Interviews with mathematics education researchers about recent studies. Hosted by Samuel Otten, University of Missouri. www.mathedpodcast.com Produced by Fibre Studios
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LikedGet your free custom nutrition plan (exclusive to podcast listeners) when you join Wits & Weights Physique University for just $27/month -- There was a day when everything we thought we knew about losing weight got turned upside down. For decades, the advice was simple: eat less, move more. But then scientists started asking why weight loss always seemed to get harder over time, and what they discovered changed everything. This landmark Episode 350 explores the paradigm shift that revolutionized our understanding of metabolism, fat loss, and why 95% of people regain lost weight. Main Takeaways: Your body doesn't just passively lose weight, it actively fights back by slowing metabolism and increasing hunger within 2-3 weeks of dieting The shift from moral food judgments to flexible, data-driven nutrition revolutionized sustainable fat loss Three game-changing strategies emerged: macro tracking as a foundation, working with (not against) metabolic adaptation, and strength training as metabolic insurance This scientific revolution changed how we view our bodies, from broken machines needing punishment to intelligent adaptive systems responding to our lifestyle signals Episode Mentioned: Fat Loss vs. Weight Loss Timestamps: 0:01 - The day everything changed about weight loss 4:30 - Why the "eat less, move more" approach failed 8:47 - How your body fights back: the hormone cascade 10:47 - The rise of flexible dieting and evidence-based coaching 12:29 - Key people who changed the game 14:37 - From food restriction to food awareness 19:35 - 3 game-changing strategies from the research Support the show 🎓 Lose fat for good in Physique University, now just $27/mo ( tap here and I’ll create a FREE custom nutrition plan when you join ) 👥 Join our Facebook community for Q&As & support 👋 Ask a question or find me on Instagram 📱 Try MacroFactor 2 weeks free with code WITSANDWEIGHTS (my favorite nutrition app)…
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Content provided by Sean M. Fox and EMGuideWire Team - From Carolinas Medical Center Emergency Medicine Residen. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Sean M. Fox and EMGuideWire Team - From Carolinas Medical Center Emergency Medicine Residen or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://ppacc.player.fm/legal.
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Content provided by Sean M. Fox and EMGuideWire Team - From Carolinas Medical Center Emergency Medicine Residen. All podcast content including episodes, graphics, and podcast descriptions are uploaded and provided directly by Sean M. Fox and EMGuideWire Team - From Carolinas Medical Center Emergency Medicine Residen or their podcast platform partner. If you believe someone is using your copyrighted work without your permission, you can follow the process outlined here https://ppacc.player.fm/legal.
Join the team from EMGuidewire from CMC Emergency Medicine Residency for another Intern Nuggets! In this episode, Drs. Crow and Lim discuss some tips on how they have approached the first half of their intern years as well as review management of Atrial Fibrillation and Atrial Flutter.
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Join the EMGuidewire team as Drs. Serven and Blackwell discuss the management of the patient presenting with Severe Status Asthmaticus in the Emergency Department. Don't forget to review the basic concepts that were published earlier... this time the focus is on the critically ill patient.
Join the EMGuidewire Team as they address how to prepare for the arrival of a trauma patient in your Emergency Department. Drs. Serven and Blackwell from Carolinas Medical Center Emergency Medicine Residency Program will give us some insight and pearls on how to manage the potential chaos.
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Join the EMGuideWire team as Drs. Serven and Shreve are joined by Dr. Trigonis to discuss simple strategies to make sure your room is set up and you are prepared for performing an emergent intubation on your patients in the Emergency Department. Shownotes - Once through start to finish: Set up suction Set up pre-oxygenation (nasal cannula, NRB, BVM as backup) Choose a tube + back up tube Lube the tube, check the tube Choose a stylet Set up video and DL Ask nurse for meds (nicely) Check hemodynamics Acknowledge preoxygenation Positioning Give meds Wait for paralytic medications to work Tube ‘em Call out your tube positioning Leave the blade in place until tube placement assured Confirm with color change, EtO2, bilateral breath sounds Wait for RT to secure the tube Call for post-intubation meds Check CXR for position…
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Play Later Play Later Lists Like LikedJoin the EMGuideWire team as they explore the use of Point-of-Care Ultrasound for the evaluation of patients with possible COVID-19 infection. Dr. Patrick Lam, from the Carolinas Medical Center Department of Emergency Medicine Department Division of Ultrasound, will guide us on the techniques and pro-tips for this application.…
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Play Later Play Later Lists Like LikedJoin the EMGuideWire team as they learn from one of the world's foremost experts in neurologic emergencies, Dr. Andrew Asimos. This episode will address the Neurologic Manifestations and Complications of the COVID-19 Infection.
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OB Trauma Core Concepts Physiologic changes of pregnancy: physiologic anemia, decreased SVR, increased HR, increased RR, and pelvic vessel engorgement Traumatic complications: placental abruption, preterm labor (PTL), uterine rupture, and pelvic fx Abruption triad = abd pain, large for dates uterus, vaginal bleeding Perform cervical check to eval for PTL Obtain Type and Screen and KB test Give Rhogam if mom is Rh neg. 50 mcg if 12 wks Check fetal HR after E-FAST, nml is 120-160 -Travis Barlock…
Join the EMGuideWire Crew from CMC EM Residency Program as they discuss Ludwig's Angina and the management Priorities!!! BACKGROUND Angina = “Strangling” Bilateral infection of submental, submandibular, and sublingual spaces 70-85% of cases arise from odontogenic source Periapical abscesses of mandibular molars Piercings (frenulum) URI more common cause in children Source of infection often polymicrobial Most commonly viridans ; also Staphylococcus and Bacteroides species Patients usually 20-60 years-old; more common in males1 Mortality in treated Ludwig’s Angina = 8%7 ***Airway compromise = leading cause of death8 Who Is At Risk? Diabetes mellitus Chronic alcohol abuse IVDA HIV/AIDS Malnutrition Poor oral hygiene Smokers Anatomy & Pathophysiology Mylohyoid subdivides submandibular space: Sublingual space Submaxillary (submylohyoid) space Infection extends posteriorly and superiorly, elevating tongue against hypopharynx If left untreated, can extend inferiorly to retropharyngeal space and into superior mediastinum3 Clinical Signs & Symptoms Dysphagia Odynophagia Trismus Edema of upper midline neck and floor of mouth Raised tongue "Woody" or brawny texture to floor of mouth with visible swelling and erythema Late Findings Drooling Tongue protrusion Trismus Dysphonia Cyanosis Acute laryngospasm Stridor Patients may demonstrate signs of systemic toxicity → fever, tachycardia, and hypotension How Do I Make the Diagnosis? Clinically! Consider CT head/neck Can help evaluate extent of infection if clinical situation persists CBC Chemistry Lactate Blood Cultures Management Emergent ENT/OMFS consult for I&D in OR and extraction of dentition if source is dental abscess Airway Management Intubation will be VERY difficult due to trismus and posterior pharyngeal extension Ideal situation = awake fiberoptic intubation in OR ALWAYS have a surgical airway ready as your back up plan Blind insertion devices (e.g. intubating LMA) are NOT recommended Management - Antibiotics Must cover typical polymicrobial oral flora Immunocompetent 3rd-generation Cephalosporin + (Clindamycin or Metronidazole) Ampicillin/Sulbactam Penicillin G + Metronidazole Clindamycin (allergic to penicillin) Immunocompromised → *Need MRSA and GNR coverage!3 Cefepime + Metronidazole Meropenem Piperacillin-tazobactam Add Vancomycin if concern for MRSA risk factors Steroids Dexamethasone 10 mg IV Thought to chemically decompress for airway protection and increase antibiotic penetration6 Nebulized epinephrine Resuscitation and pain control Complications Intracranial infections (e.g. CST, brain abscess) IJ thrombophlebitis (Lemirre’s Syndrome) Mediastinitis Mandibular osteomyelitis Empyema Pearls Three characteristics of Ludwig’s angina can be remembered as the 3 Fs: Feared Often Fatal Rarely Fluctuant ABCs—Sit upright Early notification of ENT/OMFS and anesthesia to facilitate definitive airway management Arrange for the patient to be admitted to ICU Priorities!!! Secure the airway EARLY! Prepare and be ready for a difficult airway — expect that the patient will require a surgical airway Prevent the development of septic shock and multi-organ failure — give antibiotics early References Lin HW, O’Neil A, Cunningham MJ. Ludwig’s Angina in the Pediatric Population. Clin Pediatr (Phila) 2009;48:583-7. Baez-Pravia, Orville V. et al. “Should We Consider IgG Hypogammaglobulinemia a Risk Factor for Severe Complications of Ludwig Angina?: A Case Report and Review of the Literature.” Medicine. 2017;96(47):e8708. Pandey M, Kaur M, Sanwal M, Jain A, Sinha SK. Ludwig’s Angina in children anesthesiologist’s nightmare: Case series and review of literature. J Anaesthesiol Clin Pharmacol. 2017 Jul-Sep;33(3):406-409. Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina Ann Maxillofac Surg. 2015 Jul-Dec;5(2):168-73. Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol 110: 1051, 2001. Saifeldeen K, R Evans. Ludwig’s Angina. Emerg Med J 2004; 21: 242-243 Nanda N, Zalzal HG, Borah Gl. Negative-Pressure Wound Therapy for Ludwig’s Angina: A Case Series.Plast Reconstr Surg Glob Open2017 Nov 7;5(11):e1561. Pak S, Cha D, Meyer C, Dee C, Fershko A.Ludwig’s Angina. Cureus. 2017 Aug 21;9(8):e1588.…
Join the EMGuideWire team as they discuss Superior Vena Cava Syndrome! Shownotes: Definition: Any condition leading to obstruction of blood flow through the SVC Pathophysiology: Pathology in adjacent anatomy (lung, lymph node, thymus, mediastinum) or within the SVC itself obstructs venous return to the right atrium. As the SVC is compressed, venous collaterals form alternative pathways returning blood to the right atrium which can dilate over several weeks. As a result, upper body venous pressure increases, which in extreme cases lead to airway congestion and venous cerebrovascular congestion and edema. Hemomdynamic compromise is most often by direct compression of the heart, not from SVC obstruction. Risk factors: Indwelling device through the SVC (Central line, dialysis catheter, pacemaker) Lung cancer Lymphoma Thymoma Presentation: Signs – plethoric appearance, dilated neck and chest veins, swollen face/neck/chest Symptoms – congestive symptoms (head fullness, swelling), cardiopulmonary symptoms (chest pain, dyspnea, stridor, hoarseness), and neurologic symptoms (headache, confusion, obtundation, visual disturbances) Work-up: Is the patient unstalbe? Do they have severe SVC? If yes, secure airway, support breathing, support circulation Consult vascular/cardiothoracic surgery If patient is stable, then: Confirm diagnosis and evaluate for malignant obstruction CBC, CMP, PT/INR, CXR, CT chest w/contrast Does the patient have a malignant obstruction or thrombosis? Yes -> consult heme/onc and admit No -> observe in ED References: García Mónaco R, Bertoni H, Pallota G, et al. Use of self-expanding vascular endoprostheses in superior vena cava syndrome. Eur J Cardiothorac Surg 2003; 24:208. Rice TW, Rodriguez RM, Light RW. The superior vena cava syndrome: clinical characteristics and evolving etiology. Medicine (Baltimore) 2006; 85:37. Schraufnagel DE, Hill R, Leech JA, Pare JA. Superior vena caval obstruction. Is it a medical emergency? Am J Med 1981; 70:1169. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356:1862.…
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Play Later Play Later Lists Like LikedOctober was Domestic Violence month and in an effort to help highlight this very important topic, join Drs. Salzman, Dragoo, and Richardson from Carolinas Emergency Medicine Residency while they discuss the very important presentation of Strangulation. This is not a mere gesture of power, it may be our last opportunity to save this patient's life! Pearls Strangulation victims are 750% more likely to become a homicide victim. Strangulation is not choking. Call it what it is. External exam findings are often not present and do not rule out internal injury. History is key. Look for neck pain, dizziness, vision/hearing changes, dysphagia, and SOB. Most common internal injury is hyoid fracture. Suspect strangulation? Get CTA neck. Neuro findings? Get non-con CT head + MRI brain. Summarized by Travis Barlock, MD PGY-1…
Join the EMGuideWire crew as they discuss some tips and pearls on how to skillfully run a medical resuscitation. Pearls Preparation is everything. Get your staff, and get your stuff! Call out names, be redundant, and say what you are thinking out loud. Don’t go for the tube! Supraglottic airways are quicker and safer! High quality compressions are life saving. V-tach and V-fib are usually ischemic. PEA is usually non-cardiac. PEA? Is it Wide or Narrow? Narrow - think procedural. Wide - think chemical. Ultrasound is your friend. RV strain, pericardial tamponade, and pneumothorax can all be quickly found! Wide complex (but not V-tach) is hyperkalemia until proven otherwise. Provide Calcium Chloride (not gluconate). Summarized by Travis Barlock, MD PGY-1…
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EMGuidewire's Podcast
The EMGuideWire Team is visited by a prior crew member, Russell Trigonis, MD! Join them as they discuss how the patient diagnosed with Sepsis in your ED has their care continued in the ICU! Pearls Start pressors with IVF (30-40cc/kg). NE at 7mcg/min peripherally can always be stopped, but better earlier than later. Increase NE until at 20mcg/min, if still hypotensive, then add a 2nd pressor like Vasopressin at 0.03units/min and 100mg Hydrocortisone Q8h. Start antibiotics early and identify source. CXR, US lungs/abd, UA, CT abd should all be considered. Procalcitonin is helpful for stopping abx. Doesn’t change ED treatment. Don’t order Vitamin C or thiamine in ED. -Travis Barlock, MD…
It it the end of Sepsis Awareness Month, but there is a BONUS Monday (Sept. 30th), so why not a BONUS episode! Join the EMGuideWire Team as they explore the challenges the children bring to this clinical condition. Let's review Pediatric Sepsis! Pearls: Screening should be age adjusted. Identify severe sepsis. Treat w/early antibiotics, balanced fluid administration, and EPI if needed. SIRS in children must be age-adjusted. HR & RR > 2 standard deviations of nml; WBC age adjusted. Screen: high risk medical history + vital sign abnormalities (age based SIRS) require check of cap refill, mental status, and general appearance followed by a physician assessment. Identify: Severe sepsis = sepsis + organ dysfunction (CV/resp/neuro/renal/hepatic dysfunction). Order a lactate, CBC, CMP, and blood cultures, and consider CXR and UA. CRP is helpful for inpatient team. Higher lactate has higher mortality and is associated with septic shock. Treat: Start 20cc/kg bolus LR and reassess. Those with heart disease can’t take anymore fluids after this, so only add pressors if needed. Continue to 40cc/kg and up to 60cc/kg total bolus prior to pressors for other patients. If still hypotensive, start 0.1 mcg/kg/min of EPI (peripheral or IO). Early antibiotics saves lives. LR is better than NS. Summarized by: Travis Barlock, MD PGY-1 References: Emrath ET, Fortenberry JD, Travers C, McCracken CE, Hebbar KB. Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis. Critical Care Medicine. 2017 Jul;45(7):1177-1183 Ventura et al. Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock. Critical Care Medicine. 2015; 43(11):2292-302…
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EMGuidewire's Podcast
Join the EMGuideWire Crew as they continue to explore the High Yield management points for Sepsis! This week's Episode's Pearls: Early fluids save lives. Give 40cc/kg bolus in first 3 hours. But don’t fluid overload the patient! U/S the heart and lungs: A plethoric IVC, immobile mitral valve, and B lines on the lungs should urge you to be more cautious with fluids. Goal in all patients is to establish an adequate MAP ASAP! Fluids + Vasopressors! Vasopressor titration algorithm: First low dose NE (10mcg/min); if still in shock, initiate vasopressin (0.04 units/min); do not wait on providing vasopressin if EPI is readily available (establish MAP ASAP!). Initiate vasopressors early with fluids! NE can be initiated peripherally, so don’t wait for a central line! Only consider dopamine for absolute bradycardia. Methylene blue is a last resort consideration. Vasopressors are commonly needed at high doses (i.e., 1mcg/kg/min EPI). Hydrocortisone 50-100mg for patients with septic SHOCK, not sepsis alone. Summarized by: Travis Barlock, MD PGY-1 References: Farkas J. PulmCrit- Epinephrine challenge in sepsis: An empiric approach to catecholamines. EMCrit Project. https://emcrit.org/pulmcrit/epi/ . Published August 21, 2018. Accessed September 17, 2019. Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine. 44(3):486-552.…
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EMGuidewire's Podcast
Join the EMGuideWire crew once again for this month's series on Sepsis in honor of Sepsis Awareness month. Episode 3 will cover antibiotic use and selection. Antibiotics for Sepsis Take a history and perform a chart biopsy first! Consider past infections, bug susceptibilities, healthcare acquired vs. community acquired infection, foreign travel, and comorbidities. Always check local antibiogram and prior culture results. Septic shock - Start broad spectrum antibiotics within 1 hour. Stable patient - find the source! UA, CXR, and a good skin exam are fast and can help guide antibiotic choice. Remember some patients need surgical management! Antibiotic choice in septic shock. 1st agent - Piperacillin/Tazobactam (covers GP/GN + Pseudo) 2nd agent - Choose based on patient characteristics Ceftriaxone - simple community acquired infections. Vancomycin - covers MRSA. Meropenem - use for patients with a hx of ESBL. Flagyl + cefepime/meropenem - Use for intra-abdominal infections. Clindamycin - Useful for skin infections (toxin suppression). Cefazolin - IV line infections, endocarditis, soft tissue infections w/o MRSA (covers MSSA, GAS, GBS). Summarized by: Travis Barlock, MD PGY-1 References: Alam N et al. 2018. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet. Respiratory Medicine. 6(1): 40-50. Dellinger RP, Levy MM, Rhodes A, et al. 2017. Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2016. Critical Care Medicine . 44(3):486-552.…
Sepsis Awareness Month continues! Join the EMGuideWire Team as they dive into the issues of Fluid selection for resuscitation. 1) Fluids are not all created equal. Use balanced fluids for large volume resuscitation. 2) Lactated Ringers is likely the best choice available in the ED. Plasmalyte is also a good option, if you have it. 3) You can start low dose vasopressors peripherally if you need to, rather than continuing to flood patients with fluids for hypotension.…
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