In the past few weeks, there has been considerable debate regarding whether or not early COVID respiratory failure is ARDS. This is a linguistic mess, but it has real implications for treatment. So, it’s worth trying to sort it out… definition(s) of ARDS When clinicians use the term “ARDS” they are referring to a variety […]
Search Results for: mental toughness
Thoracic Radiology: Ground-Glass Opacification (GGO)
CONTENTS Ground-glass opacity (GGO) Initial approach to GGO Subtypes of GGO Diffuse GGO Mosaic GGO Crazy-paving ➡️ GGO in a nodular configuration: Centrilobular GGO nodules ➡️ Non-centrilobular GGO nodules GGO involved in larger nodules: Halo sign ➡️ Reverse halo sign ➡️ Mosaic attenuation (1) Mosaic GGO (2) Mosaic 2/2 small airway disease (3) Mosaic 2/2 […]
Lights Camera Action: Redirecting Videolaryngoscopy (Guest Post)
Bob Dylan, Leonard Cohen, & the Cochrane review of videolaryngoscopy
Nontuberculous mycobacteria (NTM)
CONTENTS Basics Epidemiology Clinical manifestations Fibrocavitary disease Nodular bronchiectatic disease (Lady Windermere syndrome) NTM in cystic fibrosis NTM in non-CF (cystic fibrosis) bronchiectasis Disseminated Mycobacterium avium complex (MAC) Hypersensitivity pneumonitis due to NTM Diagnosis Significance of positive culture Relative pathogenicity of different species Diagnostic criteria Decision to treat Treatment Treatment overview Antibiotic regimens for various […]
PulmCrit- Sedation update: IV olanzapine & combo vs. monotherapy
The potential role for IV olanzapine was examined in a post last year. The following conclusions were reached: IV olanzapine appears to be safe. IV olanzapine has equal potency compared to IV droperidol and about twice the potency of IV haloperidol. Olanzapine doesn’t affect QT interval or cause torsade de pointes. Two articles were just […]
Approach to thoracic imaging in acute illness (radiograph, CT scan)
CONTENTS Preamble: A slightly different approach Frontal chest radiograph algorithm CT algorithm (1) Lines & tubes (2) Right heart & pulmonary embolism Contrast reflux into the IVC Pericardial effusion Right atrial dilation Right ventricular dilation Right ventricular wall thickness Pulmonary artery dilation Evaluation for PE (3) Left heart Left atrial dilation Left ventricular dilation Left […]
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 […]
The Case of the Anatomic Heart
Our obsession with diagnostic certainty has led us down many false paths and blind alleyways in the history of medicine. This statement has never been more true than when spoken in regards to cardiovascular health. The small successes that we have obtained when treating the highest acuity patients have been enthusiastically and incorrectly applied across […]
Acute Liver Failure (ALF)
CONTENTS Rapid reference 🚀 Definition & classification Diagnosis Causes of acute liver failure Laboratory & imaging evaluation Treatment Liver transplantation Treatment of inciting cause & N-acetyl cysteine Cardiovascular Pulmonary Gastrointestinal Renal Infectious diseases Hematology Endocrine Neurology Podcast Questions & discussion Pitfalls diagnostics Order initial test panels as listed below. 📖 Serial labs (including: ammonia levels, […]
Nonconvulsive Status Epilepticus (NCSE)
CONTENTS Definition of NCSE Epidemiology and causes of NCSE Various clinical presentations General clues to the diagnosis of NCSE Common differential diagnostic considerations EEG: Indications to obtain an EEG Duration of continuous EEG monitoring Antiepileptic trial for ictal/interictal continuum abnormalities Management of NCSE Subtypes of NCSE NCSE with coma Absence NCSE with onset in adulthood […]
PulmCrit Wee: Is piperacillin-tazobactam nephrotoxic?
A recent series of articles suggest that the combination of vancomycin and piperacillin-tazobactam are synergistically nephrotoxic. Is piperacillin-tazobactam truly nephrotoxic, or is this merely pseudo-nephrotoxicity?
Ventricular arrhythmias
CONTENTS approach to wide-complex monomorphic tachycardia Diagnostic approach to wide complex tachycardia [1] Consider pretest probability for VT [2] Compare to old ECG if available [3] Initiation of wide complex tachycardia [4] Signs of potential VT mimic [5] Evidence of AV dissociation? [6] Morphology in Leads II & aVR Morphology rules [7a] RBBB-type [7b] LBBB-type […]
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 […]
The Adventure of the Cardboard Box
There have been a number of seemingly negative studies published recently in which the authors, using ordinal analysis, have claimed their trials are in fact positive. Though not the first, the most notable of these studies was the IST3 trial published in May of last year. In this trial, the largest to date, comparing thrombolytics […]
PulmCrit- Power, the forgotten error, and inconclusive trials
The new HYPRESS trial tests whether steroid could prevent deterioration from sepsis into septic shock. The study found no significant benefit from steroid, but I thought it was underpowered. However, an accompanying editorial in JAMA didn’t even mention power. This raises some questions: How can we measure type-2 error? How should it be reported? What is an acceptable level of type-2 error?
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