@mmi2422 on GrepMed

An Algorithm for the Diagnosis of Wheezing and Stridor Stridor: Louder, constant-pitch sound over central airways Wheezing: Musical sound produced primarily during expiration Inspiratory Stridor (Supraglottic): • Extraluminal Compression: Goiter, Retropharyngeal abscess • Intraluminal Compression: Malignancy, Foreign body • Inflammatory: Anaphylaxis, Angioedema, Epiglottitis Biphasic Stridor (Glottic/Subglottic): • Functional: Vocal fold paralysis, Paradoxical vocal fold motion • Extraluminal Compression: Malignancy, Vascular ring, aneurysm • Intraluminal Compression: Foreign body • Stenosis: Iatrogenic, Endotracheal intubation Expiratory (Tracheal) Stridor: • Extraluminal Compression: Malignancy, Mediastinal mass, Vascular ring, aneurysm • intraluminal Compression: Foreign body • Stenosis - Iatrogenic: Endotracheal intubation, Tracheostomy - Structural weakness: Tracheomalacia, Connective tissue disorder, GERD - Autoimmune: GPA Lower Airway Wheezing (Intrathoracic): • Bronchoconstriction: Asthma, COPD, Anaphylaxis, Carcinoid • Compression: Extraluminal - Peribronchial pulmonary edema • Infectious: Bronchitis, Bronchiolitis, Parasite • Focal: Mass, Foreign body, Consolidation (Infection, Infarction) #Wheezing #Stridor #Noisy #Breathing #differential #diagnosis #algorithm #pulmonary

Severe Asthma Algorithm - Management of Life-Threatening Asthma in the Emergency Department Step One 1. Nebulized Albuterol 2. Nebulized ipratropium bromide 3. Methylprednisolone 125 mg IV 4. Magnesium sulfate 2 g IV 5. Nebulized epinephrine Step Two 1. Epinephrine 0.5 mg IM 2. Fluid bolus 20 cc/kg 3. Diagnostics: Chest X-ray. CBC, chemistry, verous blood gas. HCG, ECG if concern for non-sinus rhythm or cardiac ischemia Dr. Reuben Strayer @emupdates #Emergency #Management #CriticalCare #Severe #Asthma #Exacerbation #Algorithm

Comparison of Asthma and COPD Exacerbation Treatment - Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedicalLectures/ #Asthma #COPD #Comparison #Exacerbation #Treatment #Management

Medical Management of Acute RV Failure • Evaluate and Treat Etiology of RV Failure [e.g. Acute Myocardial Infarction involving RV, Pulmonary Embolism] • Evaluate for Primary/Concomitant Pericardial Disease • RV Supportive Measures Act Quick to Prevent RV Spiral - Karan Desai MD @karanpdesai via CardioNerds @cardionerds #RV #failure #rightventricular #cardiology #management #treatment

Airway Intubation Dumpkit and Cognitive Checklist #Dumpkit #Airway #Intubation #CriticalCare #Management #Checklist

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

Modified Hyponatremia Algorithm Hypertonic Hyponatremia: Hyperglycemia, Mannitol, Urologic irrigants Hypotonic Hyponatremia: • ADH ON (UOsm > 100): - RAAS ON (UNa < 30): Hypovolemia, Heart failure, Cirrhosis, Nephrotic syndrome - RAAS OFF (UNa > 30): SIADH, Medications (diuretics), Hypothyroidism, Adrenal insufficiency, Reset osmostat, Cerebral salt wasting • ADH OFF (UOsm < 100): Primary polydipsia, Low solute intake, Beer potomania Isotonic Hyponatremia: Hyperlipidemia, Paraproteinemia, IVIG Step-by-step Guide: http://bit.ly/HyponatremiaAlgorithm by Satya Patel, MD @SatyaPatelMD #Hyponatremia #Algorithm #diagnosis #sodium #nephrology

Physiologic Approach to Hypotonic Hyponatremia The next time you have a case of hypotonic hyponatremia, give the physiologic approach a try. It can be easier to remember than the normal volume-based algorithm Urine Na+K / serum Na >1 is predictive of poor response to volume restriction alone in SIADH RAAS Inactive or Ineffective (UNa >30) • ADH Present (Uosm ≥100): SIADH, Renal Sodium loss (diuretics, mineralocorticoid deficiency, Post-AKI diuresis can be high or low Uosm), Hypothyroidism, Adrenal Insufficiency, Cerebral Salt Wasting • ADH Not Present (Uosm <100): Renal Losses (AKI, Post-AKI diuresis) RAAS Active (or too little relative solute intake, UNa <20) • ADH Present (Uosm ≥100): Hypovolemia, Hypervolemia with poor renal perfusion (Heart failure, Cirrhosis, Nephrotic syndrome) • ADH Not Present (Uosm <100): Excessive Free water intake (Primary polydipsia), Low solute intake (Beer potomania, malnutrition), Reset Osmostat Stanford Internal Medicine Chiefs @StanfordChiefs #Physiologic #Hypotonic #Hyponatremia #differential #diagnosis #table #sodium #nephrology

Coverage of common antibiotics used in the hospital For empiric coverage, first define the type of infection, then review prior cultures (check for prior resistance. e.g. AmpC. ESBL, KPC, VRE. etc) and allergy history. Obtain cultures as much as possible to guide therapy. Consult ID if needed (and as much as possible). Deescalate to preferred & narrowest therapy as much as possible. For example: VRE — Dapto, Linezolid Amp-S Enterococcus — ampicillin #management #infectiousdisease #antibiotics #coverage #antibiogram #pharmacology #table #sensitivities

Acid Base and Blood Gas Analysis 1. pH - What’s the primary disturbance? 2. pCO2 - What’s the pCO2? 3. HCO3 - What’s the bicarb? Respiratory Acidosis - Airflow obstruction • COPD, asthma, ↓ Drive, Medications, Central, ↑ CO2 production Respiratory alkalosis drive • Hypoxemia • Pain/anxiety • Hepatic enceph • Pregnancy • Salicylates Metabolic Alkalosis - “BLVD PLACE” B - Bartter's L – Laxative V – Vomiting D - Diarrhea/diuretics P - Post-hypercapnea L - Licorice A - Alkali ingestion C - Contraction alkalosis E - Endocrine (Conn’s or Cushing’s) Metabolic Acidosis - non anion gap metabolic acidosis - anion gap metabolic acidosis Nick Mark MD @nickmmark #acidbase #workup #algorithm #diagnosis #acidosis #alkalosis #metabolic #respiratory #bloodgas #interpretation