All right, so welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas, and we're going to explore all things endocarditis.

This one's going to be a bit of a beast. So find a nice little cafe or a nice little bench outside and put your feet up for a minute because we're going to tackle

the diagnosis and that's not easy it doesn't come just down to the due criteria we'll give you the

nuances of when to do a t-tee when do you bump it up to a teete we'll talk about antibiotics for that

empiric or definitive therapy and then a smorghage board of who goes to surgery or needs

a surgical opinion, how do you anticoagulate these patients, who needs opioid use disorder

treatment, and we'll polish it off with an algorithm for how to approach these patients.

So Josh, let's start it off running.

When do we suspect endokiditis?

Is it only when a track mark is in the arm,

or when they've had prior, or what's going on? All the time, man. Like, when I see people

walking down the street, I'm just like, they have an eukriditis. Everywhere. It's everywhere.

Seriously, this is a tough diagnosis because it presents in lots of different ways. So I think

it starts with at-risk patients.

So IV drug use, huge issue. Anyone with active IV drug use, it's going to be higher

in your radar, chemo-dialysis patients, valpular heart disease, and then any sort of endovascular

hardware, prosthetic valves, indwelling catheters, port, stuff like that. So those are going

to be your at-risk patients.

A TAVie patient can get endocarditis?

Yeah, unfortunately, this is going to become a thing as TAVY is, you know, more and more common.

Man, you just blew my mind, Josh. Clinical presentation. We got left-sided disease. We got

right-sided disease. Think about where the ambelia going and then throw in a little caveat for a PFO. What am I going to think about

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