Clinical Resources

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]

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]