non-invasive ventilation are discussed in quick question-based format with cases as a preparation to the next major episode (i.e. discussion of management options in different types & severities of respiratory failure)

Question-based and quick review of important subject of patients in need of invasive active airway intervention (as opposed to those who benefit from non-invasive intervention or those who just need supplemental oxygenation without a need for active airway). We discuss endotracheal intubation (including crash intubation, RSI, Elective ETI) and we discuss alternatives including crycothyrotomy versus long-term surgical airway indication (i.e. Tracheostomy).

Basics of approach to patient in need of respiratory support and airway management. Question-Based Discussion of "Hierarchical Ladder of Respiratory Support", patient stratification based on indications & contraindications to different modalities of respiratory support. This provides initial management considerations and framework for proper algorithmic approach when addressing the airway management in trauma or respiratory failure patients.

Brief but high-yield question-based approach to differential diagnosis in hypercapnic failure.

Analyzing the differentials and management options based on the formula of Alveolar Minute Ventilation:

Alveolar Minute Ventilation = Respiratory Rate x (Tidal Volume - Dead Space Volume)

VA = RR x (Vt-Vd)

DDxing of hypercapnia includes low RR (e.g. opiate use), Low Vt (e.g restrictive lung disease) or high Vd (COPD).

Discussion of initial workup, classification and differential diagnosis of hypoxia & Hypoxemic respiratory failure.

1- Please make sure you have the formulas ready in front of you (including PA-O2 formula, O2 delivery, O2 content and Fick's Formulas among others).

2- If you need to pause and repeat do so before moving on (it can save lives ....!)