Jon-Emile S. Kenny [@heart_lung] A 58 year old man with ethanol-related cirrhosis is admitted to the floor with anuria and a rising creatinine. Over the day, serial ultrasounds of his interior vena cava [IVC] consistently reveal that it is diminutive and collapsing. He receives many liters of crystalloid without much change in his urine output. [… read more]
Jon-Emile S. Kenny [@heart_lung] On this snowy, Stockholm Sunday, I look out from my quarters on the Mälardrottningen across the still, icy waters and I think about a cirrhotic patient for whom I recently cared. She presented with significant dyspnea as she had stopped taking her diuretics. Instead, she was using excessive doses of her friend’s [… read more]
ICU Physiology in 1000 Words Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) Jon-Emile S. Kenny M.D. [@heart_lung] Perhaps the most memorable patient of both my pulmonary and critical care fellowships was that of a very young woman who suffered from propofol-related infusion syndrome [PRIS]. As a consequence of PRIS, she endured multiple cardiac arrests and was placed [… read more]
ICU Physiology in 1000 Words The Right Ventricular Afterload [Part 2 of 2] Jon-Emile S. Kenny M.D. [@heart_lung] Having considered the short-comings of Laplace’s Law and the PVR with respect to the RV afterload in part 1, we will now turn to each of the following in turn: the pulmonary arterial input impedance, a measureable [… read more]
ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 1 of 2) By Jon-Emile S. Kenny M.D. With my trusted-resident – Dr. Lina Miyakawa – at my side we watched as our patient could not maintain his oxygen saturation above 82%. The patient had terrible aspiration pneumonia superimposed upon horrendous methamphetamine-related pulmonary arterial hypertension [… read more]
Cardiopulmonary Resuscitation by Jon-Emile S. Kenny, MD The first time I performed cardiopulmonary resuscitation [CPR] on a patient was in the emergency department of Sunnybrook Hospital in Toronto, Canada; it was certainly an indelible moment in my training. As an intern, and especially as medical consult at Bellevue Hospital in New York City, I was [… read more]
In Defense of the Central Venous Pressure Jon-Emile S. Kenny M.D. In the waning days of my fellowship I received a hemoptysis consult in the cardiac care unit. Sifting through CT scans, I overheard two house-officers giving sign-out for the evening. When reviewing the clinical data, one of the residents referred to the central venous pressure [… read more]
Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [… read more]
ICU Physiology in 1,000 Words “The Hemodynamics of Prone” by Jon-Emile S. Kenny MD A physiological maelstrom has recently swirled about the hemodynamic effects of the prone position in severe ARDS [1-5]; but how exactly does this maneuver alter the cardiovascular system? A good approach to this problem is a Guytonian one whereby we consider [… read more]
image: EM Ultrasonography ICU Physiology in 1,000 Words: “Inspiratory collapse of the inferior vena cava: What is it telling us?” Jon-Emile S. Kenny M.D. With the dissemination of small, portable, ultrasound devices [or SPUDs], it seems that it is every house-officer’s dream to own the ability and wherewithal to place an ultrasound probe on a [… read more]
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