Pulmonary Archives - Page 2 of 5 - The Emergency Medical Minute

Pulmonary

Podcast 553: Airway Management in the Hypoxic COVID-19 Patient(Recorded 4/3/20)

Contributor: Dylan Luyten, MD Educational pearls: Clinical management of COVID-19 is rapidly evolving, relying on case reports and clinical experience In just a month, the consensus around management of COVID patients with severe hypoxia has shifted from an early intubation strategy to other, non-invasive means Intubating early can quickly consume ventilator resources, require increased intensive…

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Podcast 552: PE Management and Risk Stratification

Contributor: Dylan Luyten, MD Educational Pearls: After you diagnose a pulmonary embolism (PE) via CT or VQ scan, we need to categorize the PE as massive, sub-massive, or just PE to dictate treatment.   Massive PE: shock with hypotension due to an embolism, and the treatment of choice is thrombolysis with IV tPA with anticoagulation after…

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Podcast 545: So You Quit Smoking… Now What?

Author: Aaron Lessen, MD Educational Pearls:  New data shows within 5 years of smoking cessation, the risk of cardiovascular disease becomes half of those who continue to smoke After 10-15 years of cessation, cardiovascular disease rates return to rates seen in non-smokers. Lung disease, COPD, and cancer rates do not decrease quite as rapidly, but…

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Podcast 541: Needle Thoracostomy

Author: Aaron Lessen, MD Educational Pearls: Traditional technique of needle thoracostomy for tension penumothorax is along the 2nd intercostal space at the midclavicular line Inserting a large angiocatheter along the 4th or 5th intercostal space at the mid-axillary line may provide a thinner area that is more easily identified, overcoming many of the obstacles of…

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Podcast 522: e-Cigarette and Vaping Related Lung Injury  

Contributor: John Winkler, MD Educational Pearls: Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO It is thought to be related to the contents of homemade vaping fluid, mostly in THC-containing products (“brands” include DankVapes, PaxPen) Ask patients with vague constitutional or respiratory symptoms about…

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Podcast 517: It’s all about the PEEP 

Contributor: Dylan Luyten, MD Educational Pearls: Bag-valve masks (BVM) typically  have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered to the patient. This can be overcome by using a PEEP (positive end-expiratory pressure) valve on the BVM  PEEP valves function by keeping alveoli open in…

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Podcast 516: Narcan and Pulmonary Edema

Contributor: Erik Verzemnieks, MD Educational Pearls: Important to realize complications can occur in the post-opioid overdose patient regardless of cause Narcan administration has been associated with non-cardiogenic pulmonary edema, although the mechanism of this is not quite known Symptoms include progressive shortness of breath and hypoxia.  Treatment is with positive-pressure ventilation and diuresis, similar to…

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Podcast # 474: Obesity Hypoventilation Syndrome

Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and common cause of right heart failure. Nighttime hypoventilation leads to pulmonary hypertension, causing right heart strain followed by right heart failure OHS criteria includes obesity, sleep disordered…

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Podcast # 461: Breath Stacking

Author: Gretchen Hinson, MD Educational Pearls: Breath stacking occurs when a patient is unable to expire fully before another inspiration In intubated/ventilated patients, this is because adequate time has not passed before exhalation Asthmatics are susceptible due to the prolonged expiratory phase Complications can include reduction in cardiac preload and cardiovascular collapse Pursed-lip breathing can…

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Podcast #445: Hunting for the endotracheal tube

Author: Michael Hunt, MD Educational Pearls: Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific Curvilinear probe may be preferable as it provides a larger field of view Editor’s Note: rather than explain what you’re looking for… just…

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