Sep 122012
 
Anemia in the ICU (Review)

Anemia in the ICU: Review and Update (More PulmCCM Topic Updates) This document will be updated periodically to incorporate new research findings. To suggest an article for inclusion, please comment below. Anemia is almost inevitable during many episodes of critical illness, and has been associated with worsened outcomes and prognosis. However, the preponderance of evidence suggests that correcting anemia [… read more]

Sep 042012
 
Hyperosmolar Therapy for Increased Intracranial Pressure (Review)

Hypertonic Saline & Mannitol for Raised Intracranial Pressure (More PulmCCM Topic Updates) Acute brain injuries of all sorts increase the pressure inside the skull (intracranial pressure). Traumatic brain injury, bleeding in or around the brain, severe ischemic stroke, and acute hepatic failure all raise intracranial pressure, and increased intracranial pressure often becomes the most severe [… read more]

Sep 022012
 

Definition of Severe Sepsis by the Surviving Sepsis Guidelines Severe sepsis is sepsis (known or suspected infection with systemic manifestations of sepsis) along with sepsis-related tissue hypoperfusion or organ dysfunction. Organ dysfunction or tissue hypoperfusion are defined by the Surviving Sepsis Campaign as any of the below signs or findings: Signs of Severe Sepsis: Organ [… read more]

Aug 302012
 
From the Surviving Sepsis Guidelines: Criteria for diagnosis of sepsis

Surviving Sepsis Guidelines’ Criteria for Sepsis Diagnosis See all the Surviving Sepsis Guidelines According to the Surviving Sepsis Guidelines, a sepsis diagnosis requires the presence of infection, which can be proven or suspected, and 2 or more of the following criteria: Hypotension (systolic blood pressure < 90 mm Hg or fallen by >40 from baseline, [… read more]

Aug 212012
 
Singulair (montelukast) goes generic (FDA)

The FDA announced earlier this month that it granted approval to 10 generic manufacturers to produce and market generic forms of montelukast, sold by Merck since its approval in 1998 as Singulair. Brand-name Singulair currently costs about $168 per month, so cost competition could bring considerable savings to those taking the medication (and their insurance [… read more]

Aug 172012
 
Advanced bronchoscopy yields are 70% in meta-analysis (Review)

(image: Wikipedia) As one after another specialty society endorses routine lung cancer screening with chest CT scans, we all know a Nodule Storm is coming to a pulmonology clinic near you. Thankfully, smart people are asking how we can systematically and successfully handle this soon-to-be-common outpatient clinical problem. Most of these many thousands of nodules [… read more]

Aug 152012
 
Assess the IVC for fluid responsiveness with ultrasound (EMCrit Video)

Have you seen EMCrit.org? It’s the brainchild of Scott Weingart, an ED intensivist in New York City. ED docs like to do things (not just debate and deconstruct them endlessly like us pulmonologist-intensivists). In that spirit, Scott’s site is in my opinion more practical, “virtual-hands-on,” and skills/procedure-based than PulmCCM.org. Here’s a great example — his [… read more]

Aug 112012
 
Intubation & Airway Management Review (LITFL)

When it comes to airway management skills, muscle memory rules, and there’s no substitute for hands-on experience. But in between intubations and endotracheal tube changes, what’s the best way to bolster your skills and knowledge base? Reading textbooks and journal articles provides truthful information, but I suspect it gets filed away and stashed in your [… read more]

Aug 082012
 
CPAP gives the heart a tune-up for 1 year or 30 million beats, whichever comes first

Obstructive sleep apnea (OSA) might be the perfect disease to describe the American health care system. The condition is overwhelmingly due to our over-indulgence and under-activity; its expensive diagnosis (polysomnography) and best treatment (CPAP) help physicians and device manufacturers prosper while consternating those who pay (the government and insurance companies), who then threaten to cut off [… read more]

Aug 032012
 
Non-small cell lung cancer (NSCLC): Advances in Diagnosis and Treatment (Update/Review)

Advances in Diagnosis and Treatment of Non-Small Cell Lung Cancer (NSCLC) This review document is periodically updated and reposted as new information is published. Please comment below with your suggestions for inclusion in upcoming updates of this review. (More PulmCCM topic reviews) The diagnosis and treatment of non-small cell lung cancer (NSCLC) is rapidly evolving, [… read more]

Aug 022012
 
How many times has giving empiric antibiotics saved your professional behind?

Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers? As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide [… read more]

Jul 272012
 
Idiopathic Pulmonary Fibrosis 2014 Update (Review)

Idiopathic Pulmonary Fibrosis (IPF) 2012 Review (More PulmCCM Topic Updates) This document is updated periodically as new research findings in IPF are published. What Causes IPF? (Etiology/Pathogenesis of IPF) Since it’s still called “idiopathic,” you probably figured out already that the cause(s) of IPF remain unknown. Researchers use a paradigm for studying idiopathic pulmonary fibrosis called [… read more]

Jul 232012
 
Hypersensitivity Pneumonitis Update (Review)

Hypersensitivity Pneumonitis 2012 Review (More PulmCCM Topic Updates) Hypersensitivity pneumonitis (external intrinsic alveolitis) is an “orphan disease,” which means it’s uncommon and lacks any likely way to effectively “monetize” the disease with drugs or device therapy, resulting in its being largely ignored from a research funding standpoint. If you think you don’t know much about [… read more]

Jul 212012
 
Black lung resurges in Appalachian coal country; mining co's not penalized (Ctr for Public Integrity)

In the 1950s, half of coal miners who worked 25 years contracted black lung, or coal workers pneumoconiosis. A 1969 federal law mandated dust controls in coal mines, and the incidence of black lung declined dramatically. But that was temporary. A new report by the Center for Public Integrity and National Public Radio shows that [… read more]

Jul 202012
 
Should pleurodesis or PleurX drain be 1st-line Rx for malignant pleural effusion?

(image: Wikipedia) There are an estimated 200,000 pleural effusions due to malignancy each year in the U.S. alone, and these represent an important cause of suffering and limitation in functional ability for people living with advanced cancer. Pleurodesis (using talc or other sclerosants) and placement of indwelling pleural catheters are both accepted, reasonable approaches to the [… read more]

Jul 152012
 
Superior Vena Cava Syndrome Review

Superior Vena Cava Syndrome: A Cancer-Related Medical Emergency (More PulmCCM Topic Updates) Multiple cancers are expected to rise in prevalence in the U.S. over the coming decades, and so is the risk for cancer-related medical emergencies. For a few, superior vena cava syndrome (SVC syndrome) will be the first manifestation of their cancer. It’s important [… read more]

Jul 142012
 
Talking to COPD patients about end-of-life makes them like you more?

We may see it more often, but we doctors don’t really know anything more about death than anyone else, and we find it just as scary. Yet we are expected to spontaneously discuss death-as-a-coming-event with seriously ill patients who (we assume) probably want to avoid the subject, well, like the plague. Maybe they do. But [… read more]

Jul 122012
 
New molecular test predicts lung cancer survival better than staging

Non-small cell lung cancer (NSCLC) unfortunately recurs even more often than other cancers, even when early stage and apparently completely resected. The explanation, of course, is it wasn’t completely resected: there was residual metastatic disease hiding out somewhere, but in such microscopic quantities as to be undetectable by our improving but still crude techniques (i.e., [… read more]