Tag Archive for: Pulmonary

Classic Journal Review – Wells + Dimer to Rule Out PE

03 Sep
September 3, 2018

EM Journal Update: Safety of Using Wells’ Clinical Model With D-Dimer To Manage Patients In The ED With Suspected Pulmonary Embolism

Background: In the US, pulmonary embolism (PE) kills 100,000 people each year and over 360,000 new cases of PE are diagnosed each year (Horlander 2003). Currently, the gold standard for diagnosing PE is the computed tomographic pulmonary angiography (CTPA). Patients with PE present with varying symptoms, from anxiety and tachycardia, to shortness of breath and syncope. Thus, it is difficult to exclude this life-threatening diagnosis and thus far there is no validated method to exclude PE. Prior work from this group derived and validated Wells’ criteria for calculating clinical probability of PE, and using it to determine which patients should get serial ultrasonography, venography, or angiography after an equivocal ventilation perfusion (VQ) scan (Wells 1998). Now, this group examines how the D-dimer assay, together with Wells’ clinical model can help manage PE patients. Read more →

Simplifying Mechanical Ventilation – Part 6 – Choosing Your Initial Settings

27 Aug
August 27, 2018

Choosing Your Initial Settings: I hope you now see what physiologies to consider when setting up the ventilator and your goals for each. If your patient doesn’t fit into one of these three categories, then I set up my ventilator as if I was managing a patient who has refractory hypoxemia to maintain a lung protective strategy even if they don’t think they have very significant lung disease. Maintaining a lung protective strategy with low tidal volume ventilation has been shown to decrease ventilator induced lung injury and minimize harm, even in patients without refractory hypoxemia and ARDS (1-2). Read more →

High Flow Nasal Cannula (HFNC) – Part 2: Adult & Pediatric Indications

23 Aug
August 23, 2018

The use of heated and humidified high flow nasal cannula has become increasing popular in the treatment of patients with acute respiratory failure through all age groups.  In part 1 we summarized how High Flow Nasal Cannula (HFNC) works.  In part 2, we will discuss the main indications for its use in adult and pediatric patients. Read more →

High Flow Nasal Cannula (HFNC) – Part 1: How It Works

20 Aug
August 20, 2018

The use of heated and humidified high flow nasal cannula (HFNC) has become increasingly popular in the treatment of patients with acute respiratory failure through all age groups.  I first started using it as a pediatric intensive care fellow, but had little knowledge of how it actually worked.  I noticed a few years after using it successfully in children, mainly with severe bronchiolitis, that we began to use it in the adult intensive care unit as well.  It seems over the past several years many studies have come out reviewing the mechanisms of action as well as its use in a variety of conditions.  In this part we will summarize how it works and for part 2 we will discuss the main indications for its use in adult and pediatric patients. Read more →