The Point of Care Podcast

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 [https://www.pointofcaremedicine.com/inpatient/acute-pancreatitis] 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 [https://www.pointofcaremedicine.com/inpatient/acute-pancreatitis] 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)⁠ [https://pubmed.ncbi.nlm.nih.gov/33496779/] * Acute Pancreatitis ⁠(NEJM, 2016) [https://pubmed.ncbi.nlm.nih.gov/27959604/] 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) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492535/] Other Literature * Enteral versus parenteral nutrition for acute pancreatitis ⁠(Cochrane, 2010)⁠ [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492535/] * A Critical Evaluation of Laboratory Tests in Acute Pancreatitis ⁠(Am J Gastroenterol, 2002) [https://pubmed.ncbi.nlm.nih.gov/20091534/] Blogs and Summaries * Clinical Problem Solvers - Acute Pancreatitis Illness Script [https://clinicalproblemsolving.com/acute-pancreatitis/] * Internet Book of Critical Care - Pancreatitis [https://emcrit.org/ibcc/pancreatitis/] * Radiopaedia - Imaging Findings in Acute Pancreatitis [https://radiopaedia.org/articles/acute-pancreatitis?lang=us] * Pathway Guidelines Summary - Acute Pancreatitis [https://www.pathway.md/diseases/recaG49TSo0aGldQK]

Visit pointofcaremedicine.com [https://www.pointofcaremedicine.com/inpatient/hyperkalemia] 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) [https://pubmed.ncbi.nlm.nih.gov/33160639/] An Integrated View of Potassium Homeostasis (NEJM, 2015) [https://pubmed.ncbi.nlm.nih.gov/26132942/] Risk of Hospitalization for Serious Adverse Gastrointestinal Events Associated With Sodium Polystyrene Sulfonate Use in Patients of Advanced Age (JAMA, 2019) [https://pubmed.ncbi.nlm.nih.gov/31180477/] - 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) [https://pubmed.ncbi.nlm.nih.gov/25415807/] - reduces K over placebo Other Resources: Clinical Problem Solvers - Hyperkalemia Schema [https://clinicalproblemsolving.com/hyperkalemia-causes/] Core EM - Hyperkalemia [https://coreem.net/core/management-of-hyperkalemia/] (good EKG change images) Life in the Fastlane - EKG [https://litfl.com/hyperkalaemia-ecg-library/]Features of Hyperkalemia [https://litfl.com/hyperkalaemia-ecg-library/]

Visit pointofcaremedicine.com [https://www.pointofcaremedicine.com/infectious-disease/diabetic-foot-wound-and-osteomyelitis] 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 [https://pubmed.ncbi.nlm.nih.gov/37779323/]Metab [https://pubmed.ncbi.nlm.nih.gov/37779323/] Res Rev, 2023) [https://pubmed.ncbi.nlm.nih.gov/37779323/] Diabetic Foot Ulcers and Their Recurrence (NEJM, 2017) [https://pubmed.ncbi.nlm.nih.gov/28614678/] Diabetic Foot Ulcers: A Review (JAMA, 2023) [https://pubmed.ncbi.nlm.nih.gov/37395769/]

Visit pointofcaremedicine.com [https://www.pointofcaremedicine.com/inpatient/acute-gout-flare] 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) [https://pubmed.ncbi.nlm.nih.gov/36383714/]STOP Gout Trial (NEJM, 2022) [https://pubmed.ncbi.nlm.nih.gov/35434725/] - allopurinol non-inferior to febuxostat for preventing flares and for reaching target urate concentrations at 48 weeks CARES Trial (NEJM, 2018) [https://pubmed.ncbi.nlm.nih.gov/29527974/] suggested an increased risk of mortality in febuxostat from cardiac events, but a follow-up FAST Trial (Lancet, 2020) [https://pubmed.ncbi.nlm.nih.gov/33181081/] showed no difference compared to allopurinol - FDA still has a black box warning Calcium Pyrophosphate Deposition Disease (CPPD) Review (NEJM, 2016) [https://pubmed.ncbi.nlm.nih.gov/27355536/]