CONTENTS Amyloidosis basics Interstitial lung disease Tracheobronchial amyloidois Parenchymal nodular amyloidomas Other pulmonary manifestations Amyloid pleural effusion ➡️ Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid-fast bacilli AIP: Acute interstitial pneumonia (Hamman-Rich syndrome) 📖 ANA: […]
Search Results for: acid base
PulmCrit- Shrug Technique for US-guided subclavian lines
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
Pulmonary Function Tests (PFTs)
CONTENTS Rapid reference: Approach to PFT interpretation 🚀 Approach to spirometry Approach to lung volumes About pulmonary function tests (PFTs) Contraindications to PFTs Brief discussion of commonly utilized tests Obstruction Large airway obstruction Restriction Nonspecific ventilatory limitation PRISM (preserved ratio impaired spirometry) DLCO Bronchial responsiveness: Bronchodilator response Methacholine bronchoprovocation Neuromuscular weakness & inspiratory pressures Changes […]
Drug induced-lung disease
CONTENTS Preamble – Limitations on the data Medications Antibiotics Daptomycin ➡️ Minocycline Nitrofurantoin Cardiovascular Amiodarone Checkpoint inhibitors ➡️ Immunosuppressives: Methotrexate mTOR inhibitors (e.g., sirolimus) Substance use: Sympathomimetics (cocaine, amphetamines) Crack lung Cannabinoids Opioids Noncardiogenic pulmonary edema Intravenous administration of tablets (talc) ➡️ Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary […]
Pain and Terror as Effective Pressors
Psychic Terror as an Effective Pressor
Letter to the Editor – High-Sensitivity Troponin is not a Myth, and “Myth-busting” is often another Myth to be Busted
Shots fired…
Pulmonary & cardiac complications of pregnancy
CONTENTS GENERAL APPROACH History & symptoms Dyspnea Chest pain Cough Hemoptysis ➡️ Palpitations Peripheral edema Physical examination Laboratory tests Common laboratory tests ABG interpretation Radiology Pharmacologic issues in pregnancy Antibiotic ➡️ Anticoagulation & antiplatelets Cardiac medications Steroid Uterotonic medications SPECIFIC DISEASE STATES Airway Asthma Cardiac Acute coronary syndrome (ACS) Aortic dissection Arrhythmias SVT (supraventricular tachycardia) […]
Lung abscess
CONTENTS Basics Common causes: Epidemiology & clinical presentation Laboratory investigations Radiology Differential diagnosis Bronchoscopy Treatment Antibiotics Antibiotics for anaerobic abscess due to aspiration Antibiotics for other types of lung abscess Drainage Treatment failure Related: Echinococcosis Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD […]
EM Nerd-The Case of the Indecisive Antidote
Studies examining the use of tranexamic acid (TXA) inescapably seem to pit our methodological rigorous demons against our practical clinical angels. The CRASH-2 trial published in the Lancet in 2010 by Shakur et al, randomized 20,211 adult trauma patients presenting to 274 hospitals in 40 different countries to receive 1g of TXA over 10 min […]
PulmCrit Wee – Multicenter RCT evaluating ruxolitinib (a JAK inhibitor) for COVID-19
Janus kinases (JAKs) are named after Janus, the Greek god of beginnings, gates, transitions, and duality. They’re named after Janus because they contain a mirror-image structural element. However, given their role within the immune system as a multi-functional gateway for cytokine systems, the name seems apt. The cytokine storm induced by COVID-19 has received considerable […]
Eosinophilic lung diseases
CONTENTS Eosinophilic lung disease Approach to eosinophilic lung disease Understanding blood eosinophil count Acute critical illness Chronic systemic steroid Asthma or COPD Causes of eosinophilia Atopic Medications Infection Neoplastic & paraneoplastic Bronchoalveolar lavage eosinophilia IgE level Specific diseases DRESS syndrome AEP (acute eosinophilic pneumonia) CEP (chronic eosinophilic pneumonia) ABPA (allergic bronchopulmonary aspergillosis) EGPA (eosinophilic granulomatosis […]
Invasive candidiasis
CONTENTS Introduction Candidemia Clinical manifestations Diagnosis Further investigation after diagnosis Treatment Intra-abdominal candidiasis Candida pneumonia? Candiduria Podcast Questions & discussion Pitfalls candida in the ICU Most cultures of Candida represent colonization (e.g., in the urine or especially in the sputum). Thus, there is a major risk of overtreating candidiasis. However, candida does occasionally cause severe […]
PulmCrit- Alpha-2 agonists: clonidine, guanfacine, lofexidine, and KetaDex
Dexmedetomidine is an intravenous alpha-2 agonist used as a sedative infusion. It has some uniquely useful properties, particularly that it doesn’t suppress respiration (allowing it to be safely used in non-intubated patients). The main drawbacks of dexmedetomidine are logistic: it is expensive and can be administered only as an IV infusion within an ED or ICU. Oral clonidine offers some similar benefits compared to dexmedetomidine, without these logistic constraints.
EM Nerd-A Brief Addendum to the Adventure of the Red-Headed League
What is the clinical significance of a post traumatic seizure (PTS) in children presenting to the Emergency Department following minor head trauma? This is a question surrounded by myth and dogma. As with most questions regarding traumatic brain injury (TBI) in children, the PECARN authors have come to our aid. Badawy et al published a […]
The Sign of Four…
…Factors that is. On April 23rd 2013, the FDA approved CSL Behring’s product Kcentra as the first 4-Factor Prothrombin Complex Concentrate (PCC) available in the United States for the use in treatment of anti-coagulated patients with acute hemorrhage. 4- Factor PCC has been widely available in Europe and Canada for years, but the FDA wanted […]
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