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. […]
GI Bleed Admissions
From Dr. Swiderek: Due to high MICU patient volume and MICU remaining over capacity, the SICU and MICU teams have been working on a plan to redistribute patients with non-cirrhotic GI bleeds to the SICU. The goal is to open up MICU beds and to allow for a more consistent patient population to be admitted […]
Recording and photography policy at Henry Ford
Henry Ford has a policy for patient/family recording in the hospital. Section 3.9 refers to recording or photographing health care personnel without consent.
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 […]
Fluids in ICU
A prospective trial published in 2012 compared a chloride-restricted fluid strategy with a chloride-liberal strategy for critically ill patients. What were the findings of this study? JAMA 2012;308(15):1566-1572 There was an additional study published in 2015 evaluating hyperchloremia in critically ill septic patients. What were the findings of this study? Crit Care Med 2015 Sep;43(9):1938-44 […]
Hypoxia continued
Continued from previous Case. You bring your patient back to clinic after testing. She tells you she may have had a TIA a few years ago, and that she was recently diagnosed with iron deficiency anemia. 2D ECHO with bubble study reveals bubbles in left ventricle within 1 cardiac cycle (almost immediately) Her ABG on […]
Vent Waveform 1
A patient is agitated during mechanical ventilation and interventions are made to achieve better patient-ventilator synchrony. Flow and pressure curves from before and after the intervention are shown. Based on the change, which of the following best describes the intervention? Matching intrinsic PEEP with Extrinsic PEEP to facilitate triggering each breath Increasing flow rate and […]
Hypoxia
A 52 yo woman is sent to you by her primary care physician for evaluation of hypoxia. She has no symptoms except for early fatigue when she attempts to exercise. She is a lifelong nonsmoker and has no significant past medical history except for hypertension. Pulse oximetry on room air at rest is 80%. You […]
Hart Medical Equipment Company information
The Hart Medical Equipment Company provided information to make placing orders for medical equipment easier. Hart Medical Information 2016