IM Basics

About IM Basics

Resident physicians teach topics that are commonly encountered during internal medicine rotations. Hosts are Dr. Eric Acker and Dr. Tark. Other appearances by Dr. Michael Bass and other resident physicians. We attempt to distill topics into easy-to-listen-to episodes that will help a medical student or intern quickly learn the basics of a topic. We strive to provide real-world experiences grounded in evidence-based medical practices.

Publisher

Eric Acker

Category

health & fitness

Language

en

Explicit

No

First episode

30 May 2025

Latest episode

21 Jan 2026

Latest episodes

13 episodes in the feed.

1. 

   21 Jan 2026

   Right Ventricular Failure: The Forgotten Side of Cardiogenic Shock

   In this episode of IM Basics, Dr. Eric Acker and co-host Dr. Tark take a deep dive into right ventricular (RV) failure—a high-risk but often under-recognized cause of clinical deterioration. The discussion frames RV failure as a problem of both forward flow limitation and backward congestion, emphasizing that a preserved left ventricular ejection fraction does not rule out severe cardiogenic pathology. The hosts walk through the typical clinical presentation, highlighting early altered mental status, lactic acidosis, acute kidney injury, hepatic congestion, and gastropathy as hallmark features. Unlike left-sided failure, RV failure often causes early end-organ hypoperfusion despite relatively preserved blood pressure, making “normotensive shock” a key concept. Etiologies are divided into chronic and acute causes. Chronic drivers include pulmonary hypertension (pre- and post-capillary), COPD, chronic thromboembolic disease, and longstanding left-sided heart disease. Acute causes most notably include massive or submassive pulmonary embolism and acute right coronary artery infarction. The conversation emphasizes distinguishing acute from chronic RV failure, as this distinction directly affects management decisions. Diagnostic evaluation extends beyond routine labs. While BNP, lactate, CMP, and liver enzymes help identify congestion and hypoperfusion, bedside ultrasound plays a central role. The hosts caution against relying solely on IVC size, instead advocating for venous Doppler assessment (portal and femoral veins) and focused echocardiography. Key echo findings include RV dilation, septal flattening (“D-sign”), reduced TAPSE, tricuspid regurgitation velocity, and features suggesting chronic remodeling versus acute strain. Management is framed around “RV-specific do’s and don’ts.” Core principles include aggressive but thoughtful diuresis—even in the presence of AKI—correction of hypoxia and acidosis, and avoidance of negative inotropes. The episode strongly cautions against premature intubation due to the risks of sedation, positive pressure ventilation, and increased RV afterload. When shock develops, vasopressin is favored for hemodynamic support, often combined with inotropes such as low-dose norepinephrine or dobutamine. Finally, the hosts discuss escalation of care, including when to involve the ICU, consider mechanical circulatory support, or pursue advanced therapies such as Impella RP or ECMO in select patients. The episode closes with practical bedside pearls and reinforces the importance of early recognition and RV-specific management strategies to prevent rapid clinical collapse. Academic References & Guidelines Echocardiography: ASE Guidelines for the Echocardiographic Assessment of the Right Heart in Adults (Standards for TAPSE <17 mm and RV diameter >4.2 cm). Pulmonary Hypertension: ESC/ERS Guidelines for PH (Defined by mPAP >20 mmHg). Cardiogenic Shock: SCAI Clinical Expert Consensus (SCAI/SKY SHOCK Criteria) for staging severity. Management: AHA Scientific Statement: Evaluation and Management of Right-Sided Heart Failure. Content Reviewed by Dr. Alejandro Chapa-Rodriguez

2. 

   1 Jan 2026

   Running on Empty: Hypovolemic and Hemorrhagic Shock

   In this episode of IM Basics, Dr. Eric and Dr. Tark continue their shock series with a practical discussion of hypovolemic and hemorrhagic shock, focusing on bedside recognition, diagnostic strategies, and early management. The episode begins with a review of shock pathophysiology, emphasizing reduced preload as the primary driver of both conditions. Loss of intravascular volume leads to decreased cardiac output and impaired end-organ perfusion, triggering a compensatory sympathetic response with vasoconstriction, tachycardia, and narrow pulse pressures. The hosts highlight that hypotension is often a late finding. Earlier signs include tachycardia, cool extremities, delayed capillary refill, and altered mental status. The shock index (heart rate divided by systolic blood pressure) is introduced as a useful early marker, with values above 0.7 suggesting instability and values ≥1.0 indicating severe shock. A major focus is on identifying the source of volume loss or bleeding. Hemorrhage is framed simply: patients bleed externally or into limited internal compartments such as the chest, abdomen, pelvis, or thighs. Point-of-care ultrasound (FAST exam) is emphasized as a first-line tool in unstable patients, with CT angiography and interventional radiology considered when patients can be stabilized. For hypovolemic shock, common causes discussed include gastrointestinal losses, poor oral intake, diuretic use, osmotic diuresis (e.g., DKA), and third spacing from conditions like pancreatitis or advanced liver disease. Management centers on early resuscitation, distinguishing fluid replacement for hypovolemia from early blood product administration for hemorrhagic shock. The hosts caution against excessive crystalloid use due to dilutional coagulopathy and DIC risk, and review massive transfusion principles, including balanced ratios of blood products and emerging data on whole-blood transfusion. The episode also covers fluid selection, favoring balanced crystalloids such as lactated Ringer’s, and discusses vasopressors as adjuncts when hypotension persists despite adequate resuscitation or while definitive hemorrhage control is pending. Key pitfalls are reviewed, including reliance on a normal initial hemoglobin, failure to reassess volume status, fluid overload causing pulmonary edema, and delays in specialist involvement. The episode closes with an emphasis on early communication with surgical, interventional, GI, and critical care teams to improve outcomes. *Episode reviewed by Dr. Teshome Hailemichael, Core Faculty - Internal Medicine Key References Guyton AC, Hall JE. Textbook of Medical Physiology. 14th ed. Elsevier; 2021. Advanced Trauma Life Support (ATLS®): Student Course Manual. 10th ed. American College of Surgeons; 2018. Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018;378:370–379. – Comprehensive review of hemorrhagic shock pathophysiology and resuscitation strategies. Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021. Holcomb JB, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 ratio and mortality in patients with severe trauma. JAMA. 2015;313(5):471–482. Semler MW, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378:829–839..

3. 

   25 Oct 2025

   Infammatory Bowel Disease Overview with Drs. Amulya Anumolu, Nicole Ebalo, and Michael Bass

   Episode Summary Dr. Eric Acker is joined by Drs. Amulya, Michael Bass, and Nicole Ebalo to discuss Inflammatory Bowel Disease (IBD). The team reviews presentation, diagnosis, imaging, pathology, and management from mild to fulminant disease. Key Discussion Points 1. Presentation & Epidemiology Typical symptoms: diarrhea, abdominal pain, weight loss, fatigue. UC: Bloody diarrhea, urgency, tenesmus. Crohn’s: Non-bloody diarrhea, crampy pain; may have constipation Extraintestinal: Arthritis, erythema nodosum, uveitis, primary sclerosing cholangitis. Epidemiology: Bimodal (15–30 & 50–80 yrs); Crohn’s—slight female predominance, UC—slight male predominance. 2. Diagnostic Evaluation Initial workup: CBC, ESR, CRP, stool cultures (Salmonella, Shigella, Campylobacter, C. difficile) and fecal calprotectin. Colonoscopy: Diagnostic gold standard. UC: Continuous mucosal inflammation from rectum. Crohn’s: “Skip lesions,” transmural inflammation, often terminal ileum. Histology: UC—mucosal/submucosal inflammation. Crohn’s—non-caseating granulomas, transmural inflammation. Imaging: CT or MR enterography for strictures, fistulas, abscesses. 3. Treatment Approach Mild–Moderate: UC: 5-ASA (mesalamine) ± topical therapy. Crohn’s: Budesonide (if colonic involvement). Moderate–Severe: UC: Corticosteroids → immunomodulators (6-MP, azathioprine, methotrexate) ± biologics (infliximab, vedolizumab). Crohn’s: Corticosteroids → biologics (infliximab, adalimumab) ± immunosuppressants. Severe/Fulminant: UC: IV steroids (methylpred 60 mg/day or hydrocortisone 100 mg TID); add infliximab or cyclosporine if refractory. Crohn’s: IV steroids; Notes: Screen for TB and hepatitis before anti-TNF therapy. Key complications: toxic megacolon (UC), short gut syndrome (post-surgery). Maintenance: Continue lowest effective biologic/immunosuppressive dose. Surveillance: Colonoscopy every 1–5 years 4. Lifestyle & Long-Term Care Smoking cessation: Improves Crohn’s outcomes; mixed data in UC but overall beneficial. Diet: GI soft, hydration, monitor B12, folate, micronutrients. Pregnancy: Adjust biologics/immunosuppressants before conception 💡 Clinical Pearls Fecal calprotectin is more specific for IBD activity than CRP/ESR. Crohn’s: Transmural, skip lesions → fistulas/strictures. UC: Continuous mucosal disease → toxic megacolon risk. Immunosuppressives: Used for maintenance, not induction. Multidisciplinary management GI, surgery, nutrition, primary care References: The Washington Manual of Medical Therapeutics ECCO Guidelines on Pregnancy and IBD. UpToDate

4. 

   8 Sept 2025

   AFib Basics: Staging, Stroke Prevention, and Management Strategies

   In this episode of IM Basics, Dr. Eric Acker is joined by Dr. Harmandip Parmar for a deep dive into atrial fibrillation (AFib)—the most common sustained arrhythmia worldwide. They explore AFib’s definitions, staging, risk factors, clinical presentation, diagnostic strategies, and evidence-based management, with a focus on the latest 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial FibrillationAfib【ACC/AHA 2023 Guidelines†DOI:10.1161/CIR.0000000000001193】. Key Topics Covered AFib staging and progression: The episode reviews the updated classification from the ACC/AHA guidelines, beginning with “at risk” and “pre-AFib” states (associated with modifiable risk factors such as obesity, hypertension, diabetes, and sleep apnea) through paroxysmal, persistent, longstanding, and permanent AFib. Clinical presentation & workup: While many patients present with palpitations, dyspnea, or fatigue, others are asymptomatic and diagnosed incidentally. Recommended evaluation includes ECG confirmation, transthoracic echocardiography, thyroid and metabolic panels, and exclusion of reversible causes (e.g., hyperthyroidism, acute illness). Not all patients require ischemic evaluation, aligning with Class III recommendations. Stroke prevention & anticoagulation: The team emphasizes CHA₂DS₂-VASc scoring as central to risk stratification. Direct oral anticoagulants (DOACs) are first-line for most, with apixaban favored over rivaroxaban due to lower GI bleeding risk (supported by observational data and network meta-analyses). Warfarin remains the standard for patients with mechanical prosthetic valves or moderate-to-severe mitral stenosis. Risk factor modification: Lifestyle interventions—weight loss ≥10%, regular exercise (≥210 min/week), alcohol reduction, smoking cessation, and blood pressure optimization—are strongly recommended to reduce AFib burden【Pathak 2014 JACC†DOI:10.1016/j.jacc.2014.03.058】. While caffeine restriction is not recommended (Class III), screening and managing sleep apnea may prevent AFib progression. Lifestyle vs. ablation: The PRAGUE-25 trial showed catheter ablation to be superior, but notably ~35% of patients in the lifestyle modification arm achieved sinus rhythm without invasive intervention. Rate vs. rhythm control: The discussion contrasts findings from AFFIRM (rate and rhythm strategies equivalent in older populations with EAST-AFNET 4 (early rhythm control associated with lower cardiovascular outcomes, particularly in younger patients or those with HF). Procedural & pharmacologic strategies: Management options include synchronized cardioversion (with anticoagulation protocols), catheter ablation (radiofrequency, cryoballoon, or emerging pulse-field technologies), and antiarrhythmic drugs such as amiodarone, flecainide, dofetilide, or propafenone. The CAST trial warns against Class IC agents in structural heart disease, though nuances remain in non-ischemic cardiomyopathy. Takeaway: AFib is a progressive disease requiring early identification, aggressive risk factor management, stroke prevention, and individualized rhythm or rate control strategies. As new therapies (e.g., Factor XI inhibitors, pulse-field ablation) emerge, ongoing research continues to refine optimal care. Episode reviewed by Dr. Mathhar Aldaoud - Interventional Cardiologist

5. 

   22 Aug 2025

   Acute Heart Failure Explained: Diagnosis, Workup, and Treatment

   In this week’s episode, Eric is joined by Dr. Tark, now 3rd year resident, to break down the recognition and management of acute heart failure exacerbation. Key Discussion Points: Patient Presentation: Common symptoms include peripheral edema, pulmonary congestion with dyspnea, and paroxysmal nocturnal dyspnea. Physical exam findings such as S3/S4 gallops, jugular venous distension, and hepatic jugular reflux play a critical role in making a clinical diagnosis. Workup: While BNP is frequently ordered, heart failure remains a clinical diagnosis. Supportive labs include CMP, renal function, troponins, ECG, and occasionally lactate in suspected shock. Chest X-ray can confirm pulmonary congestion, and echocardiography helps define the type of HF (HFrEF vs. HFpEF). Management: Diuretics remain the cornerstone—IV loop diuretics with escalation as needed, targeting 2–3 L of diuresis in the first 24 hours. Acetazolamide has emerged as a promising adjunct. The ADVOR Trial (Mullens et al., NEJM 2022) showed that adding acetazolamide to loop diuretics in acute decompensated HF increased decongestion rates and reduced hospital stay. Non-invasive ventilation (CPAP/BiPAP) provides symptomatic relief in flash pulmonary edema by improving oxygenation and reducing preload/afterload. Guideline-Directed Medical Therapy (GDMT): Beta-blockers should be continued in stable patients but held in cardiogenic shock. ACE inhibitors/ARBs/ARNIs and SGLT2 inhibitors are central pillars of therapy in chronic HFrEF, with trials like DAPA-HF and EMPEROR-Reduced demonstrating mortality and hospitalization benefits. SGLT2 inhibitors also benefit patients with HFpEF, as shown in EMPEROR-Preserved Pearls and Pitfalls: BNP should be interpreted in context Always rule out mimickers such as pulmonary embolism, ischemic events, arrhythmias, thyroid disease, and infections. Early and aggressive diuresis in the first 24–48 hours can shape the patient’s entire trajectory of recovery. Takeaway: Acute heart failure requires a careful balance of clinical recognition, judicious use of diagnostics, and evidence-based diuretic strategies. Early intervention, guided by both bedside exam and trial evidence, makes the difference between stabilization and deterioration. References: Felker GM, et al. "Diuretic Strategies in Patients with Acute Decompensated Heart Failure" NEJM. 2011;364:797–805. (DOSE Trial) Mullens W, et al. "Acetazolamide in Acute Decompensated Heart Failure with Volume Overload." NEJM. 2022;387:1185–1195. (ADVOR Trial) McMurray JJV, et al. "Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction." NEJM. 2019;381:1995–2008. (DAPA-HF) Packer M, et al. "Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure." NEJM. 2020;383:1413–1424. (EMPEROR-Reduced) Anker SD, et al. "Empagliflozin in Heart Failure with a Preserved Ejection Fraction." NEJM. 2021;385:1451–1461. (EMPEROR-Preserved)

6. 

   13 Jul 2025

   Navigating Alcohol Withdrawal with Dr. Bass

   In this episode of "IM Basics," host Dr. Eric Acker is joined by Dr. Michael Bass to tackle the frequently encountered topic of alcohol withdrawal. They provide a comprehensive overview, starting with the fundamental definitions and pathophysiology, moving through patient presentation, workup, and the nuances of treatment. Learn to look beyond simply ordering a protocol and gain a deeper understanding of how to manage these complex patients dynamically. In this episode, you will learn about: Defining and Scoring Alcohol Withdrawal: Symptoms are categorized as mild (anxiety, tremors, insomnia, palpitations) or severe (hallucinations, seizures, delirium tremens). Only about 20% of patients develop severe symptoms. The DSM-5 criteria for diagnosis require two or more specific symptoms following the cessation or reduction of alcohol use. The CIWA is a common scoring system used by nursing staff to guide treatment based on symptom severity. The Pathophysiology of Withdrawal: Chronic alcohol use enhances the effect of the inhibitory GABA receptors and inhibits the excitatory NMDA receptors. The body adapts by decreasing the sensitivity of GABA receptors and increasing the sensitivity of NMDA receptors. When alcohol is stopped, the brain is left in a state of uninhibited excitatory stimulation. Timeline of Symptoms: 6-36 hours after last drink: Mild symptoms like tremors, sweats, and agitation may appear. 6-48 hours: Seizures can occur. 12-48 hours: Hallucinations (visual, auditory, or tactile) may develop. 48-96 hours: The most severe manifestation, delirium tremens (DTs), can set in. Patient Workup: A thorough history is the most critical part of the workup, especially the timing of the last drink and the quantity consumed. Labs are essential to rule out other conditions and should include a blood glucose, CBC, electrolytes, and blood cultures. An ethanol level can be checked, but a patient can be in withdrawal even with a detectable alcohol level. Treatment Strategies: Symptom-Triggered Therapy: This is the most recommended approach, where benzodiazepines are given based on a CIWA score threshold (e.g., a score greater than 8 or 10). Benzodiazepines: These are the mainstay of treatment and work by stimulating the GABA receptor. Lorazepam (Ativan): Slower onset (15-30 mins) but shorter duration. Diazepam (Valium): Faster onset (2-3 mins) but longer half-life, which can lead to accumulation. Refractory Withdrawal: For patients who don't respond to high doses of benzodiazepines, phenobarbital is an option. It can be used as a dual therapy with benzos or as a monotherapy. Front-Loading: For patients at high risk of severe withdrawal (e.g., history of DTs), proactively administering high doses of benzodiazepines can be considered. Pearls and Pitfalls: Be aware that benzodiazepines can cause paradoxical agitation in elderly patients, Don't get anchored on alcohol withdrawal, especially considering hepatic encephalopathy in patients with cirrhosis. Remember supportive care: thiamine, along with a multivitamin and electrolyte repletion Always reassess your patient if the treatment isn't working.

7. 

   28 Jun 2025

   Decoding Heart Block: From ECG to Treatment with Dr. Harmandip Parmar

   Host Dr. Acker interviews Dr. Harmandip Parmar about identifying different atrioventricular blocks on an ECG, investigating underlying causes like MI or electrolyte imbalances, and managing symptomatic emergencies, including the use of pacemakers.

8. 

   20 Jun 2025

   Multiple Myeloma: The Basics & Beyond with Dr. Vinh Dao

   Hematologist Vinh Dao MD, is interviewed by Eric Acker MD, and explains multiple myeloma's diagnosis, workup, and management, highlighting subtle presentations and treatment approaches.

9. 

   13 Jun 2025

   Mastering GI Bleeds: Stabilize, Diagnose, Treat with Dr. Amulya Anumolu

   Dr. Amulya Anumolu elucidates the critical steps in managing gastrointestinal bleeds, emphasizing rapid stabilization, thorough diagnosis, and appropriate treatment strategies in this interview episode.

10. 

    6 Jun 2025

    Managing Hyperkalemia in the Hospital: Recognizing, Reacting, and Responding

    Doctors Eric Acker and Tark explain the critical steps for identifying and treating hyperkalemia, including recognizing symptoms, interpreting ECG results, and applying appropriate therapies like calcium gluconate and dialysis, in this interview episode.

11. 

    30 May 2025

    Distributed Shock - Sepsis/Septic Shock

    Drs. Eric Acker and Tark elucidate septic shock for medical trainees, dissecting its pathophysiology, atypical presentations, and diagnostic tools, while stressing tailored treatments and source control in this educational episode.

12. 

    30 May 2025

    Shock Overview

    Doctors Eric Acker, Tark, and Bass present a high-yield overview of shock, breaking down clinical signs and early indicators to equip medical learners to recognize and manage it effectively; this is an interview episode.

13. 

    30 May 2025

    Prelude Episode

    The hosts introduce the IM Basics podcast and outline the show's goals to improve patient care, setting the stage for future episodes.

Who has been a guest on IM Basics

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• Dr Harmandip Parmar
• Vinh Dao
• Dr Amulya Anumolu

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Podcast Authority Score: 13 / 100

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