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]
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]
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]
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]
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]
Alpha-1 Antitrypsin Deficiency: Review & Update More PulmCCM Topic Updates Alpha-1 antitrypsin deficiency is underrecognized and by implication undertreated. But many people with alpha-1 antitrypsin deficiency are asymptomatic and will never develop significant emphysema, and the benefits of antiprotease replacement therapy are still unknown. Should you routinely test your patients with chronic obstructive pulmonary disease [… read more]
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]
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]
(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]
Management of Opioid Overdose in the ICU: Review (More PulmCCM Topic Updates) Thanks to a 700% increase in the number of opioid prescriptions for pain management, combined with a perhaps greater rise in the rate of prescription opioid abuse, the number of serious opioid overdoses in the US has climbed dramatically over the past decade. [… read more]
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]
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]
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]
Pulmonologists become fairly good semi-professional chest radiologists simply by showing up, paying attention and working hard during their training, and making an effort to keep learning throughout their careers. We have the advantage over radiologists of actually being able to “clinically correlate” the findings with what’s really going on, and to integrate that into our understanding [… read more]
In the first randomized trial of its kind, patients with severe sepsis or septic shock who were given meropenem alone had equivalent clinical outcomes to patients who were given combination therapy including meropenem and moxifloxacin. The results, reported in JAMA, provide ethical support to critical care physicians who prefer to be conservative antibiotic stewards. But [… read more]
Cancer-Related Medical Emergencies: Acute Tumor Lysis Syndrome (More PulmCCM Topic Updates) The prevalence of multiple cancers are expected to rise in the United States over the coming decades. Despite improved survival with some cancers, some people with malignancy will develop cancer related emergencies; for a few, this will be the first manifestation of their cancer. [… read more]
Human recombinant granulocyte macrophage colony stimulating factor (GM-CSF or Leukine) did not reduce ventilator-days in patients with acute lung injury / ARDS in a randomized trial published in the January 2012 Critical Care Medicine. Why would it have? Interestingly, patients with ARDS with higher levels of GM-CSF in their BAL fluid are more likely to survive. GM-CSF maintains [… read more]
Immunotherapy — creating antibodies to tumor markers, then activating the immune system to selectively kill cancer cells — is the newest and most-hyped frontier of oncology. And with some justification: the mechanism is cleaner and kinder than chemotherapy, and being a whole new treatment modality, can complement and augment traditional therapies. Results of immunotherapy in [… read more]
If you and your team just can’t get an arterial line into your critically ill, hypotensive patient for continuous invasive blood pressure measurement, you may be somewhat comforted by a study in Critical Care Medicine. Authors found that among 150 critically ill patients (83 of whom were in shock), mean arterial pressure (MAP) measurements with an [… read more]
For a great video example of dynamic extra-thoracic airway obstruction, click the below link to the July 5, 2012 New England Journal of Medicine. This 53-year-old woman had a traumatic laryngeal fracture as a child, and presented with daytime somnolence and inspiratory stridor. On laryngoscopy, she had proliferation of the mucosa over the vocal cords, [… read more]
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