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 […]
Search Results for: asthma
PulmCrit – Understanding happy hypoxemia physiology: how COVID taught me to treat pneumococcus
Happy hypoxemia is severe hypoxemia (poorly responsive to supplemental oxygen) without dyspnea. This isn’t anything especially new – we have occasionally seen this since time immemorial. However, COVID is causing us to re-think how to manage this physiology. understanding the paradox of happy hypoxemia The key to understanding this is thinking about oxygenation and CO2 […]
answers to ABG/VBG questions
Here are the answers to todays discussion questions on ABG & VBG. A woman with history of heart failure, COPD, and recent international plane travel presents with dyspnea to the ED. ABG shows 7.52/29/65/23. What does this test reveal about her diagnosis? (2/6) — 𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 (he/him) 💊 (@PulmCrit) September 4, 2019 (1) Answer = […]
PulmCrit- Metoprolol causes harm in COPD?? Déjà vu all over again
We’ve been all over the road with beta-blockers and COPD. For a long time, there was a belief that beta-blockers were contraindicated in COPD. Eventually that concept fell out of favor. Subsequently, some correlative data suggested that beta-blockers might be beneficial in COPD. This led to the current BLOCK-COPD trial which (spoiler alert) shows that […]
PulmCrit- Do phenylephrine and epinephrine require central access?
Until recently I believed that prolonged vasopressor administration requires a central line, to avoid extravasation. I lumped together all vasopressors, treating them all as equal. I used the occurrence of an extravasation reaction from one vasopressor as evidence that all vasopressors could cause extravasation reactions (the fallacy of inappropriate generalization). Upon closer examination, these beliefs aren’t supported by evidence.
EMCrit 343 – CV-EMCrit: Who to Refer for VV ECMO – Patient Selection and When to Call for Help
Who and When to Refer for VV ECMO
Other diagnostic tests in pulmonology
CONTENTS Physical examination: Wheeze Stridor Clubbing Bronchoalveolar lavage (BAL) Lymphocytic CD4/CD8 ratio Neutrophilic Eosinophilic ➡️ Mixed cellularity Foamy macrophages Hemosiderin-laden macrophages Atypical hyperplastic type-II pneumocytes 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: […]
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 […]
High-flow nasal cannula to prevent post-extubation respiratory failure
0 Background: Post-extubation failure and noninvasive ventilation (NIV) 0 Post-extubation respiratory failure requiring re-intubation is a major setback for any critically ill patient. Current evidence mainly involves the pre-emptive use of NIV to reduce post-extubation failure, particularly in hypercapnic COPD patients. However, in practice this is difficult to implement widely. Except for the sickest COPD […]
Waveform capnography in the intubated patient
CONTENTS Rapid Reference 🚀 Introduction: An emerging standard of care Physiology etCO2, PaCO2, and dead space etCO2 and cardiac output Clinical background Evidence: accuracy of etCO2 in predicting PaCO2 What is the PaCO2 target for an intubated patient? Interpretation of etCO2 waveform morphology Clinical utility Confirming endotracheal tube placement Guidance of cardiac arrest management Guidance […]
EMCrit 26 – Patient Controlled Analgesia by Edward Gentile
Even when we can’t cure a patient, we can relieve suffering. On average, we kind of stink at pain control in the ED. One physician, Dr. Ed Gentile, has created a simple path to optimal acute pain control in the ED. I heard this lecture on the EM:RAP podcast and got permission from Drs. Gentile and Herbert to repost it here. This is not a critical care topic per se, but it is applicable to the critically ill, the non-critically ill–basically any patient who is in pain in the ED.
Viral pneumonia (non-COVID/influenza)
CONTENTS General properties of viral pneumonias Herpesviruses ⍺-herpesviruses HSV VZV β-herpesviruses CMV Paramyxoviruses RSV (respiratory syncytial virus) Parainfluenza Metapneumovirus Adenovirus Rhinovirus Hantavirus Questions & discussion abbreviations used in the pulmonary section: 2 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast Bacilli AIP: Acute interstitial […]
EMCrit CQiR – IV Bolus Epinephrine for Anaphylaxis: A Double-Edged Sword
Is IM still the way to go with epi in anaphylaxis?
“The Adventure in the Valley of Fear”
In the biomedical industry’s relentless war against clinical reasoning, a multitude of biomarkers have been developed that promise assistance in the diagnosis and management of sepsis. In this ocean of mediocrity, procalcitonin has risen to the top. Since its predictive value is only slightly better than chance alone, it behooves those promoting its value to […]
Sleep-disordered breathing
CONTENTS Sleep-disordered breathing basics Obstructive sleep apnea (OSA) Epidemiology (including causes & consequences) Clinical features & assessment Diagnosis Treatment Obesity hypoventilation syndrome (OHS) Chronic OHS Epidemiology Signs & symptoms Evaluation & diagnosis Treatment Acute exacerbation of OHS (AEOHS) Definition Causes & patient evaluation Treatment Central sleep apnea (CSA) overview Hypercapnic CSA Nonhypercapnic CSA CSA due […]
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