@mattamin on GrepMed

Causes of Hypoxemia- Differential Diagnosis Algorithm Ventilation/perfusion Mismatch • Airway Disease (Asthma, COPD) • Vascular (PE*) • Parenchymal Disease Diffusion Limitation • Interstitial lung disease • Pulmonary Arterial Hypertension Intracardiac Right to Left Shunt • Ventricular Septal Defect ** • Atrial Septal Defect Pulmonary Right to Left Shunt • Arteriovenous Malformation • Severe Pneumonia • Atelectasis Central Hypoventilation • Drugs* • Coma • Hypothyroidism Peripheral Hypoventilation • Obesity Hypoventilation Syndrome • Neuromascular Weakness • Pleural Abnormalities • Chest Wall Abnormalities #Hypoxemia #Hypoxia #Differential #Diagnosis #Algorithm #Causes #Pulmonary

Causes of Cyanosis in the Newborn - Differential Diagnosis Algorithm Peripheral Only: • Poor Perfusion • Acrocyanosis Hemoglobinopathy: • Congenital • Acquired • Sulfhemoglobin Left-to-Right Shunt: • Patent Ductus Arteriosus • Ventricular Septal Defect • Atrioventricular Septal Defect • Truncus Arteriosus • Atrial Septal Defect • Total Anomalous Pulmonary Venous Return Right-to-Left Shunt: • Transposition of the Great Arteries • Tetralogy of Fallot • Obstructive/Hypoplastic Lesions • Aortic Atresia/Stenosis • Interruption of the Aortic Arch • Aortic Coarctation #Cyanosis #Newborn #Differential #Diagnosis #Algorithm #Causes #Peds #Pediatrics

The Relative Size of Particles From the COVID-19 pandemic to the U.S. West Coast wildfires, some of the biggest threats now are also the most microscopic. A particle needs to be 10 microns (pm) or less before it can be inhaled into your respiratory tract. But just how small are these specks? Here's a look at the relative sizes of some familiar particles Human hair 50-180 µm Fine beach sand 90 µm Grain of salt 60 µm White blood cell 25 µm Grain of pollen 15 µm Dust particle < 10 µm Red blood cell 7-8 µm Respiratory droplets 5-10 µm Dust particle 2.5 µm Bacterium 1-3 µm Wildfire smoke 0.4-0.7 µm Coronavirus 0.1-0.5 µm T4 bacteriophage 225 nm Zika virus 45 nm #Particles #Relative #Size #Particles #virus #bacteria #pollen #comparison #droplets

Infective endocarditis - etiology and sources of infection. • Native and prosthetic valve endocarditis • Soft tissue infections • Mouth • Prolonged indwelling vascular catheters (especially for TPN) and antibiotic use • IVDUs who dissolve heroin in infected lemon juice • Gut and perineum • Bowel malignancy #Infective #Endocarditis #Sources #Causes #Bacteria #Etiology #Differential #Microbiology #Diagnosis #Pathogens

Antibiotics for Atypical Bacteria - Macrolides (Azithromycin) - Tetracyclines (Doxycycline) - Quinolones (Levofloxacin, Moxifloxacin) - Chloramphenicol Dr. Eric Strong @DrEricStrong - Strong Medicine #Antibiotics #Atypical #Bacteria #Pharmacology #Table #Susceptibility #Coverage #Management

Inpatient Pnuemonia Management Algorithm - IDSA 2019 Guidelines Carla Canepa MD https://www.instagram.com/_carlemd_ #Pneumonia #Management #Algorithm #IDSA2019 #Guidelines #Inpatient #HAP #HCAP #Treatment #Severity #Criteria

Pneumonia - Causative Organisms • CAP - Typical, Atypical, Endemic • Aspiration • Decreased Immunity • Hospital - HAP, VAP - CMC IM Residency @CMC_IM #Pneumonia #microbiology #differential #diagnosis #organisms #causative #algorithm

Antibiotics for severe community-onset pneumonia Atypical coverage always - Usually azithromycin 500 mg daily - Doxycycline if animal exposure or contraindication to azithromycin Beta-lactam backbone - Usually ceftriaxone (safe for non•anaphylactic penicillin allergy) Consider two grams IV daily esp. in heavier patients. - Risk for pseudomonas: cefepime or piperacillin-tazobactam Septic Shock Structural lung disease (severe COPD, bronchiectasis, cystic fibrosis) Broad-spectrum antibiotics for >7 days in past month Hospitalization for > 1 day in last three months Immunocompromise (e.g. chemotherapy, steroid > I Omg/d) Nursing home resident with poor functional status - History of penicillin anaphylaxis: meropenem - Don't use ceftazidime (poor gram-positive coverage) MRSA coverage? only in selected cases - Linezolid 1 st line 600 mg ql 2hr - Vancomycin #Community #Acquired #Pneumonia #CAP #Antibiotics #Coverage #Management

Community Acquired Pneumonia - Severity and Prognosis Criteria for Severe CAP - Severe CAP present in 1 major criterion or 3 minor criteria are met • Major criteria: Septic shock, Respiratory failure requiring mechanical ventilation • Minor criteria: RR ≥ 30 breaths/min, PaO2 / FiO2 ratio ≤ 250, Multilobar infiltrates, Confusion, Uremia (BUN ≥ 20 mg/dL), Leukopenia (WBC < 4000 cells/uL), Thrombocytopenia (platelet <100k cells/uL), Hypothermia (temp < 36° C), Hypotension responsive to IV fluids CURB-65 Pneumonia Severity Index (PSI) - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #CAP #Community #Acquired #Pneumonia #Severity #Prognosis #stratification #curb65 #severe #psi #diagnosis

Outpatient Treatment of with Community-Acquired Pneumonia (CAP) No comorbidities or risk factors for MRSA or Pseudomonas aeruginosa: • Amoxicillin or • doxycycline or • macrolide (if local pneumococcal resistance is < 25%) With comorbidities: • Combination therapy with amoxicillin/clavulanate or cephalosporin AND macrolide or doxycyclinex OR • monotherapy with respiratory fluoroquinolone #IDSA #Outpatient #CAP #Community #Acquired #Pneumonia #Antibiotics #Treatment #Regimen #Management #Guidelines #pharmacology