SYSTEMS Cardiology Endocrinology Gastroenterology Hematology & Oncology Infectious diseases Nephrology Neurology Obstetrics Pulmonology Rheumatology Toxicology & Temperature Overview: Guide to supportive care in critical illness Medication reconciliation in the ICU About this book How to create your own IBCC smartphone app 📲 General Approaches to problems Cardiac arrest 🔜 Chest pain Hypertensive emergency SCAPE (Sympathetic […]
Search Results for: asthma
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 […]
Bronchiolitis
CONTENTS Constrictive bronchiolitis: Bronchiolitis obliterans Epidemiology Clinical presentation Radiology Pulmonary function tests Bronchoscopy Diagnostic criteria Treatment DIPNECH (diffuse idiopathic pulmonary neuroendocrine cell hyperplasia) Cellular bronchiolitis: Aspiration bronchiolitis Diffuse panbronchiolitis Infectious bronchiolitis ➡️ RBILD (Respiratory bronchiolitis interstitial lung disease) ➡️ Follicular bronchiolitis ➡️ Questions & discussion abbreviations used in the pulmonary section: 2 ABPA: Allergic bronchopulmonary aspergillosis […]
Anaphylaxis
CONTENTS Rapid Reference 🚀 Diagnosis Clinical findings & definition Causes Differential diagnosis Investigation Anaphylaxis vs. bradykinin-mediated angioedema Treatment Source control Components of therapy Epinephrine IV epinephrine infusion Fluid resuscitation Antihistamines Steroid Inhaled beta-2 agonists Overall treatment strategy General treatment strategy Anaphylaxis in the beta-blocked patient Airway management Recovery phase & extubation Disposition Podcast Questions & […]
ABG, VBG, and pulse oximetry
CONTENTS Assessment of oxygenation: Advantages of pulse oximetry over ABG Situations where ABG is needed to assess oxygenation: Poor arterial waveform Dyshemoglobinemia P/F ratio A-a gradient Patients with dark skin Other causes of inaccurate pulse oximetry Assessment of ventilation: VBG to assess pH and ventilation end tidal CO2 (etCO2) Additional topics related to pulse oximetry: […]
Flash cigarette burns: To intubate or not to intubate?
0 Getting warmed up with a multiple-choice question 0 A 70-year-old man with oxygen-dependent COPD is admitted following a flash burn. He started smoking with his oxygen running, and the cigarette “exploded” in his face. Currently he is in the emergency department on four liters nasal cannula (twice his chronic oxygen prescription). He is mentating […]
Sleep-protective monitoring to reduce ICU delirium
0 Introduction 0 Recently an excellent post on the Trauma Professional’s Blog pointed out that nocturnal vital signs disrupt sleep and may be unnecessary in stable patients (e.g. patients recovering from minor orthopedic surgery). I couldn’t agree more. Allowing restorative sleep is one of the best approaches to prevention of delirium. 0 What about patients […]
Sympathomimetic intoxication
CONTENTS Overview Clinical presentation Evaluation Management Serotonergic medications to avoid Agitation Seizures Hyperthermia Hypertension Chest pain & acute coronary syndrome Arrhythmia Atrial fibrillation Monomorphic ventricular tachycardia QT prolongation & torsade de pointes Hepatic failure Respiratory complications Rhabdomyolysis Hyponatremia Podcast Questions & discussion Pitfalls common sympathomimetic intoxications: Cocaine. Methamphetamine: Illicit “crystal meth.” Medicinally prescribed methamphetamine, used […]
PulmCrit – Is piperacillin-tazobactam safe in patients with penicillin allergy?
Historically it was believed that allergic reactions could be mediated by the core structures. This would imply that a patient could be allergic to all penicillins, all cephalosporins, or even all beta-lactams. That would be hugely problematic, because a patient could simultaneously be allergic to dozens of antibiotics – greatly complicating their management.
Large airway disorders (trachea and central bronchi)
CONTENTS Guide to the differential diagnosis: Bronchoscopic findings CT scan findings Flow-volume loops ➡️ Specific disorders Bilateral vocal fold paralysis Stenosis Laryngeal stenosis Tracheal stenosis Tracheobronchomalacia (TBM) Congenital tracheobronchomegaly (Mounier-Kuhn syndrome) Tracheobronchopathia osteochondroplastica (TPO) Tracheobronchial amyloidosis ➡️ Infectious: Respiratory papillomatosis Tracheobronchial aspergillosis ➡️ Broncholithiasis due to granulomatous mediastinitis ➡️ Inflammatory disorders: Sarcoidosis ➡️ GPA (granulomatosis […]
Approaching undifferentiated cardiopulmonary failure: Which tests are most useful?
0 Introduction 0 Recently point-of-care ultrasonography (POCUS) has risen in prominence within acute care medicine. It has been shown to provide immediate and critical information about a variety of conditions ranging from nephrolithiasis to pulmonary edema. However, POCUS is not without its critics, who point out weaknesses including detection of incidental findings (i.e., small […]
PulmCrit: “ARDS” is not a real thing
My dear pulmonologists, I have some bad news. Santa Claus isn’t real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they’re one and the same. But they aren’t. The ability […]
Sickle Cell Acute Chest Syndrome
CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Rapid progression & multi-organ failure Definition & differential diagnosis Management Non-transfusion related Aggressive oxygenation & monitoring Volume resuscitation Antibiotics Pain management Transfusion General considerations about transfusion Simple transfusion (top-up transfusion) Exchange transfusion Manual exchange transfusion […]
Bronchiectasis
CONTENTS Basics of bronchiectasis Definition Symptoms Radiologic findings Basic findings Radiologic types of bronchiectasis Clues regarding etiology Mucus impaction of bronchi (MIB) Pulmonary function tests Diagnosis Causes Evaluation for etiology Ambulatory management of chronic bronchiectasis Bronchiectasis exacerbation (non-CF) Diagnosis & evaluation Management Hemoptysis in non-CF bronchiectasis Related topics: Primary ciliary dyskinesia (PCD) Bronchiectasis and COPD […]
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 […]
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