Clinical Resources

Nov 112021
 
ICU Physiology in 1000 Words: Phenylephrine Pushes & Stroke Volume

Jon-Emile S. Kenny MD [@heart_lung] About a decade ago, a handful of terrific reviews and investigations about phenylephrine – an alpha1 agonist – were published [1-3].  While this vasoactive medication might be thought only to ‘increase afterload,’ phenylephrine’s hemodynamic effects are knotty and noteworthy.  Therefore, this dedicated dispatch delineates the difficulties encountered when predicting the hemodynamics [… read more]

Feb 172021
 
Open Critical Care: a great new hub for critical care resources

I’m excited to share the link to Open Critical Care, a new hub providing open access critical care learning tools, COVID-19 treatment guidelines, and loads of other high-quality resources. Funded by USAID and directed by physicians at UCSF, it’s an endeavor worth following. Although their offerings are directed especially toward health care workers in resource-variable [… read more]

Jan 292021
 
A Cursory Review of Casirivimab and Imdevimab for COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “Booksellers are the most valuable destination for the lonely, given the numbers of books that were written because authors couldn’t find anyone to talk to.” – Alain de Botton Introduction An important reason for treating both tuberculosis and HIV with multiple pharmacological agents is the ability of these infectious scourges to [… read more]

Jan 082021
 
Kambô Intoxication for the Intensivist – Part 2

Jon-Emile S. Kenny MD [@heart_lung] “There are poisons that blind you, and poisons that open your eyes.“ – August Strindberg. In the introduction to kambô, or what Esparmer and colleagues called a “fantastic chemical cocktail with potential medical applications, unequaled by any other amphibian,” a superficial overview was offered. This first part included a very basic [… read more]

Jan 072021
 
Kambô Intoxication for the Intensivist – Part 1

Jon-Emile S. Kenny MD [@heart_lung] “All things are poisons, for there is nothing without poisonous qualities. It is only the dose which makes a thing poison.” -Paracelsus Background Per one account, many living in the village Kaxinauá were seriously-ill and the shaman could not help them with known herbal medicines. During a ritual involving ayahuasca, the [… read more]

Nov 112020
 
ICU Physiology in 1000 Words: Pulmonary Vascular Resistance & Linear Assumptions

Jon-Emile S. Kenny MD [@heart_lung] A recent review of Paul Wood’s consummate approach to pulmonary hypertension is well-worth a read [1].  In it, the basic physiology of the calculated pulmonary vascular resistance [cPVR] is presented, as it often is, as a linear function.  Recall, maybe traumatically, the grade-school equation y = mx + b.  With this [… read more]

Mar 092020
 
ICU Physiology in 1000 Words: All Perfusion Is Local

Jon-Emile S. Kenny MD [@heart_lung] About a year ago, I explored blood pressure – underscoring mean arterial pressure [MAP] as a determinant, but not necessarily an indicator, of perfusion.  The inspiration for that post were these excellent reviews [1, 2] by the legendary Dr. Magder. With the recent 65 Trial [3], a deeper exploration of tissue [… read more]

Oct 302019
 
Vaping-Associated Lung Injury – Part 2

Jon-Emile S. Kenny MD [@heart_lung] “There are sadistic scientists who hurry to hunt down errors instead of establishing the truth.” -Marie Curie In part 1 of Vaping-Associated Lung Injury, the very basics of electronic nicotine delivery systems [ENDS] were covered as well as highlights on clinical presentation, radiology and pathology.  In this second part, flurries of [… read more]

Oct 292019
 
Vaping-Associated Lung Injury – Part 1

Jon-Emile S. Kenny MD [@heart_lung] with illustration by Carla M. Canepa MD [@_carlemd_] “Inside the word ‘emergency’ is ‘emerge’; from an emergency, new things come forth.” -Rebecca Solnit Case A 32-year-old man is admitted with three days of fevers, chills, malaise, dyspnea and productive cough.  He works in a stressful job in the heart of Manhattan [… read more]

Aug 072018
 
In-Flight Medical Events & Emergencies: part 2

Jon-Emile S. Kenny MD [@heart_lung] “I’m learnin’ to fly … but I ain’t got wings … comin’ down … is the hardest thing.” -Tom Petty Common Events Continued … Abdominal Pain Like chest pain, abdominal pain carries a wide differential diagnosis.  Abdominal pain comprises 4% of all in-flight events and 10% of all diversions.  An [… read more]

May 232018
 
A Free On-Line Hemodynamic Curriculum Grows

Jon-Emile S Kenny MD [@heart_lung] “What is memory but a story about how we have lived?” -Mark Doty During the recent ‘Hospitalist and the Resuscitationist’ conference in Montreal, there were discussions around the hemodynamics of prone positioning as well as using venous Doppler as a hemodynamic metric.  Much of this discussion was generated and driven [… read more]

Apr 232018
 
Lectures from the Inaugural 'Hospitalist and the Resuscitationist' Conference in Montreal, Canada

Jon-Emile S. Kenny MD [@heart_lung] “The real process of education should be the process of learning to think through the application of real problems.” -John Dewey On April 18 & 19, 2018, I had the pleasure of participating in the inaugural conference “The Hospitalist and the Resuscitationist” in Montreal.  The entirety of this meeting was [… read more]

Feb 222018
 
The Great Lactate Debate Part 2: can we ‘myth-bust’ the strong ion approach?

Jon-Emile S. Kenny MD [@heart_lung] “The truth is rarely pure and never simple.” -Oscar Wilde In part 1, the crux of this ‘Great Lactate Debate’ was distilled into the unclear origin of the proton in the setting of ‘lactic acidosis.’  Is the [H+] secondary to biochemical work and ATP hydrolysis or is the proton from [… read more]

Jan 292018
 
ICU Physiology in 1000 Words: Venous Doppler & Volume Tolerance

Jon-Emile S. Kenny MD [@heart_lung] With the birth of ‘fluid responsiveness’ physiology [1], there has been a slow and solemn drumbeat ushering the central venous pressure [CVP] up the squeaking planks of the hemodynamic gallows [2, 3].  Despite this, a few years ago I made a humble defense of the central venous pressure.  Importantly, I was [… read more]

Nov 112017
 
ICU Physiology in 1000 Words: Venous Excess & the Myth of Venous Return

Jon-Emile S. Kenny MD [@heart_lung] In the last few weeks I have been contacted by curious clinical physiologists craving my conceptions of ‘venous excess’ [1].  These words will address this model, concisely and – I pray – clearly. The Myth of Venous Return The roots of venous excess took hold within the fertile soil of [… read more]

Oct 192017
 
ICU Physiology in 1000 Words: Fighter Pilots!

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD Pilots of high-performance, tactical fighter jets each have continuous positive airway pressure [i.e. CPAP] masks as a part of their flight suit.  Strikingly, beyond the clinically-commonplace airway pressure of 5-15 cm of H2O, a fighter pilot may endure a mask-applied pressure of 90 [… read more]

Jul 222017
 
ICU Physiology in 1000 Words: IVC Collapse, Revisited – Part 1

Jon-Emile S. Kenny MD [@heart_lung] Three years ago I wanted to share my physiology website heart-lung.org; I needed a topic to stoke some interest, so I sent a brief essay to Matt here at pulmccm.org.  In it, I briefly described inspiratory IVC collapse and its relationship to volume status and volume responsiveness.  With this, the [… 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]