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-dizzinessRelated ContentDizziness 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.