Archive

Author: Frank Lodeserto MD

Pediatric DKA: Do Fluids Really Matter?

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details ...

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Pediatrics

Simplifying Mechanical Ventilation – Part 5: Refractory Hypoxemia & APRV

Refractory Hypoxemia: Now maybe you have intubated a patient secondary to hypoxemic respiratory failure who is at high risk for the development of acute respiratory distress syndrome (ARDS). These patients, and really all patients, with exception of severe obstructive disease, I ...

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Thoracic and Respiratory

Simplifying Mechanical Ventilation – Part 4: Obstructive Physiology

Obstructive Physiology: Setting up the ventilator for a patient with severe obstructive physiology like asthma or COPD is almost a completely opposite strategy compared to the patient with severe metabolic acidosis. They both have problems with ventilation (removal of carbon dioxide), ...

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Thoracic and Respiratory

Simplifying Mechanical Ventilation – Part 3: Severe Metabolic Acidosis

Before I set up the ventilator, I consider if my patient has one of the following 3 physiologic processes: severe metabolic acidosis, an obstructive process (Asthma or COPD), or refractory hypoxemia. If my patient doesn’t fit into one of these ...

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Thoracic and Respiratory

Simplifying Mechanical Ventilation – Part 2: Goals of Mechanical Ventilation & Factors Controlling Oxygenation and Ventilation

In part 1, we discussed that the ventilator can deliver 3 types of breaths: controlled, assisted or spontaneous breaths. These breaths can be delivered either by a set pressure or a set tidal volume. Then we closed with a discussion ...

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Thoracic and Respiratory

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