Jon-Emile S. Kenny

Dr. Kenny can usually be found poaching the M-turbo from 7 Dazian. His favourite places are: Pier 64, The Hall of Ocean Life, Grand Central Station and the cafe at the top of Fotografiska. He has inherited his grandmother's fascination with the cosmos and Carl Sagan. Enjoy his homage to classical cardiorespiratory physiology at www.heart-lung.org

Apr 222017
 
ICU Physiology in 1000 Words: Weaning-Induced Cardiac Dysfunction & the Passive Leg Raise

Jon-Emile S. Kenny MD [@heart_lung] Reminder: Help me with my master’s thesis!  Please complete a learning module, and fill out this exceptionally brief survey! Perhaps the landmark trial elaborating an evolving cardiac dysfunction during the spontaneous breathing trial [SBT] is that of Lemaire and colleagues – published in 1988 [1].  One particularly memorable patient of [… read more]

Apr 062017
 
Free Online Hemodynamic Physiology Modules: an update & request

Jon-Emile S. Kenny MD [@heart_lung] “Oh, East is East and West is West, and never the twain shall meet …” -Kipling Last year, I began adding physiology modules to heart-lung.org as a part of a Master’s Degree I am undertaking at the Karolinska Institutet in Stockholm, Sweden.  The goal of these modules has been to encourage [… read more]

Mar 202017
 
ICU Physiology in 1000 Words: Heliox & Mechanical Power

Jon-Emile S. Kenny MD [@heart_lung] Of the countless things taught to me by Dr. Chitkara at the Palo Alto VA Health Care System, one that sticks is the difference between density-dependent and viscosity-dependent airflow.  He often used the chronic bronchitic suffering through the viscous, humid New York City summers as a teaching example.  The importance [… read more]

Feb 142017
 
A Primer on the Perils of Intravenous Fluids – Part 2

Jon-Emile S. Kenny [@heart_lung] Read part 1 here Fluids and the Glycocaylx Critically-ill patients all likely have endothelial dysfunction to some degree.  This perturbation in microvascular physiology may be underpinned by abnormal glycocalyx structure and function.  Sepsis, trauma, surgery and ischemic insults are all known to disrupt the glycocalyx which will increase vascular fluid capacitance.  [… read more]

Feb 132017
 
A Primer on the Perils of Intravenous Fluids – Part 1

Jon-Emile S. Kenny [@heart_lung] “To every (wo)man is given the key to the gates of heaven. The same key opens the gates of hell.  And so it is with science.” -Richard Feynman A rich, frosty wind etherizes my face; this cool gust rips through the medieval, labyrinthine passageways of Old Stockholm like frayed edges of [… read more]

Jan 242017
 
2016 Surviving Sepsis Guidelines: A Review and Analysis

By Jon-Emile S. Kenny [@heart_lung] PulmCCM is not affiliated with or endorsed by the Society of Critical Care Medicine or the Surviving Sepsis Campaign. Click here to read the Surviving Sepsis Guidelines. “I am at the moment writing a lengthy indictment against our century.  When my brain begins to reel from my literary labors, I make [… read more]

Jan 112017
 
ICU Physiology in 1000 Words: Hidden Hemodynamics in Respiratory Mechanics

Jon-Emile S. Kenny MD [@heart_lung] Hemodynamic assessment, by any means, demands a shrewd familiarity with mechanical heart-lung interaction.  The two ventricles communicate in series and in parallel; each ventricle’s pressure-volume characteristics and loading conditions pulsate between systole and diastole.  And around the heart and pericardium lies the respiratory pump – the lungs within the thorax [… read more]

Dec 242016
 
Pneumonia or Atelectasis?  Here's a trick to tell them apart

By Jon-Emile S. Kenny [@heart_lung] “New York is cold, but I like where I’m living … There’s music on Clinton Street all through the evening.” -Leonard Cohen It’s the end of December; we collectively reflect on the year that was and try to find our footing for the next.  In the short winter days of 2016, it [… read more]

Dec 012016
 
ICU Physiology in 1000 Words: The Folly of Pulmonary Vascular Resistance

By Jon-Emile S. Kenny [@heart_lung] When interpreting hemodynamic studies of drugs which – potentially – alter the resistance of the pulmonary vascular tree, we often turn to the calculated pulmonary vascular resistance [cPVR] as our guide.  For instance, a vasopressor determined to increase the cPVR is wholly avoided in a patient with pulmonary arterial hypertension.  We [… read more]

Nov 112016
 
Methylene Blue: the drug you’ve never used

By Jon-Emile S. Kenny [@heart_lung] “Major Major had been born too late and too mediocre. Some men are born mediocre, some men achieve mediocrity, and some men have mediocrity thrust upon them. With Major Major it had been all three …” -Joseph Heller In my younger days, parked on a bench overlooking Stanley Park, I sought [… read more]

Nov 052016
 
Levosimendan in Septic Shock: the LeoPARDS study

By Jon-Emile S. Kenny [@heart_lung] “I want to be your medicine, I want to feed the sparrow in your heart …” -Kristian Matsson Case A 39 year old woman is admitted to the intensive care unit for hypotension, anuria and altered mentation despite 3 litres of intravenous lactated ringers infusion.  She is febrile and found to [… read more]

Oct 212016
 
PESIT Investigators: the prevalence of PE in those hospitalized following first syncope

By Jon-Emile S. Kenny [@heart_lung] “The only way to get rid of temptation is to yield to it.” -Oscar Wilde The Case A 76 year old woman without known medical comorbidity is ambulating along 7th avenue, rounding the corner where St. Vincent’s Hospital once operated.  It is an exceptionally humid August afternoon and she has not [… read more]

Oct 142016
 
Piperacillin-Tazobactam: The Antibiotic You’re Not Administering Correctly

By Jon-Emile S. Kenny [@heart_lung] “Half of the time we’re gone but we don’t know where, and we don’t know where …” -Paul Simon The Case A 42 year old man is admitted with fever, right upper-quadrant pain and jaundice.  Over the last few hours he has become progressively confused and hypotensive.  He has normal renal [… read more]

Sep 252016
 
Sepsis-Associated AKI – Bellomo Kidney – Implications for Management

Jon-Emile S. Kenny [@heart_lung] “Rather than love, than money, than fame, give me truth.” -Thoreau The Case A 56 year old man with non-ischemic cardiomyopathy [LVEF 40% and mitral regurgitation] is admitted with severe sepsis due to appendicitis.  One month prior to admission, his outpatient cardiologist saw him and noted a dry weight of 88 kg.  [… read more]

Sep 102016
 
Let’s Plan for Extubation in the Morning

Jon-Emile S. Kenny [@heart_lung] “Truth is like the sun, its value wholly depends upon our being at a correct distance away from it.” -Hjalmar Söderberg The evening is invigorating; the Stockholm Marathon has been run and cobblestoned cafés, concealed within winding, narrowed side-streets are in the throes of summer’s end.  I take a coffee and [… read more]

Aug 262016
 
Rising Lactate & the Art of Venous Blood Gas Interpretation

Jon-Emile S. Kenny [@heart_lung] A 23 year old woman is admitted with severe abdominal pain following 5 days of profound non-bloody diarrhea and 72 hours of recalcitrant non-bloody emesis.  She has lost 7 pounds in this time frame and has been unable to maintain oral hydration.  Her eyes are sunken and her vital signs are [… read more]

Aug 252016
 
FAQ: How To Study for the Critical Care Medicine Board Examination?

Jon-Emile S. Kenny [@heart_lung] “Let the wild rumpus start!” -Maurice Sendak Many of you are preparing for the Critical Care Medicine Board Examination; thank you to those who have downloaded my free review notes.  I often receive a question or two about the exam and how germane my notes were, in retrospect.  This is a [… read more]

Jul 302016
 
IDSA Guidelines 2016: HAP, VAP & It’s the End of HCAP as We Know It (And I Feel Fine)

Jon-Emile S. Kenny [@heart_lung] “It is important to realize that guidelines cannot always account for individual variation among patients.  They are not intended to supplant physician judgement with respect to particular patients or special clinical situations.” -IDSA/ATS Guidelines 2016 A 73 year old man is admitted from a nursing home for an NSTEMI and is [… read more]

Jul 142016
 
Intra-abdominal Pressure and Renal Function: The Venous Side of the Road

Jon-Emile S. Kenny [@heart_lung] “An’ it ain’t no use in turnin’ on your light, babe, I’m on the dark side of the road …” -Bob Dylan A 44 year old man with cryptogenic cirrhosis is admitted with large ascites and acute kidney injury.  A 50 mL, diagnostic paracentesis reveals 12 PMNs and he is admitted from the [… read more]