This document outlines workflow for common ICU and/or coverage questions. It is meant to clarify current expectations, and will be updated as new processes change or new questions come up. I hope you find it to be a useful reference.
Author: Geneva Tatem
NICU ventilation case
You are on the NICU service and your attending asks you to see a patient with impending respiratory failure while he continues examining another patient. The patient is a 45 yo man who was being evaluated for Cushing’s syndrome and was found to have a pituitary adenoma. He underwent transsphenoidal hypophysectomy earlier in the day. […]
NSCLC Staging
You have a 60 yo male patient being evaluated for a cough of two month’s duration. He is an active smoker with a 45 pk year smoking history. He reports increased dyspnea on exertion and right chest heaviness and discomfort. You perform a screening CT scan on him as he meets lung cancer screening guidelines, […]
Pleural Disease I
Your 55 yo female patient (from Japan) with newly diagnosed adenocarcinoma is seeing you back in clinic 9 months later for gradually increasing dyspnea over the past 3 weeks. She has been receiving gefitinib oral therapy. PFTs reveal restriction with a diffusion abnormality. Ann Oncol-2013-Inoue-54-9 Gefitinib As part of her evaluation you order a CXR […]
NSCLC
You are seeing in clinic a new patient who is a 55 yo woman from Japan. She moved to the US 30 years ago to attend graduate school. She has a 35 pack year smoking history and underwent lung cancer screening CT scan. On CT a 4cm LLL mass was seen, with bulky mediastinal lymphadenopathy. […]
ICU Post
You have a 70 yo woman with COPD and HTN that was admitted to your ICU service 5 days ago in acute respiratory failure with sepsis due to CAP. She remains intubated and mechanically ventilated. She received early goal directed therapy and needed vasopressor support for the first 3 days of her ICU stay, but […]
Toxidrome
A 31 yo man was brought to the ED after being found unresponsive. His wife reports he had been having lots of back pain after falling at work and was taking “some pills” for it. She also tells you that he drinks heavily every day, and has no history of illicit drug use. He is […]
Wheezing
You have a 24-year-old female with a history of juvenile rheumatoid arthritis, treated with hydroxychloroquine who sees you in clinic for a new consultation. She reports a history of dyspnea on exertion that has been slowly progressive over the previous six weeks. She is now short of breath with walking 40 steps on flat surface. […]
Exercise testing
A 41 yo woman is referred to you for cardiopulmonary exercise testing (CPET). She has a history of systolic CHF due to non-ischemic cardiomyopathy (EF 15%). She is currently on maximal medical therapy. Pulmonary function testing reveals no airflow obstruction and no restrictive ventilatory defect. FEV1 is 99% predicted, FVC is 97% predicted and DLCO […]
Vents II
A 56 yo man with COPD has been receiving mechanical ventilation using volume assist control for the last 36hrs. His settings are: TV 6mL/kg RR 24 FiO2 0.4 PEEP 5. His ABGs have improved to: PO2 82mmHg, PCO2 42mmHg pH 7.37 and you switch him to a pressure support mode to provide a comparable tidal […]