Gout Management
From May 2019, Difficult patient vs. personality disorder?Bryan and Mike discuss the pathophysiology of gout, what chronic gout medications patients might be taking, and acute pain management strategies with a focus on NSAIDS, glucocorticoids, and colchicine. They also present a pathway for when to refer the patient for outpatient follow up and possible …
18min 7Bryan Hayes, PharmD and Mike Weinstock, MD
Opiate Prescribing In The Urgent Care
From April 2019, April Showers, Syncope & SprainsThe opioid crisis is the most catastrophic and enduring public health crisis of our time. Recent legislative advances have provided more tools for clinicians to fight the epidemic.
14min 57Mike Weinstock, MD and Rick Pescatore, DO
Listener Feedback & Questions
From March 2019, Bun (Not) In The OvenPatients with compressive lesions in the lumbosacral spine below the level of the conus medullaris may present with signs and symptoms of cauda equina syndrome. Symptoms are due to compression of multiple nerve roots of the cauda equina and may include pain radiating into one or both legs …
15min 17Mike Weinstock, MD and Matthieu DeClerck, MD
Hyperkalemia
From February 2019, No...You Aren't Gonna Die!Bryan and Mike discuss the the presentation of acute hyperkalemia with a focus on ECG changes, medications available in urgent care to treat severe cases, and when to recommend outpatient follow up or arrange transfer to an emergency department.
16min 1Bryan Hayes, PharmD and Mike Weinstock, MD
DOAC Reversal
From February 2019, No...You Aren't Gonna Die!Continuing the recent discussion between Matt DeClerck and Dr. Tom Deloughery on the direct oral anticoagulants (DOACs), this month we bring you a segment on reversing these DOACs with Matt, Neda, and Dr. Tarlan Hedayati. What are the agents currently on the market, including the newest kid on the …
20min 27Tarlan Hedayati, MD, Neda Frayha, MD, and Matthieu DeClerck, MD
Medication Adherence
From January 2019, Can't We All Just Get Along?There are many barriers to patients compliance with prescriptions. Mike sits down with Bryan Hayes to discuss what are the issues, and also practical solutions to increase patient adherence to medications.
15min 34Mike Weinstock, MD
Gastroesophageal Reflux Disease
From December 2018, Head, Shoulders, Knees and ToesMiz and Jenny discuss current diagnosis, workup and management of GERD. Jenny highlights the step-up approach to treatment when lifestyle modifications alone are insufficient.
19min 28Mizuho Morrison, DO and Jenny Beck-Esmay, MD
Listener Questions
From December 2018, Head, Shoulders, Knees and ToesWhile steroids are not usually first line treatment for odontogenic pain they have been shown to be efficacious in treating post-endodontic pain in multiple studies in the dental literature. Steroids may play a role in pts that can not tolerate, are allergic too, or have contraindications to our …
12min 13Matthieu DeClerck, MD and Mike Weinstock, MD
Opioid Withdrawal
From November 2018, Breaking Bad - Insulin Pumps and MandiblesOpioid withdrawal is becoming more and more prevalent. Treatment for opioid withdrawal should be much like treating any other disease. Zachary Repanshek MD discusses use of common medications to treat withdrawal symptoms.
22min 57Neda Frayha, MD, Matthieu DeClerck, MD, and Zack Repanshek, MD
Nitrofurantoin in Pregnancy
From November 2018, Breaking Bad - Insulin Pumps and MandiblesRick does a deep dive on the literature surrounding the use of nitrofurantoin (macrobid) in the first trimester of pregnancy, and finds that the literature does not support ACOG recommendations. When risks of resistant organisms are high, Rick advocates for the routine use of nitrofurantoin for …
10min 17Rick Pescatore, DO and Jessica Pescatore, DO
Dystonic Reactions and Akathisias
From October 2018, You'll Shoot Your Eye Out!Acute extrapyramidal syndrome aka: drug-induced dystonias and akathisia are known side effects to commonly used medications that patients may be taking at home or that we may prescribe in the urgent care setting. The most commonly used medications that can lead to acute dystonia or akathisia …
22min 17Dave Diller, MD and Matthieu DeClerck, MD
What Would I Do Next? | Lactic Acidosis From Glucophage
From October 2018, You'll Shoot Your Eye Out!Patients who are taking metformin and present with weakness should have metformin associated lactic acidosis (MALA) considered in their differential.
14min 59Mike Weinstock, MD, Brent Arnold, DO, and Mike Pallaci, DO
Antibiotic Prescribing In the Urgent Care
From October 2018, You'll Shoot Your Eye Out!A study recently published in JAMA Internal Medicine by Palms et al, demonstrated that urgent cares are overprescribing antibiotics more than any other clinical setting. We need to do a better job of antibiotic stewardship, and Mike and Miz tackle HOW.
14min 13Mizuho Morrison, DO and Mike Weinstock, MD
What Would I Do Next? | More Than Just Sciatica?
From September 2018, Broken Toof...Now What???We see a lot of back pain in the UC. And although it might be easy to jump to sciatica as the most COMMON cause of back pain, developing a mental checklist and asking “What else could this be?” can be an important habit to ensure patient safety. • Here we discuss features of dx and initial mgmt …
18min 56Mizuho Morrison, DO, Mike Weinstock, MD, and Josh Russell, MD
Opioid Alternatives
From August 2018, Avoiding BurnoutBryan and Mike discuss the 2017 American Academy of Emergency Medicine’s White Paper on Acute Pain Management in the Emergency Department with a focus on strategies applicable to the urgent care setting.
17min 35Mike Weinstock, MD and Bryan Hayes, PharmD
Listener Comments & Questions
From August 2018, Avoiding BurnoutMike and miz respond to a listener comments about treating a patient for anxiety when they have undiagnosed bipolar. What to do, how to screen for it, and how to manage these patients.
11min 7Mizuho Morrison, DO, Mike Weinstock, MD, and Melanie Leadley, DO
Clinical Conundrums - Trigeminal Neuralgia
From June 2018, TRAUMAramaTrigeminal neuralgia can occur in a wide variety of patients and typically presents with unilateral facial pain. Providers who suspect trigeminal neuralgia should employ early imaging to rule other potential diseases. Carbamazepine is a reasonable first line agent yet a large majority of patients …
13min 41Malcom Thaler, MD and Matthew DeLaney, MD
Mailbag Questions
From June 2018, TRAUMAramaMIz and mike start out the month answering listener questions and feedback. They review NSAID efficacy amongst other clinical questions.
8min 23Mizuho Morrison, DO and Mike Weinstock, MD
Hyperemesis Gravidarum
From June 2018, TRAUMAramaMiz and Jenny discuss diagnosis and management of hyperemesis gravidarum. Given recent concerns raised about the safety profile for Ondansetron in both maternal and fetal health, Miz and Jenny review the most recent ACOG guidelines for treatment regimens as well as referral indications.
20min 26Mizuho Morrison, DO and Jenny Beck-Esmay, MD
5 Meds Not To Rx in Urgent Care
From June 2018, TRAUMAramaBryan and Mike make a top-five list of drugs to avoid prescribing to Urgent Care patients. Fluoroquinolones top the list, followed by tramadol, clonidine, and dabigatran. Lidocaine patches can be a useful analgesic, but prescribe the 4% OTC strength instead of the 5% prescription strength. They are …
18min 27Bryan Hayes, PharmD and Mike Weinstock, MD
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