Pulmonary Emergencies
My “first 10 minute” approach to a sick patient with undifferentiated difficulty breathing is focused on rapidly finding the right therapy, but not necessarily on finding the right diagnosis. I find that this simplifies my thinking - Justin Morgenstern
image by: NIH National Heart, Lung and Blood Institute
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Crashing Patient on a Ventilator
A truism in resuscitation is to always rule out the easily correctable causes immediately. In this case, it means removing the complexity of the ventilator and making things as idiot-proof as possible. Once you’ve ruled out the life threats like pneumothorax, tube displacement, and vent malfunction, you can try to bring their sats up by bagging. Just make sure that you have an appropriately adjusted PEEP valve attached to your BVM for your ARDS patients; the patient who was just requiring a PEEP of 15 isn’t going to improve with you bagging away with a PEEP of 5.
Resources
Approach to Acute Respiratory Failure
Acute respiratory failure has many causes which can affect the ability to either take up oxygen (hypoxemic), eliminate carbon dioxide (hypercapnia), or both.
Four Common Respiratory Emergencies Among the Elderly
we'll examine four common respiratory emergencies that you will likely encounter among your older patients: pneumonia, chronic obstructive pulmonary disease (COPD), asthma, and lung cancer. Although lung cancer is considered a chronic, long-term illness, it can still precipitate a respiratory emergency.
POTD: Can I Go Home With My PE?
The PESI is designed to risk stratify patients who have been diagnosed with a PE in order to determine the severity of their disease. This can help physicians make decisions on the management of those patients who could potentially be treated as out-patient, as well as raise concern for those who are determined to be high-risk and could benefit from higher levels of care.
Pulmonary Hypertension in the ED
Pulmonary hypertension (PH) is rare disease associated with high morbidity and mortality. Given the non-specific nature of pulmonary hypertension in its early stages, it is often only diagnosed once patients have reached an advanced stage of disease.
Respiratory distress: An emergency medicine approach
My “first 10 minute” approach to a sick patient with undifferentiated difficulty breathing is focused on rapidly finding the right therapy, but not necessarily on finding the right diagnosis. I find that this simplifies my thinking.
Take My Breath Away! Evaluation of Shortness of Breath in the ED
... adopt early use of ultrasound in your assessment. In addition to looking for pneumothorax, pulmonary edema and cardiac contractility, I have been lucky to stumble upon several unexpected pericardial effusions when my exam hadn’t revealed any cardiopulmonary findings.)
Crashing Patient on a Ventilator
The frequency with which our ventilated patients stay with us in the ED has been increasing for years and will likely continue to do so1. This means that managing both acute decompensation and refractory hypoxemia needs to be in our wheelhouse.
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