Pulmonology

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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The Core of Asthma Management

The mild, moderate, or severe asthma exacerbation is cemented in the practice of Emergency Medicine. As a provider of this great speciality, one should be intimately familiar with the range of therapies employed. The goal of this post is to provide a high-yield review of the therapies we use (or sometimes use) while treating these patients.

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Respiratory Failure: Indications for ECMO

Extracorpreal membrane oxygenation is a temporizing mechanical support to heart or lung function in the setting of cardiopulmonary failure. In the setting of severe respiratory failure, patients that may benefit from and/or have an indication for ECMO are described in the Extracorporeal Life Support Organization Respiratory Failure Supplement to ESLO General Guideline, December 2013:

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The Basics of High Altitude Illness

Planning your next trip to the Rocky Mountains? Treating patients on base camp of Mount Everest? Here are the high-yield basics of High Altitude Illness including Acute Mountain Sickness, High Altitude Cerebral Edema (HACE), and High Altitude Pulmonary Edema (HAPE).

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