CORE IM

#TBT to our #5Pearls episode: rhythm control in AFib

The anti-arrythmics can be confusing, but this table breaks down the basics ‼️

🖥️: www.coreimpodcast.com/2024/04/24/r...

6/ Thanks to all!

Authors: Dr Christopher Kapp, Dr Kalaila Pais, Dr Alice Kennedy, Dr Jason krastein

YouTube video by Core IM Managing Parapneumonic Effusions

5/ Parapneumonic:

🫁 Place a 14F chest tube for diagnostic sampling and source control.
🫁 Start antibiotics promptly, including anerobic coverage.
🫁 Start tPA/ dornase per MIST-2 Trial

🎥: www.youtube.com/watch?v=OK28...

YouTube video by Core IM Management of Malignant Pleural Effusions

4/

🫁 Pleural thickening >1cm or nodularity on u/s is suspicious for malignant effusion
🫁 Depending on the rapidity of fluid reaccumulation post drainage, next steps to consider: serial thoracenteses, tunneled catheter placement, or pleurodesis

🎥 : www.youtube.com/watch?v=lfOm...

YouTube video by Core IM Interpreting Pleural Fluid Cholesterol

3/ Fluid cholesterol:

🫁 Cholesterol > 40 is consistent & < 25 is highly inconsistent w/ exudative effusions
🫁 Pleural fluid cholesterol can help diagnose pleural effusions where the etiology is uncertain
🫁 Milky pleural fluid isn’t always chylous

🎥: www.youtube.com/watch?v=tZFl...

YouTube video by Core IM Pleurodesis Pain Control

2/ Pain control:

🫁 Collaborate w/ onc & palliative care in patients w/ malignant pleural effusions
🫁 Consider pre-procedural bupivacaine, NSAIDs (if tolerated), & short-term opioids
🫁 Lidocaine patches for localized pleuritic pain

🎥: www.youtube.com/watch?v=H4zh...

1/ 🚨 NEW #BehindTheScenesInterviews: Pleural Effusions

🖥️: www.coreimpodcast.com/2025/08/06/p...
🎥: youtube.com/playlist?lis...

2/ Thanks to all for this resonating episode!

Hosts: Dr. Marissa LoCastro @shreyatrivedimd.bsky.social
Discussant: Dr. Maria Rosasco
Editor: Kathreene Gala

1/ 🚨 NEW #StoriesForTheFeels

In the midst of burnout and inboxes, this episode is a breath of fresh air 💨 Dr. Rosasco shares three stories remind us that showing up as a human is still part of the job🤍

🖥️ : www.coreimpodcast.com/2025/07/28/s...
Sponsor: Oakstone CME ACP MKSAP Companion

2/ Thanks to all!

Authors: Dr. Cindy Fang, Dr. John Hwang, @shreyatrivedimd.bsky.social
Expert: Dr. Casey McQuade
Audio Editing: Kathreene Gala

1/ 🚨 NEW #Hoofbeats episode!

Let’s diagnose BOTH the patient and the clinician by figuring out the disease process and the cognitive processes that led us towards/away from it 🩺

🖥️: www.coreimpodcast.com/2025/07/21/d...

Do beta blockers still belong among the contemporary therapies for ischemic heart disease? The latest episode of the Beyond Journal Club podcast from @coreimpodcast.bsky.social and NEJM Group explores the REDUCE-AMI trial. Full episode: nej.md/4ekdlxX 

#MedSky #CardioSky

2/ Thanks to all for this great explanation!

By: Dr. Sean Burke, @shreyatrivedimd.bsky.social , Dr. Alexandra Sheridan and Dr. Andrew Ling

1/ 🚨 NEW #WhiteboardAnimation: Cardiorenal Syndrome

How do you distinguish pure cardiorenal syndrome from other kidney injuries? ⤵️

🖥️: www.coreimpodcast.com/2025/07/16/c...
🎥: m.youtube.com/watch?v=WYiu...

Answer: ADH!

#TriviaTuesday

Urine osmolality is a window into which hormone’s activity?

Review hyponatremia diagnostics and use this graphic on the wards!

www.coreimpodcast.com/2021/02/10/5...

Brings me back to residency. Could never forget Light’s Criteria!

Always more nuanced than it would seem.

We can't get enough of pleural effusions!! We were so excited to go on @coreimpodcast.bsky.social
to discuss some pearls around pleural effusion diagnosis and management.

If you want more, check out our episodes on effusions, empyema, and malignant effusions!

www.pulmpeeps.com/2025/07/09/1...

9/ Thanks to all ‼️

By: @shreyatrivedimd.bsky.social, Dr. Kalaila Pais, Dr. Christopher Kapp, Dr. David Furfaro and Dr. Kristina Montemayor
Graphic: Dr. Jesse Powell
Peer Review: Dr. Kanupriya Soni, Dr. Laura McNamara, Dr. Michael Ferrera, Mihir Parikh

8/ Options for recurrent malignant pleural effusions:
🌊 Repeated thora
🌊 Indwelling catheter
🌊 Pleurodesis

7/ Nearly 50% of bacterial pneumonias have associated pleural effusions, but most do not result in complicated effusions or empyemas ‼️

Tx:
🌊 Antibiotics
🌊 Chest tube
🌊 Enzymatic treatment

6/ What about pleural fluid only tests?

Educative if…
🌊 Protein >  3.0 g/dL 
🌊 Cholesterol >  45-55 mg/dL 
🌊 LDH > 0.45-0.67x the lab ULN

5/ What if light’s is positive but you think it’s transudative…

🌊 SPAG (serum-pleural-albumin gradient) > 1.2 points towards transudates
🌊 SPPG (serum-pleural-protein-gradient) > 3.0  points towards transudates
🌊 NT-proBNP

4/ Light’s criteria:

💡 Pleural fluid-to-serum protein ratio > 0.5
💡 Pleural fluid-to-serum LDH ratio > 0.6
💡 Pleural fluid LDH > 0.67 (ie, two-thirds) the upper limits of the laboratory's normal serum LDH

3/

Transudative: ⬆️ hydrostatic and ⬇️ oncotic pressure
🌊 Heart failure
🌊 Renal failure
🌊 Liver failure

Exudative effusions: ⬆️ capillary permeability allowing complex materials to enter the pleural space
🌊 Infxn
🌊 Malignancy
🌊 PE

2/ Points to consider when discussing diagnostic thora:

🌊 Laterality of the effusion
🌊 Chronicity of the effusion
🌊 Patient risk factors

1/ 🚨 NEW #5Pearls: Pleural Effusions 🌊

Did you know up to 30% of pleural effusions of have more than one etiology?

Let’s dive in!

🖥️: www.coreimpodcast.com/2025/07/09/p...
Sponsor: Oakstone CME
Featuring: @pulmpeeps.bsky.social

3/ 3/ Thanks to all for sharing these stories!

Hosts: Marissa LoCastro, @shreyatrivedimd.bsky.social
Discussants: George Tran, Allie Trainor
Audio: Kath Gala

2/ Let’s also reminisce about past July stories!

1.0: www.coreimpodcast.com/2019/06/12/j...

2.0: www.coreimpodcast.com/2023/07/19/j...

1/ 🚨 NEW: July stories 3.0 🩺

Listen for some good laughs and memorable stories as a humble reminder for mixed emotions and experiences the transition can bring!

🖥️: www.coreimpodcast.com/2025/07/02/j...