The Danbury Medical Files

In this new episode of the Danbury medical files, I share with you one of the many adventures I had with my dad Dr. Victor Espana Pinetta MD, MPH. I am trying to describe one of the multiple vaccination campaigns that he led in my home country Guatemala. After that, I have a few thoughts about the situation of the measles cases that are piling up in the United States because of lack of vaccination.

I dive also on three cases I saw of measles in kids one that led to the permanent brain damage of a...

In this ad-lib podcast, I explore my first impression of my experience in teaching and using POCUS in the outpatient world.

I will try to tell you how this happened, how I feel the program is going, and whether I believe it is useful. 

Also, some of my experiences, feats, challenges, and hopes.

Hope you like the episode.  

Soon, I will have an email for you to give me feedback.  

Right now, I do not follow Twitter or X; I do not follow Facebook or Instagram.   I am trying to l...

In our medical career, one of the things that we are thought since we start is importance of privacy in to keep the patience, privacy safe. We even have laws that penalize anyone who shares private information from patients.
This is not true when large companies are irresponsible with the way that they treat our medical information.

It is also important to have awareness of this problem and many other problems that the healthcare oligopoly is creating to patients, pharmacies and physicians, as well as the taxpayers.

In this podcast we explore the data...

In this episode I am discussing the effects of hospital and healthcare systems mergers.  I have tried to place a vast amount of information in a few minutes.  
I hope this will be of your interest and will be good information. 
Lastly, a call for action from all the physician community.  We need to participate more, sadly participating more can be risky, however, in the current times not participating will be more detrimental for our profession.  Here some links:

https://www.kff.org/health-costs/issue-brief/ten-things-to-know-about-consolidation-in-health-care-provider-markets/

https://www.aha.org/aha-search?search_api_fullt...

In this episode of the Danbury Medial Files, I talk about three patients where POCUS was used successfully in the outpatient clinic. 
I also talk about lidocaine side effects, anxiety as a common side effect of procedures.
A second case of abdominal pain and a two minutes diagnosis with POCUS.
A third case in avoiding a readmission. 

Hopefully you find this interesting and entertaining. 

Hit us on X if you want to hear about other topics. 

Follow the channel in youtube #IMPOCUS
https://www.youtube.com/channel/UCpzYai7ngGjZ00NOnU...

Erratum:  I called VExUS volume excess ultrasound, and is venous excess ultrasound. 
Also I said the flow of the portal vein should be 20 to 30 mmHg, however is 20 to 30 cm/sec.  

Happy new year!  This is the first episode of the Danbury Medical Files in the 2024.  I talked about volume status, volume status is complex and deserves at least a book chapter, however, I tried to summarize the most important parts and make the case to use point of care ultrasound and learn more about the different option that POCUS has for us.  

Hope you have a...

I stopped podcasting early this year because of personal problems. I will try to keep up the next year, however, I wanted to do a final episode in 2023.  Thank you to my residents for always bringing to my attention topics that could be of benefit.  
How do we know if POCUS B lines are pulmonary edema?
What are the forces that are responsible for pulmonary edema?
What are the factors that protect the lungs from pulmonary edema?
Why we should do POCUS in patients with CHF?
What are stress B lines?

Hope th...

Hey everyone.  This is a follow-up chapter from the prior one, exploring how safe it is to auscultate a patient.  Also, how useful.
This time I try to make the case that it is safe and also useful. 
Follow me in this POCUS journey in the second season of the Danbury Medical Files. 
Below I leave some interesting articles if you feel like checking. 

Picano E, Scali MC, Ciampi Q, Lichtenstein D. Lung Ultrasound for the Cardiologist. JACC Cardiovasc Imaging. 2018 Nov;11(11):1692-1705. doi: 10.1016/j.jcmg.2018.06.023. PMID: 30409330.

Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Cresc...

Inequality in healthcare is a recognized problem.  I had the privilege of interviewing Brenda Ayers, MD.  The head of a task force to decrease and eliminate inequality in NUVANCE-HEALTH.   
I met Dr. Ayers as the Chief Hospitalist at Vassar Brothers Hospital in Poughkeepsie, New York.  
Her work in the Nuvance Health Network (Danbury Hospital, which is my employer, is part of this network) is already changing structures and effectively trying to deal with racial disparity.  
I interviewed her at Vassar in the Hospitalist's office, so some noises were not completely filtered. However, the interview was well worth...

This time I am exploring what is written about the efficacy of lung auscultation.  I found this interesting meta-analysis and saw the difficulties that the authors went thru to find literature about lung auscultation. 
Is it safe?
We have auscultation for so long right now, however is it really giving results?
The article used is below: 

Arts, L., Lim, E.H.T., van de Ven, P.M. et al. The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis. Sci Rep 10, 7347 (2020). https://doi.org/10.1038/s41598-020-64405-6<...

This is a follow-up from my prior episode; as I finished uploading and had a second look at that episode, I figured out that I was discussing the case of the patients like I was doing a small teaching, and everyone could see what I was saying.  
Today I will try to describe the findings of portal hypertension that are feasible to evaluate with POCUS in the medical ward, the outpatient clinic and the critical care setting.  
Hopefuly this is an interesting episode.  
Follow us up in Twitter @danburymedfiles.  Follow us in almost all podcast apps ther...

Welcome 2023! 
After a vacation I want to share this new Podcast with you.  In todays episode I describe the decision making and the importance of POCUS in a couple of patients with liver disease.  
Is my conviction that POCUS needs to become the rule rather than the exception in our daily lives as internists and hospitalists.  
Let's get to the PODCAST number one. 
Please leave a review in any of the apps you use to hear the Danbury Medical Files

Thank you for listening; follow us on X (Twitter) @danburymedfiles.

Also and e...

In today´s episode, I have the three Chief Residents from Danbury Hospital, a program of Internal Medicine.  I have Dr. Azadeh, Gassemi, Dr. Uneza Khawaja and Dr. Wendy Perdomo.  
We explore the topic of women in medicine and have a very good discussion about the topic, about them, their goals, and how they view the future for women in Medicine.  
Women are shaping medicine and they have been shaping medicine from the beginning of history.  
I am very happy to share this interview with you.  
Follow the Danbury Medical Files in your favorite podcast app. ...

Thank you for listening to the Danbury Medical Files!

During this episode, we dive into the history of the diagnosis of pleural effusion since the term "succussion" to POCUS.  We talk briefly about the invention of percussion and how physical examination and imaging fare in diagnosing pleural effusion.  We talk about POCUS and pleural effusion.  Finally, we talk about the black box or bag of the physicians.  The black bag used to be the signature of the physicians carrying all the paraphernalia that was needed for a physical examination and treatment.  This black bag has disappeared, but,  Is it...

Today we don´t go to the room of the patient to greet the patients and figure out what brought them to the ED.  As hospitalists, we are probably the third or fourth person they interact with.  Check first the EMR. Assure the patient of all the work that is being performed behind the scenes.  
Do not anchor or close the box.  Still, try to get as much detail as you can.  
When presenting, it is important to know the past medical history and what brought the patient in.  
Hope this episode gives your a few pearls...

Welcome to residency, in this very short chapter, I want to welcome all of you to first year in Internal Medicine.  To all the brand new second and third year, welcome again. 

Thank you for listening; follow us on X (Twitter) @danburymedfiles. Leave a review in your favorite app for podcasting.
You can suggest topics you would like to hear about.
Also I have a new youtube channel #IMPOCUS
https://www.youtube.com/channel/UCpzYai7ngGjZ00NOnUozc_w

Mass shootings are sadly way too common in America.  So far, there are more mass shootings than days during this year.  
More than 18000 people have died from a gun-inflicted injury in 2022 alone. 
We have more guns than people in the country.  
In 2018 the NRA "advised" the physicians to stay in their lane and not have an opinion or research about gun deaths. 
Since 1996 there has been a "moratorium" from the Federal Government to fund any gun-related dead study.  
This is Christian España Schmidt MD, FACP.  An welcome to the podcast, the Danbury Medical Files.  ...

Hello, this is Christian Espana Schmidt MD, POCUS associate director in Danbury Hospital.  Today we explore a little bit of history of medicine, the pulsus paradoxus in cardiac tamponade with my special guest Dr.  Ferdinand Visco FACC, Dr. Visco was born in Brooklyn NY, studied medicine in Padua Italy and became a cardiologist in Nasau County Hospital, he then became faculty in Bronx Lebanon Cardiology Fellowship and later on Program director of Saint Vincent´s Cardiology Fellowship, today he is the Director Emeritus of the Section of Cardiology in Metropolitan Hospital.  We talk also about his book "Growing up Ital...

Hello, this is Christian Espana Schmidt MD, POCUS associate director in Danbury Hospital.  Today we explore a little bit of history of medicine, the pulsus paradoxus in cardiac tamponade with my special guest Dr.  Ferdinand Visco FACC, Dr. Visco was born in Brooklyn NY, studied medicine in Padua Italy and became a cardiologist in Nasau County Hospital, he then became faculty in Bronx Lebanon Cardiology Fellowship and later on Program director of Saint Vincent´s Cardiology Fellowship, today he is the Director Emeritus of the Section of Cardiology in Metropolitan Hospital.  We talk also about his book "Growing up Ital...

Hello again, this is the second podcast.  I am Christian Espana Schmidt MD, a hospitalist and a POCUS instructor and program developer and director.  

A bit of lung point-of-care ultrasound.  
COVID 19 normalized the use of Point of Care Ultrasound.

Featuring: Beth West Director of the Patricia Tiejen Academy.

The Patricia A. Tietjen, MD Teaching Academy was founded in 2021, with the purpose of providing an interprofessional scholarly home for clinical educators across Nuvance Health. The Teaching Academy honors the life and work of the late Dr. Tietjen, a passionate advocate for edu...

Welcome to the Danbury Medical Files PODCAST.  
After a conversation with one of my residents a couple of years ago, she told me we should have a PODCAST the internal medicine community.  
That idea lingered for a while, and now it's time to act.  

Here we talk about how I started my path in #POCUS.  

We also have a guest Matt Barbery MD, he is one of the Associate Program Directors at Danbury Hospital.  He will introduce us to purposeful language in medicine.  

We define what a point-of-care test is.  

We...