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, […]
ANTICOAGULANTS AND BRONCHOSCOPY
LAST DOSE BEFORE BRONCHOSCOPY< TIME TO RESTART MEDICATIONS AFTER BRONCHOSCOPY WITH BIOPSIES Heparin SubQ No Need to stop Not applicable Enoxaparin 1mg/Kg SubQ BID > 24 hours > 12 hours Enoxaparin 1.5mg/Kg SubQ QD > 24 hours > 12 hours Warfarin (Coumadin) 5 days (confirm INR < 1.5) immediately Heparin IV > 4 hours (check […]
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 […]
Death Certificate Rules
State of Michigan – Death Certificate Instructions State of Idaho – terminology for drugs and alcohol: http://www.healthandwelfare.idaho.gov/Portals/0/Health/Vital%20Records/DrugsAlcohol.pdf
Pulmonary AVM
49 year old male with history of hypertension and hyerlipidemia that presents with hemoptysis for 1 week duration (about 1/4 a cup a day) On admission vitals and labs were normal other than hypoxia on 87% that improved to 93% on 2 liters of oxygen Chest X ray was normal on admission CT scan of […]
No Show / Walk-in clinic
Friday 12:30 to 3pm – pm checker Eligible patients: General return or new pulmonary patients who ‘No Show’ to 2 consecutive visits (resets if hospitalized, is seen in the add-on clinic), missed appointments for hospitalizations or cancellations do NOT count Process: Patients who have ‘No showed’ twice in a row (new or return) , will not […]
Pulmonary Late Policy
Clinic Visits Return visit – If the patient arrives after the end of clinic (after 11:45am for morning clinic, after 4:45 pm for afternoon clinic, they will not be seen). If the patient arrives up to 20 minutes after appointment time, check in as on time. Physician can let patient know that they only have […]
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 […]