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Пікірлер
@davidstanford4885 4 сағат бұрын
I have been in 10 major auto accidents. Several back surgeries plus elbow rebuild in 80s and metal in left shoulder. I've heard all the excuses used to keep from prescribing pain meds,even when I wasn't looking for it
@javiercarlosrodriguez 5 сағат бұрын
This is good
@yasminyouyuo 8 сағат бұрын
Thank you Doctor ❤❤ I got excited seeing a new video from u
@omygod9062 9 сағат бұрын
Van elzakker is very good on this
@workuabageda1623 11 сағат бұрын
👏👏👏
@stephanthomasvarghese2643 13 сағат бұрын
Thanks!
@StrongMed 12 сағат бұрын
You're very welcome! And thank you!
@rajamohanradhakrishnan206 14 сағат бұрын
Simple and thorough knowledge Sir. Thank you so much. ❤
@piyushsonone7 Күн бұрын
Very knowledgeable presentation in essay way thanks 🙏
@YeguadelaSierra Күн бұрын
I must be stupid compared to some of the others here because this is a little more hard for me to understand exactly I have a lot of pain in my epigastric area and I've had it for hours now it's more painful than my labor with either of my kids hurts I was fine all day long ate dinner and a few hours later I had this is pain but I have had it before but it didn't last this long was just as painful I took pepto thinking it was indigestion and later tried an alka seltzer hoping that it is still indigestion and that the pepto just wasn't working for it but now I wonder if I should go see a Dr if it doesn't go away soon or what
@Weirdisjustabrownandyellowword Күн бұрын
I think I have mild symptoms of this, but it still has a significant effect on my daily life. I need to get assessed by a medical professional.
@szxnv Күн бұрын
:)
@dityacivilizacii Күн бұрын
Also, what is health? If someone lost a limb, but otherwise has no medical issues, are they more “healthy” than someone with heartburn? Is someone with bad teeth less healthy than someone with diagnosed general anxiety? What is less healthy, skin cancer or Alzheimers? Health is multifaceted, and some aspects of it may be luck or genetics, some a result of hard work. I’m talking as a person with near perfect teeth just by brushing them twice a day and occasionally flossing. At the same time, as a person taking a bunch of pills and working with psychotherapist for more than 5 years to overcome my cPTSD.
@drektatrivedi4085 2 күн бұрын
Greetings from india. Highly informative lecture❤❤❤❤❤
@aa22aa22aa22xman 2 күн бұрын
❤ thanks 😊 Sir ❤
@mohammedalolabi499 2 күн бұрын
You’re such a great teacher
@ChloeJoe-qm2dm 2 күн бұрын
Really helpful,thanks❤
@PrincessLorie 2 күн бұрын
I spotted the fake right away and I'm just a nurse. It also pisses me off because my FIL died from glioblastoma, 8 days from diagnosis to death.
@maggiehuff9661 2 күн бұрын
Sjogrens should be added in Connective Tissue Disease
@rachurisuresh1014 3 күн бұрын
1. What if shock does not improve after resuscitation , boluses 2.once resuscitation phase is completed when to start maintenance fluid
@dillonscott227 3 күн бұрын
It should be mentioned that although joints may stiffen with age, many hypermobile people have injuries sustained due to ligament laxity that leaves joints - particularly the ankles and knees - with increased instability that can worsen with age and often requires prosthetic bracing to prevent falls and serious injuries.
@Matthew-ky6it 3 күн бұрын
When would you percuss? Only if you hear something abnormal on auscultation?
@StrongMed 3 күн бұрын
I might go as far as saying percussion has almost no role in the practice of medicine in developed nations in the 21st century. Here's why: 1. There is virtually no clinically significant finding that percussion will pick up that wouldn't either be picked up on history or on auscultation.* 2. Anyone with new respiratory symptoms (e.g. dyspnea, hemoptysis) on history, or with an abnormal auscultation should get a chest X-ray. (may not be standard practice in resource-limited areas). 3. There is no pathology that percussion provides additional information to a chest X-ray. 4. Until recently, percussion still had a role in identifying the location of a known effusion at the bedside immediately prior to thoracentesis. But now we use ultrasound for that. (This is obviously not available in all parts of the world.) * The one debatable exception would be picking up hyperresonance in someone with subclinical (i.e. presymptomatic) COPD/emphysema. Although this possible role is suggested by the literature, I'm underwhelmed by its usefulness because the only treatment for subclinical COPD is smoking cessation, which a doctor should be recommending to their patient anyway, irrespective of chest percussion findings.
@yuneed5076 4 күн бұрын
very useful. please make more videos of these acute settings
@segunpeters6201 4 күн бұрын
Thank you!
@beth4698 4 күн бұрын
The symptoms are just beginning to be understood. Meaning a long way to go to find some effective treatments. Mine as well as most of Lyme patients got worse after very long years of antibiotic treatments. Gut is definitely implicated here as 70% of immune system is in the gut. If you can slowly heal your leaky dysbiotic gut maybe it will help to some extent. But hard to recolonized your gut after good bacteria have been killed by antibiotics but some were able to do it depending on your severity.
@nagarajvairagade6581 4 күн бұрын
Nice explanation Sir
@Shivmov 4 күн бұрын
❤
@fjs1111 5 күн бұрын
Absolutely awesome Doctor Strong, awesome!!
@margarytaiastrebynska3223 5 күн бұрын
❤❤❤❤❤❤❤ спасибо вам огромное ❤️.. вы находка ❤
@nkkhan6008 5 күн бұрын
Sir llz ribs opacity kya hota hai please reply.....
@StrongMed 4 күн бұрын
Is this Hindi written phonetically with the Latin alphabet? I'm sorry, but I don't understand.
@islamyoucef9444 5 күн бұрын
is there any wroten document for this presentation Dr Strong please
@StrongMed 5 күн бұрын
I'm sorry, there isn't.
@shomokhal-otaibi9144 6 күн бұрын
The best
@aliotako1647 6 күн бұрын
Niceee
@thelongbow141 6 күн бұрын
This was a masterpiece.
@Ella4620 7 күн бұрын
Thank you!
@epsomtuzud.3932 7 күн бұрын
Can collagen supplements help?
@StrongMed 7 күн бұрын
Unfortunately, there is no evidence that collagen supplements help any form of EDS.
@allabout1783 7 күн бұрын
I wonder, what's stopping my Lecturers from teaching me like this
@maqsudaliqulov 7 күн бұрын
Hi Dr.I wanna enroll this course.Please contact me soon.I will wait
@abanoubnabil8366 7 күн бұрын
Your video is very helpful doctor ❤
@heminhimdad 7 күн бұрын
very helpful, thanks for the video!
@akshayonly 7 күн бұрын
excellent
@dg12344 7 күн бұрын
I would spend more time in excluding DDs for progressive exertional dyspnea and peripheral oedema. "She reports no orthopnea,PND or associated exertional chest pain.She also reports no reduction in UOP/frothy urine,no yellowish discoloration of eyes and no overt bleeding manifestations.She also has no long term cough or wheezing.' Doesn't take a lot of time to say that.
@jonathandball 8 күн бұрын
Non medic here, so I apologise if this is obvious.....As the patient is tachycardic, wouldn't the effect of epinepherine, although helpful in elevating BP, be unwise? How would one restore a healthy relationship between heart rate and BP in this instance? Thanks.
@StrongMed 7 күн бұрын
This is a good question, and it's not an obvious answer. All "pressors" - a general category of hemodynamically active medications - act to increase either vascular resistance (i.e. cause vasoconstriction of arteries), increase contractility (i.e. how forcefully the heart contracts), and/or heart rate. Most pressors have more than one action, with the predominant effect being dose-dependent. At normal doses used in septic shock, norepinepherine (the drug mentioned in this presentation) acts more on vascular resistance than on heart rate. So while it will likely increase the heart rate, this change will be modest compared to the vasoconstriction. The balance between vasopressor and heart rate effects is a little less favorable with epinepherine, which is partially why norepinepherine is preferentially used in septic shock over epinepherine. I have a video that discusses the pharmacology and use of pressors in detail, but there's a table that summarizes their actions relevant to this question here: kzbin.info/www/bejne/jXmqhoWwZpZgpKc
@jonathandball 7 күн бұрын
@@StrongMed Thank you for the detailed explanation. Much appreciated! 👍
@nickgowen7737 8 күн бұрын
Great work Dr. Strong as always. I particularly appreciate that you are demonstrating both the longer form and the shorter form of a good presentation. While I don't disagree with anything you said about the longer form being more preferred by many internists on a slower or more time-having service, I personally always prefer the shorter 3-5 minute version. Many of my colleagues would argue that the 3-5 minute version is too difficult for junior students and that they may miss things when trying to be that brief, but I believe in pushing students to learn the skills necessary to get down to the 3-5 minute style sooner. Either way, you've demonstrated both brilliantly, and these videos will help many learners at many levels of training. I do disagree with your fictional trainee who thinks FENa is helpful in differentiating ATN from prerenal azotemia (which I suspect reflects your own opinion), but reasonable people can disagree on that point as long as learners don't forget urinalysis. Also if a learner said "pain out of proportion" to me in any setting about either context that phrase is used (here for nec fasc or in other settings for acute mesenteric ischemia), I would push that learner to tell me what they meant by out of proportion. I'm assuming your fictional learners would have handled those questions though, so I won't judge them.
@StrongMed 7 күн бұрын
Dr. Gowen, I'm always happy to see you stop by! Thanks for the comments. Here's how I would summarize my opinion on the 3-5 min vs. 7-10 presentation: if it's going to be done well, the 3-5 minute version is preferable, but if it's going to be done poorly, the 7-10 minute one is. That's because important details are less likely to be left out entirely, and errors in reasoning are easier to classify and correct the more time someone spends explaining their thought process. Certainly, at some point, learners need to make that transition from long to short presentations, and I don't know where the sweet spot is for encouraging the shorter one. At our institution, it seems to be during sub-Is, but maybe it should be earlier as you suggest.
@nickgowen7737 7 күн бұрын
@@StrongMed Yes you are 100% correct. I think I use questions to get the other information I want regarding reasoning error, which works well for me but can sometimes make the students nervous if I'm not very careful with the technique. I have too little patience for longer presentations, a bit of a personal flaw that influences my attitudes and practices. I think I might push learners too quickly toward the shorter version, and there is a risk of them flying with it before they are ready. My approach has advantages, but it has the disadvantages you mention. But now my life is easier as I can direct them to your videos here to get more nuance about how to do each version well, and hopefully how to manage the transition better. As someone who spends most of my time with learners and thinks of myself as mostly a clinical educator, I can appreciate how much hard work goes into making these videos. We are lucky to have you sir.
@ClaireKarue-wi9bj 8 күн бұрын
Thank you😄
@leonardotedesi972 8 күн бұрын
One of the best videos on pv loop. Thank you very much
@StephanieLockler 8 күн бұрын
I haven't been diagnosed but I have signs of this daily I might miss a few days a week it's horrible im going to see if my dr can see if I have this
@omidahomi712 8 күн бұрын
Awesome! Thank you Dr.Strong!
@dg12344 8 күн бұрын
In the presentation shouldn't you note the PaO2/FiO2 to exclude sepsis induced ARDS?
@StrongMed 8 күн бұрын
Thanks for a good point. Pulm/CC doc might want this included, particularly since her O2 sat of 92% on 4L suggests she may actually have mild ARDS (although "sepsis-induced non-cardiogenic pulmonary edema" is a non-specific term that would include ARDS). This oral presentation was based on a teaching case in which an ABG was not included in the presented data, which in retrospect was an oversight.
@ATA-wi2lh 8 күн бұрын
Huberman is a grifter, period. A real scientist would know to stay in their own lane. Huberman persistently and confidently steps out of his lane.
@user-zw2qs7ud4q 8 күн бұрын
Все понятно!