Podcast From St Mungo's Eoghan Colgan

Medical researcher and scientific author, Estrelita van Rensburg, explains how bad science and misinformation leads us down the road to insulin-resistance, the precursor of illness and chronic disease. Her book will shake the foundations of standard nutritional advice and demonstrate how this leads to lifestyle diseases such as obesity, diabetes, high blood pressure, dementia and cancer.

Climate change is a risk multiplier for disasters. Disasters cause multi billion dollars worth of damage worldwide therefore, prevention should be the aim. Paradigm shift from disaster response to disaster risk reduction, hazard to community resilience. Disasters have immediate, short term and long term impacts on health and clinical practice.

Superior Vena Cava syndrome (SVC) may be the first presentation of a cancer and therefore not suspected. The most common symptoms are facial edema, distended neck and/or chest veins, cough and dyspnea. Acute life-threatening symptoms such as airway obstruction from laryngeal edema, cerebral edema, hypotension and coma are possible, but fortunately rare. Over 60% of SVC syndromes are malignant in etiology, with 85% of those due to either lung cancer or lymphoma. Tumors can invade or compress the vessel and predispose to thrombus formation. Benign etiologies are rising in number, and mostly due to intravascular devices, which are often present in cancer patients as well. Diagnosis is dependent on having the clinical suspicion then confirming the diagnosis with imaging, preferably CT chest with contrast or angiogram. Management urgency is based on grading. Grade 4 represents life threatening symptoms requiring emergent intervention with stenting, thrombolysis or angioplasty. Lower grades allow for tissue diagnosis to tailor more definitive therapy to the cancer type: chemotherapy versus radiation therapy. Because SVC syndrome is often found in the later stages of cancer with less than 6 months survival and goals of care should be addressed. However, prognosis is dependent on tumor type. Readily curable cancers such as lymphoma and germ cell tumors long-term survival are expected despite SVC syndrome. In sum, the emergency physician needs to maintain a high level of suspicion when presented with classic symptoms of SVC syndrome, confirm the diagnosis with contrast chest CT and plan for advanced management with cardiology, interventional radiology, oncology or radiation oncology, which may necessitate transfer to a hospital with these capabilities.

Calcium channel blockers and beta blockers are potentially devastating ingestions. This is a targeted review of the mechanisms behind toxicity and the rationale behind various management options available during resuscitation.

Neutropenic fever is an oncologic emergency that carries high morbidity and mortality and is a common condition seen in the Emergency Department. This lecture provides a concise and condensed overview of the definitions, etiology, workup, and up to date treatment strategies to manage neutropenic fever. Ultimately, the aim of this lecture is to make practitioners feel more comfortable managing neutropenic fever in their current practice environments.

Right heart failure is often misunderstood and underappreciated. It is more common than we think and presents in a number of common conditions such as sepsis. Using anatomic principles, this talk demystifies RV Failure and applies some basic principles to guide practice.