23 episodes

Your work is hard; staying current shouldn’t be. Keep your practice ahead of the curve with entertaining, engaging and concise primary care and family medicine topics from world-class educators.

This iTunes segment is just one monthly free segment of the full Primary Care RAP show. Get 3 hours of fresh podcast episodes per month and 42 AMA PRA Category 1 credit(s)™ per year when you sign up for the full podcast at hippoed.com.

Don’t forget to download the Primary Care RAP app in the app store for even more streamlined listening.

Primary Care RAP Hippo Education LLC.,

    • Medicine

Your work is hard; staying current shouldn’t be. Keep your practice ahead of the curve with entertaining, engaging and concise primary care and family medicine topics from world-class educators.

This iTunes segment is just one monthly free segment of the full Primary Care RAP show. Get 3 hours of fresh podcast episodes per month and 42 AMA PRA Category 1 credit(s)™ per year when you sign up for the full podcast at hippoed.com.

Don’t forget to download the Primary Care RAP app in the app store for even more streamlined listening.

    Community Acquired Pneumonia - Guideline Update

    Community Acquired Pneumonia - Guideline Update

    We have been waiting and waiting and waiting for the new community acquired guidelines. And here they are! Infectious Diseases expert Dr. Devang Patel, MD joins Matt DeLaney, MD, FACEP, FAAEM and Neda Frayha, MD for a conversation on CAP in general and the new guidelines in specific.
    For more incredible segments like this, subscribe to PC:RAP today. You'll never miss a moment of the program and earn 42 hours of CME per year. 

    Pearls:
    The latest guidelines for community acquired pneumonia now includes amoxicillin or doxycycline for 5-7 days as first-line treatment given the rising rates of macrolide resistance and less emphasis on coverage of atypical pneumonia pathogens.
    Review of pathophysiology:
    Lower respiratory tract often preceded by an upper respiratory tract infection, that inhibits ability to clear mucus and pathogens invade the lungs
    Other risk factors:
    Smoking
    Elderly
    Immune compromise (ie: infection, steroids, cancer)
    Pathogens:
    Typical - strep pneumo, haemophilus, staph aureus
    Atypical (more common) - influenza, parainfluenza, mycoplasma, chlamydia pneumoniae, legionella, coccidioidomycosis (in the southwest)
    EPIC Study (2015) - study to determine pneumonia pathogens using all the tools we have available (culture, PCR)
    62% no pathogen detected
    22% viral - most were rhinovirus which does not cause lower respiratory tract infections but predisposes to pneumonia
    Strep pneumonia was the number one bacterial pathogen
    Bottomline: we still don’t know what causes most pneumonias but just that our patients get better with antibiotics
    Differentiating between typical v. atypical pneumonias - there’s no good way to know viral versus bacterial → default is to treat as bacterial pneumonia with antibiotics
    Diagnosis:
    Clinical features (cough, fever, sputum production, pleuritic chest pain, crackles)
    Guidelines recommend a chest x-ray
    For outpatient uncomplicated pneumonia, don’t get blood or sputum cultures
    For severe cases (those with risk factors for multidrug resistance, MRSA, or pseudomonas) you still want to get blood and sputum cultures
    Pearls:
    No more healthcare-associated pneumonia
    Emphasis on CURB-65 to assess severity of who does NOT need to be admitted
    Procalcitonin is NOT endorsed as a way to determine who gets antibiotics and who doesn’t
    Treatment:
    Increasing strep pneumo resistance to macrolides so no more monotherapy with macrolide (azithromycin) unless resistance is less than 20% in the area
    First-line in non-hospitalized adult is amoxicillin or doxycycline for 5-7 days
    Steroids recommended not use but may be considered in septic shock
    Commentary from Dr. Patel (ID specialist):
    Not a major change in practice other than to consider not covering atypicals in an otherwise healthy person
     
    REFERENCES:
    Metlay JP, Waterer GW, Long AC, et al on behalf of the American Thoracic Society and Infectious Diseases Society of America. Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST 
    Jain S, Self WH, Wunderink RG, et al for the CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med 2015; 373:415-427.
    Postma DF, van Werkhoven CH, van Elden LJR, et al for the CAP-START Study Group. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med 2015; 372:1312-1323.

    • 27 min
    Bonus Short - Novel Coronavirus

    Bonus Short - Novel Coronavirus

    In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness. 

    References:
    Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMoa2001017. 
    Munster VJ, Koopmans M, van Doremalen M, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 24 Jan 2020. DOI: 10.1056/NEJMp2000929
    Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 24 Jan 2020. https://doi.org/10.1016/ S0140-6736(20)30183-5   
    Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 24 Jan 2020. https://doi.org/10.1016/S0140-6736(20)30154-9
    Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med, 28 Jan 2020. DOI: 10.1056/NEJMc2001272
    Wuhan Coronavirus - 2019-n-CoV. Infectious Diseases Society of America. https://www.idsociety.org/public-health/wuhan-coronavirus/. Accessed 29 Jan 2020
    2019 Novel Coronavirus (2019-n-CoV), Wuhan, China. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/summary.html. Accessed 29 Jan 2020.
    Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-n-CoV) in Wuhan, China. Centers for Disease Control and Prevention. https://emergency.cdc.gov/han/han00426.asp. Accessed 29 Jan 2020.
     
    Resource:
    Centers for Disease Control and Prevention 2019-n-CoV PUI Case Investigation Form: https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdfpdf icon

    • 18 min
    Breast Cancer Screening: When to Begin?

    Breast Cancer Screening: When to Begin?

    Primary Care RAP has covered the start-screening-mammos-at-age-50 perspective in the past. Today, we’ll explore the other side of the coin: why women’s health focused organizations recommend beginning annual screening mammography at age 40. Neda Frayha, MD sat down with Dr. Alison Chetlen, DO a breast imaging expert and Associate Professor and Vice Chair of Education in the Department of Radiology at Penn State Health and Hershey Medical Center, for a deeper dive into the evidence we don’t always hear about in primary care. 

    • 28 min
    Hoarseness and Laryngeal Disorders

    Hoarseness and Laryngeal Disorders

    Hoarseness is a common complaint in the primary care setting. Our ENT colleague, Dr. Elizabeth Guardiani, sits down with Drs. Matt DeLaney and Neda Frayha to discuss how we can approach this in primary care as well as when to refer to a specialist. 
    For more incredible segments like this, subscribe to PC:RAP today. You'll never miss a moment of the program and you'll stay up-to-date on all the latest with your favorite Primary Care RAP hosts and contributors.

    • 18 min
    Cardiac Surgery Pre-Op Part 1

    Cardiac Surgery Pre-Op Part 1

    We all know what to do in pre-op visits for non-cardiac surgery. But guidelines on the pre-op management of cardiac surgery patients are hard to find. Neda Frayha, MD sat down with Dr. Michael Grant, a cardiac anesthesiologist at the Johns Hopkins University School of Medicine, to learn what we need to worry about (and what our pre-op evaluations should include) when our patients go off to cardiac surgery.
    For more incredible segments like this, subscribe to PC:RAP today. You'll never miss a moment of the program and earn 42 hours of CME per year. 

    • 25 min
    Oh, Porphyria!

    Oh, Porphyria!

     It all started when Paul and Neda researched porphyria to answer a mailbag question. Paul couldn’t get the song ‘Ophelia’ by the Lumineers out of his head. So he did what any self-respecting lyrical genius would do and wrote a different version of the song. Hippo Education’s own Melinda Hershey brought her vocal talent to the collaboration, and voila - ‘Oh, Porphyria!’ was born.
     
    For more incredible education like this, subscribe to PC:RAP today. You'll never miss a moment of the program and earn 42 hours of CME per year. 
     

    • 3 min

Customer Reviews

gayerdoc ,

Great podcast!

I’ve been listening for a few years now...we’ll, since it started (having been a listener of EM:RAP prior)

Excellent content...told in a fun way.

Highly recommend this podcast to ALL primary care providers!

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