HAP and VAP not HCAP!

The new guideline by IDSA published’ Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.” There are some answered questions that previously we were practicing based on them. I. Should Patients With Suspected VAP Be Treated Based on the Results […]

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COPD and risk of PE

Chest published an article regarding risk of chronic pulmonary obstructive disease and pulmonary embolism. There are different reported risk from 3% to 30%. In this study, prevalence of pulmonary embolism in unexplained acute exacerbation of COPD reported as high as 16%. We should be worry about PE in patients with unexplained acute exacerbation of COPD […]

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COPD and NIV

British Thoracic Society/Intensive Care Society published a guideline regarding ventilatory management of acute hypercapnic respiratory failure(AHRF). I believe there are good recommendations for junior residents who do not know to deal with NIV machine and also setting initial parameter. This is augment our practice that how to approach COPD patient in ED with NIV. Link […]

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Prednisone and Dexamethasone for Asthma

Can we use Dexa instead of Prednisone when we are discharging patient home? old question and as I remember the answer was always Sure! but why are we asking still this question: Symptomatic improvement following emergency department management of asthma: a pilot study of intramuscular dexamethasone versus oral prednisone. J. Asthma 1997 2 articles within […]

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COPD and Beta Blocker and Contraindication!

We all shaky when we want to start Beta Blocker in COPD Patients! One of the traditional contraindication in COPD patients is using Beta Blcoker, Thorax BMJ reported a study that was done in US and showed betal blockers are  associated  with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction.   […]

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Nasal Cannula and Pre-oxygenation

If we add nasal cannula to nonrebreather face mask or BVM with air leak, we will improve pre-oxygenation phase. This study that just published in Annals of EM enrolled 6o Healthy volunteers ,30 nonrebreather face mask and 30 bag-valve-mask. There will be an argument that Healthy lungs will be different from patients with restrictive or […]

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Venous Blood Gas, You Rock!

We had a long journey to get here! I can’t tell how many times that I had argument with consultants regarding COPD or DKA patient that they ask for ABG and we had VBG! My old Post was focused mostly on DKA patient but Thanks to Throax that published a study among COPD patients. Using […]

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Cavity Lesion

Very nice mnemonic for Cavity lesion DDx in cxray: Cavity, C: Cancer or Mets, A: autoimmune; granulomas from, V: vascular (both bland and septic pulmonary embolus), I: infection(TB, fungall), T: trama (pneumatocoeles), Y: youth (congenital pulmonary airways malformation) Reference  

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Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolism

Jeffry Kline is famous for his research on PE and his latest article in Academic Journal of Emergency Medicine(Jan 2012) is opening another window to PE regarding Normalization of Vital Signs Does Not Reduce the Probability of Acute Pulmonary Embolismin Symptomatic Emergency Department Patients.

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