CONTENTS Definitions Epidemiology & risk factors Symptoms Clinical examination Laboratory evaluation PFTs in COPD Radiology: Hyperinflation on radiography Centrilobular emphysema Paraseptal emphysema Panlobular (panacinar) emphysema Chronic bronchitis Bronchiectasis-COPD overlap syndrome (BCOS) ➡️ Diagnosis of COPD Differential diagnosis Differentiation of asthma vs. COPD Disorders causing emphysema (without tobacco exposure) Management Integrated approach to COPD therapies (Inhalation […]
Search Results for: asthma
IBCC chapter & cast – Vocal cord dysfunction
Vocal cord dysfunction is a masquerader of life-threatening pathologies (most notably asthma and anatomic upper airway obstruction). Vocal cord dysfunction itself is not dangerous, but if not properly diagnosed it may lead to considerable iatrogenic harm (e.g. multiple unnecessary intubations for “asthma”). On the flip side, incorrect diagnosis of vocal cord dysfunction is also dangerous, […]
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 […]
IBCC chapter & cast: hypomagnesemia & hypermagnesemia
Magnesium might be the darling ion of critical care. It has an interesting array of therapeutic applications ranging from asthma to Torsade de Pointes to preeclampsia. This pair of chapters discusses the evaluation of both hypomagnesemia and hypermagnesemia. IBCC chapter on hypomagnesemia is located here. IBCC chapter on hypermagnesemia is located here. The podcast & comments […]
Respiratory acidosis (hypercapnia)
CONTENTS Symptoms Laboratory diagnosis of hypercapnia Causes of hypercapnia Evaluation Consequences of hypercapnia Management of hypercapnia Podcast Questions & discussion Pitfalls symptoms of severe hypercapnia Delirium, somnolence, and eventually coma (“CO2 narcosis”). Coarse tremor, multifocal myoclonus, and asterixis. Headache (e.g., nocturnal hypoventilation may cause headache upon awakening). acute-on-chronic hypercapnia can be insidious Patients with chronic […]
PulmCrit – Optimizing the respiratory drive to avoid failure
Scott Weingart just posted a podcast about management of the hypercapneic, obtunded COPD patient who is failing BiPAP. Do we need to intubate these patients, or could we somehow clear their CO2 noninvasively? This post will start off by exploring respiratory drive as a mediator of disease. With that groundwork, we’ll explore the obtunded COPD patient.
Dexmedetomidine to facilitate noninvasive ventilation
Introduction 0 Noninvasive ventilation (NIV) has recently emerged as a fundamental treatment for patients with acute exacerbation of obstructive lung disease or cardiogenic pulmonary edema, often avoiding intubation. However, some patients have difficulty tolerating this therapy due to anxiety. Dexmedetomidine (PRECEDEX) is an attractive sedative to manage this problem, since it may be titrated and […]
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) […]
PulmCrit- Mastering the dark arts of BiPAP & HFNC
Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn’t comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence. Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that.
PulmCrit- Extracorporeal CO2 removal: Putting the cart ahead of the horse?
Recently the concept of extracorporeal CO2 removal has become somewhat popular, with a goal of facilitating ultra low-tidal volume ventilation. Might there be other means to achieve the same goal? Let’s start with some basic concepts of mechanical ventilation… Fundamental unanswered questions Permissive hypercapnia refers to the concept of allowing the pCO2 level to increase […]
EMCrit 19 – Non-Invasive Positive Pressure Ventilation (NIPPV)
Intubation is a sexy procedure, there is no doubt about it.
NIV does not have the glamour; it’s not nearly as cinematic. But for the patient, to spend 30 minutes on a NIV mask is preferable to a couple of days on the ventilator. In this episode, I discuss some of the basic ideas and methods of NIV.
Respiratory alkalosis (hypocapnia)
CONTENTS How important is hypocapnia? Definition & diagnosis Clinical features Causes of hypocapnia Evaluation Consequences of hypocapnia Management Podcast Questions & discussion Pitfalls Hypocapnia is the most common acid-base disorder among critically ill patients.(12097540) This shouldn’t be surprising, since hypocapnia may be caused by almost any pulmonary disease, pain/anxiety, or sepsis – exceedingly common conditions […]
Pulse Oximetry Questions!
#1) Match the oxygen titration curves below with the following five patients: (a) Carboxyhemoglobin poisoning. (b) Methemoglobinemia. (c) Aspirated foreign body completely occludes the right lower lobe bronchus. (d) Asthma exacerbation. (e) Bronchopneumonia, with CT scan showing some areas of mildly affected lung and some areas of completely consolidated lung. #2) List situations in which […]
Pneumomediastinum
CONTENTS Pathophysiology & key concepts Causes Clinical presentation Radiographic features Evaluation of the etiology (1) Evaluation for esophageal perforation (2) Evaluation for large airway laceration Management Questions & discussion abbreviations used in the pulmonary section: 3 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast […]
EM Nerd-The Case of the Deceptive Beacon
Let’s face it, we have an unhealthy relationship with antibiotics. We are all aware that we are currently in an antibiotic resistance crisis that is driven by overuse. And despite our enlightenment we cannot seem to stop prescribing antibiotics for complaints that have been clearly shown not to require antibiotics. And so, given our appalling […]
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