Over the last three decades since the introduction of the term ventilator-induced lung injury (VILI), we have recognized that positive pressure mechanical ventilation can injure the lungs. It is widely recognized that the cornerstone of lung protective ventilation requires control of tidal volume and transpulmonary pressure. On the other hand, there has been considerably less focus on the impact of respiratory rate and flow on VILI. Mechanical power unites the causes of ventilator-induced lung injury in a single variable that incorporates both the elastic and resistive load of the positive pressure breath.⁶ In other words, mechanical power quantifies the energy delivered to the lung during each positive pressure breath by assessing the relative contribution of pressure, volume, flow and respiratory rate.

Submitted by Emily Damuth, MD

40 yo M presents to ED complaining of L flank pain w/ hematuria x 1 day. 

Submitted by Loran Hatch, DO

24 year old female presented with right wrist deformity and pain after fall.

Submitted by Stacy Marshall, MD

You are working at a community trauma center when an elderly male is brought to the ED after being struck by a car.  The patient is complaining of right sided chest pain and is in respiratory distress. He has a patent airway, is breathing spontaneously and is normotensive.  He is confused and not oriented to place or time. A chest x-ray does not reveal a pneumothorax, but does reveal 5 contiguous rib fractures. The patient is likely to require intubation due to the increased work of breathing.  You review the patient's chart and note that he has a POLST on file indicating a DNR/DNI status as well as identifying his daughter as a medical power of attorney who may override the POLST. A nurse lets you know the patient’s family has arrived.  You wonder how the presence of the POLST form will influence your conversation with the family.

Submitted by Lars-Kristofer Peterson, MD