Category: Pulm

Master the BVM

Why is it important to be proficient with the BVM?  Because inevitably we will all have patients that are difficult to intubate, but if we can ventilate these patients with the BVM we can buy ourselves time to use our alternative techniques. If you can’t ventilate effectively with the BVM you find yourself in a …

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Know your RSI!

[notice textalign=”center”]AIRWAY[/notice] As some of the more junior residents realize this time of year… fumbling your way through an intubation looks bad all around. Help yourself by really becoming comfortable with induction and paralytic agents. A difficult airway is, after all, owned by the ED. I wouldn’t want anyone else, even Anesthesia, intubating when there …

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Can I use the age adjusted D-dimer in clinical practice? If so, how?

The ADJUST PE trial is hot off the JAMA presses in March 2014. The takehome: of 1141 patients excluded from scanning by clinical assessment plus age adjusted d-dimer, there were only 2 cases of non-fatal PE (0.2%). Of these 1141 patients, 331 had an age adjusted d-dimer greater than the standard cutoff of 500mg/mL. Of these …

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CHF or PE? PE is a known and common complication of CHF

challenging case: an obese 60yo patient never seen by a doctor as an adult presents marked peripheral edema, hypertension, and 2 months of worsening DOE, PND, orthopnea. BNP 400, EKG Unremarkable, trop 0.1, stating well. It feels like CHF. But the cardiologist wants a CTPE. We oblige – big saddle embolus with RV strain. This …

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How to give thrombolytics

[notice]PHARMACOLOGY[/notice] A great question came up in the zones. We see and likely should be comfortable with the dosing of Alteplase for CVA. Grady is a renowned Stroke Center and I would certainly have any of my family members come to the Marcus Stroke and Neuroscience Center if they were having a stroke. The fact …

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Blue Zone Question

How do people approach steroids in pregnant asthma patients?

Case of the Month #5

EMory Files Case #5:  Massive PE Hx:  40 yo F hx of Lupus presents with CP SOB  PE:   VS:  BP 90/50, HR 125, RR 30, O2 88%, afebrile.  Awake and alert, mild distress improved with nonrebreather.   Case Discussion Massive PE: ***Case Discussion Wissam Jaber, Dir. PE Response Team***   Teaching Point #1:  Negative …

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