Pulmonology

The Myth of Dry Drowning

With summer in full swing now, swimming emergencies are bound to increase. A recent surge in media coverage may have raised many questions about the phenomenon known as “dry drowning." Variations in nomenclature regarding drowning can lead to confusion and imprecise terminology. Check out this post for a quick review:

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Advanced Practice: Bedside Two Point Compression Ultrasound to Rule-In Pulmonary Embolism by Chad Simpkins MD

You evaluate a patient complaining of acute onset of dyspnea with hypotension and hypoxia. You immediately consider the diagnosis of acute massive pulmonary embolism, but despite your best efforts can't get good cardiac windows on bedside ultrasound. Should you administer thrombolytics? Heparin? Send the shocky patient for a CT? Today Dr. Simpkins goes through the steps to perform 2-point compression ultrasound of the lower extremity to evaluate for DVT, an easy and rapid bedside test that may allow for indrect but more rapid diagnosis of acute, massive pulmonary embolism.

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Trials Instead of Tragedy: Unexplained dyspnea on exertion in a healthy young physician....

Think just because you are a young, healthy physician that you are invinceable? Read this post and remember that we are vulnerable too...even more so because we often refuse to acknowledge when we are sick. This week's Advanced Practice topic comes to us courtesy of a Cooper EM alum. The story is told with full permission from the patient, his wife, though names are omitted to prevent any possible HIPPA entanglements!

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Chemotherapeutic Agents and Pulmonary Toxicity

As the treatment of malignancy evolves, the number patients who are receiving active chemotherapy presenting to the Emergency Department is increasing.  Many of these patients present with respiratory chief complaints ranging from mild dyspnea to acute respiratory distress. This post aims to introduce chemotherapy-induced pulmonary toxicity and review those chemotherapuetic agents that commonly affect the lungs.

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Recognize Dynamic Hyperinflation (Air-Trapping) at the Bedside Using the Flow Curve

Dynamic hyperinflation (autoPEEP, air trapping, etc.) is a process leading to an increase in end-expiratory lung volumes and increased airway pressures. This process may occur secondary to obstructive lung pathology and/or an increase in minute-ventilation without sufficient time for expiration. The pathologic effects of dynamic hyperinflation include an increased work-of-breathing, barotrauma, pneumothorax, and an increase in intrathoracic pressure leading to a decrease in cardiac output and possible hemodynamic collapse. Rapid identification of this process is crucial for reversing it.

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You Have Intubated an Asthmatic... Now What?: Initial Ventilator Settings in Severe Asthma Exacerbation

In the setting of a severe asthma exacerbation that is refractory to medical mangagment and noninvasive ventilation, mechanical ventilation can be life-saving. However, the ventilator can quickly kill your patient if careful thought is not taken to address the unique respiratory needs and pulmonary physiology inherent to severe asthma.

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