CONTENTS Rapid Reference 🚀 Causes of tamponade Symptoms Physical exam Pulsus paradoxus Kussmaul’s sign EKG Radiology Echocardiography Diagnosis: Overall approach Low pressure tamponade Management Initial stabilization measures Ultrasound-guided pericardial drainage Interventional radiology or surgical drainage Tamponade patient in cardiac arrest Finer points: Limitations of this chapter Physiology Podcast Questions & discussion Pitfalls Key tests to […]
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Takotsubo syndrome
CONTENTS Pathophysiology Epidemiology Symptoms Diagnostic studies EKG Echocardiography Cardiac MRI Labs Diagnostic approach Management Treat underlying problem Anticoagulation? Arrhythmia management Treatment if hemodynamically stable Treatment if hemodynamically unstable Prognosis Podcast Questions & discussion Pitfalls Probably results from severe catecholamine surges affecting the myocardium. Epinephrine may have the greatest effect in apical regions of the heart […]
Hypersensitivity pneumonitis (HP)
CONTENTS Basics Epidemiology Causative agents History Symptoms Laboratory evaluation Thoracic radiology Acute HP Nonfibrotic (subacute) HP Fibrotic HP Bronchoscopy Lung biopsy Differential diagnosis Diagnostic approach Treatment Questions & discussion abbreviations used in the pulmonary section: 1 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute eosinophilic pneumonia 📖 AFB: Acid Fast […]
Guide to APRV for COVID
CONTENTS Preamble Parameters Initial settings Monitoring Troubleshooting hypoxemia & acidemia Weaning Weaning initiation Spontaneous Breathing Trial & Extubation pathways Questions & discussion Pitfalls APRV can be a bit scary for folks who aren’t used to it. Everyone has slightly different ways of setting the parameters. However, over time I’ve come to believe that APRV is […]
Preoxygenation & apneic oxygenation using a nasal cannula
0 Starting Point: We do a bad job at preoxygenation 0 We could do better at preoxygenating patients before emergent intubations. In my experience the most commonly used device for preoxygenation is a bag-valve mask, which has many pitfalls. We often accept a poor mask seal in efforts to remain gentle with awake patients. […]
Pulmonary amyloidosis
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: […]
PulmCrit- Reengineering the analgesic ladder for critically ill patients
We all want to alleviate pain and suffering. Most critically ill patients are treated with opioids for this reason. Unfortunately, opioids have numerous side-effects including delirium, constipation, vomiting, and delayed extubation. Opioid infusions may eventually lead to withdrawal, causing pain, nausea, and depression. This post explores the optimal use of systemic medications to control pain while minimizing complications.
Sarcoidosis
CONTENTS Basics Epidemiology Pulmonary sarcoidosis Clinical presentation Radiographic staging (Scadding stage) Chest CT scan Lymphadenopathy ➡️ Nonfibrotic parenchymal abnormalities Fibrotic parenchymal abnormalities Necrotizing sarcoid granulomatosis Pulmonary function tests Reduced DLCO Restriction Obstruction Pleural involvement Pulmonary hypertension Large airway involvement Treatment of pulmonary sarcoid Approach to sarcoidosis patient with cardiopulmonary deterioration Extrapulmonary sarcoidosis Skin Erythema nodosum […]
PulmCrit: Fighting refractory ARDS with physiologic jujitsu
Jui-jitsu is a Japanese martial art based on flexibility and technique, rather than a directly confronting an opponent with force. In the spirit of jui-jitsu, this post explores how to support ARDS patients without directly confronting lung dysfunction. This is useful in refractory ARDS, when frontal assault has failed.
Follicular bronchiolitis (FB) and lymphoid interstitial pneumonia (LIP)
CONTENTS Basics Epidemiology Symptoms Radiology Radiology of FB (follicular bronchiolitis) Radiology of LIP (lymphoid interstitial pneumonia) Additional testing Diagnostic process Management Prognosis 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 […]
Aspiration syndromes
CONTENTS Management of aspiration itself: Risk factors for aspiration Investigation Prevention Aspiration syndromes: Aspiration pneumonitis Aspiration pneumonia Lung abscess ➡️ Lipoid pneumonia Foreign body aspiration Aspiration-induced interstitial lung disease Aspiration bronchiolitis ➡️ Questions & discussion abbreviations used in the pulmonary section: 8 ABPA: Allergic bronchopulmonary aspergillosis 📖 AE-ILD: Acute exacerbation of ILD 📖 AEP: Acute […]
EMCrit 321 – CV-EMCrit – Acute Valve Disasters – Critical Aortic & Mitral Regurgitation and Bonus: VSDs with Trina Augustin
Valve Disasters Part 1 – Regurg…
Thoracic Radiology – Nodular patterns
CONTENTS Classification of multinodular patterns, based on size: Macronodular Micronodular Classification of nodules based on distribution: Sorting out the pattern of micronodules Centrilobular Centrilobular nonbranching micronodules Ill-defined centrilobular nodules Well defined nodules Centrilobular branching (tree-in-bud) Perilymphatic nodules Random nodules (including miliary pattern) Related topics Cluster of small nodules Galaxy sign Cluster sign Nodular reverse halo […]
Guide to supportive care in critical illness
CONTENTS Rapid Reference 🚀 The understated importance of high-quality supportive care Medications to avoid in ICU Prophylaxis DVT prophylaxis GI prophylaxis Anemia & transfusion targets Glycemic control Nutrition for the intubated patient Pain, agitation, and delirium Analgesia & pain management Sedation of the intubated patient Delirium prevention Volume status & diuresis Electrolyte management Troponin elevation […]
IBCC – Neuroprognostication after cardiac arrest
CONTENTS Rapid Reference 🚀 Introduction Early brain death is (still) death Prognostic value of historical information Confounding factors & hypothermia Timing & serial evaluation Prognostic tests Neurological examination EEG Myoclonus SSEPs (Somatosensory evoked potentials) CT scan MRI Neuron-specific enolase Multimodal prognostication Podcast Questions & discussion Pitfalls PDF of this chapter (or create customized PDF) timing of tests […]
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