Clinical Practice Manual for Pulmonary and Critical Care Medicine (Nov 30, 2017)_(0323399525)_(Elsevier).pdf

Clinical Practice Manual for Pulmonary and Critical Care Medicine, by Judd W. Landsberg, MD, is a unique point-of-care manual that provides essential information on managing inpatients and outpatients with common, serious respiratory and internal medicine presentation and problems. Easy-to-follow diagnostic and therapeutic algorithms are accompanied by case-based illustrations encountered on a daily basis by attendings, fellows, residents, and students. The bulleted format, concise approach, and familiar examples provide a framework for effective teaching, learning, and patient care. Identifies common but important misconceptions that are regularly encountered in pulmonary and critical care training. Uses a concise, bulleted format throughout, helping you find key information quickly. Illustrates cases with primary data such as x-rays, monitor strips, ventilator wave forms, and other familiar documentation. Helps you develop your ability to effectively explain your thought process in the clinical setting to other practitioners at the bedside. Serves as a 'teachers guide' for clinician educators, organizing topics in an easy to teach fashion, amenable to 'chalk talks' and bedside didactics Provides focused discussions of basic physiology and pathophysiology related to pulmonary and critical care medicine. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, and references from the book on a variety of devices. Title page Table of Contents Copyright Preface Dedication Acknowledgments Section I: Pulmonary Chapter 1: Approach to oxygenation, hypoxemia, and hypoxemic respiratory failure Common misconceptions and mistakes Oxygenation Acute hypoxemic respiratory failure Chronic hypoxemic respiratory failure (physiology and underlying disease) Clinical approach to acute hypoxemic respiratory failure Co2 retention and high Fio2 Common causes and initial treatment of acute hypoxemic respiratory failure Common questions generated by this teaching Chapter 2: Ventilation and hypercapnic respiratory failure Common misconceptions and mistakes Normal ventilation Compensatory ventilatory responses to acidemia and alkalemia (A.K.A. ABG interpretation) Acute Hypercapnic Respiratory Failure Common questions generated by this teaching Chapter 3: Pulmonary function testing Common misconceptions and mistakes Pulmonary function testing Spirometry Flow volume loop Lung volumes Diffusion capacity Bronchodilator responsiveness Respiratory muscle strength Pulmonary function testing interpretation (Figs. 3.7, 3.8, and 3.9) Common questions generated by this teaching Chapter 4: The chest radiograph Common misconceptions and mistakes Approach to the chest radiograph Common questions generated by this teaching Chapter 5: Dyspnea and exercise limitation Common misconceptions and mistakes Major mechanisms of dyspnea (Fig. 5.1) Physiology of exercise (Table 5.1) Evaluation of dyspnea and exercise limitation (Fig. 5.2) Common questions generated by this teaching Chapter 6: Heart failure for the pulmonary critical care physician Common misconceptions and mistakes Heart failure and the pulmonologist (A.K.A. Occult left heart failure) The many faces of biventricular heart failure secondary to diastolic dysfunction (A.K.A. HFpEF) How left-sided heart failure causes pulmonary hypertension and right-sided heart failure (the biventricular heart failure reflex—not back pressure) The misleading nature of the transpulmonary gradient and “passive,” “reactive,” and “out of proportion” pulmonary hypertension Individual variability in the biventricular heart failure reflex challenges the concept of out-of-proportion ph Pathophysiology of biventricular heart failure (the numbers) Pathophysiology of biventricular heart failure (the process) Residual small vessel disease Biventricular heart failure: reflex, not back pressure ... so what? Pitfalls in screening for HFpEF (A.K.A. biventricular HEART FAILURE from diastolic dysfunction) Bilateral pleural effusions: the Physiologic Proof of biventricular HEART FAILURE Management of biventricular HEART FAILURE from diastolic dysfunction (trial of euvolemia) Fluid “spaces” and the anticipated sequence of fluid accumulation and mobilization in biventricular HEART FAILURE (HEpEF and HFrEF) Separating decompensated heart failure from end stage heart failure Effective diuresis (IE, achieving a significant net negative fluid balance) Perceived (but not actual) stumbling blocks encountered While Diuresing edematous LEFT-SIDED HEART FAILURE patients to euvolemia Real problems encountered while diuresing the edematous patient HEART FAILURE—Important review points Common questions generated by this teaching Chapter 7: Evaluation and treatment of pulmonary hypertension Common misconceptions and mistakes Pulmonary hypertension COMMON Questions generated by this teaching Chapter 8: Exacerbation of obesity hypoventilation syndrome Common misconceptions and mistakes Obesity hypoventilation syndrome Common questions generated by this teaching Chapter 9: Lung cancer Common misconceptions and mistakes Lung cancer epidemiology Concern for lung cancer Typical clinical radiographic and histopathologic features of lung cancer (and mesothelioma) by cell type Lung cancer staging Therapeutic approach to lung cancer Questions commonly generated by this teaching Chapter 10: Aspergillus lung disease Common misconceptions and mistakes Aspergillus Allergic aspergillus diseases Common questions generated by this teaching Chapter 11: Oral anaerobic lung infection, aspiration pneumonia, lung abscess, and empyema Common misconceptions and mistakes Aspiration defined Oral anaerobic lung infection Infected bullae (A.K.A. “bullaetis”): a lung abscess mimic Distinguishing a lung abscess (do not drain) from an empyema (must drain) Common questions generated by this teaching Chapter 12: Cough Common misconceptions and mistakes Common questions generated by this teaching Chapter 13: Cough syncope Common misconceptions and mistakes Cough syncope Conditions to be excluded when coughing is associated with syncope Diagnosis of cough syncope Treatment of cough syncope Common question generated by this teaching Chapter 14: Sarcoidosis Common misconceptions and mistakes Pathophysiology of sarcoidosis Questions commonly generated by this teaching Chapter 15: Acute venous thromboembolic disease Common misconceptions and mistakes Common questions generated by this teaching Chapter 16: Pneumothorax and bronchopleural fistulas: air in the pleural space Common misconceptions and mistakes Approach to the pneumothorax Pathophysiology of bronchopleural fistulas Common questions generated by this teaching Chapter 17: Diffuse parenchymal lung disease and its mimics Common misconceptions and mistakes Common questions generated by this teaching Section II: Critical Care Chapter 18: Shock Common misconceptions and mistakes Shock General principles of shock management Cirrhosis Common questions generated by this teaching Chapter 19: Invasive mechanical ventilation Common misconceptions and mistakes Invasive mechanical ventilation Choosing a mode of ventilation (volume controlled vs Pressure controlled) Improving oxygenation Common questions generated by this teaching Chapter 19e: Liberation from mechanical ventilation Common misconceptions and mistakes Approach to extubation Assessing readiness to extubate (Fig. 1) Performing an SBT Troubleshooting apparent sbt failure (Fig. 2) Proceeding after a failed sbt: optimization and exercise (Fig. 3) Spontaneous breathing trial versus exercise Treatment of delirium in the intubated patient (haloperidol or dexmedetomidine) Evaluation of upper airway narrowing and/or laryngeal edema Common failure to wean situations (consults from surgery) Common questions generated by this teaching Chapter 20: Noninvasive ventilatory support with bilevel positive pressure ventilation Common misconceptions and mistakes Noninvasive ventilatory support Initiation of bilevel positive airway pressure (Fig. 20.1) Trialing patients off of bilevel positive airway pressure Common questions generated by this teaching Chapter 21: Hemoptysis Common misconceptions and mistakes Initial assessment/risk stratification Pathophysiology and management of massive hemoptysis Intubation in massive hemoptysis (when, why, and with what) Interventional radiology vs cardiothoracic surgery Nonmassive hemoptysis Common questions generated by this teaching Chapter 22: Salt and water: the physiology and regulation of volume and tonicity Common misconceptions and mistakes Volume status and tonicity The normal homeostasis of tonicity and water balance The pathophysiology and evaluation of hyponatremia The pathophysiology and evaluation of hypernatremia Treatment of hypernatremia (fig. 22.5) Common questions generated by this teaching Chapter 23: Diabetic emergencies Common misconceptions and mistakes Acute diabetic presentations Ketoacidosis Diabetic ketoacidosis classic presentation and pathophysiology Hyperglycemic hyperosmolar nonketotic syndrome (HHNK): classic presentation and pathophysiology Overlap syndromes Typical derangements, causes, and initial treatments of diabetic emergencies Alcoholic ketoacidosis: classic presentation and pathophysiology Common questions generated by this teaching Chapter 24: The obtunded inpatient with normal vital signs Common misconceptions and mistakes Obtundation with normal vital signs God helps or dogs help Common questions generated by this teaching Chapter 25: Bedside presentations in the ICU Common misconceptions and mistakes Goal of the bedside presentation New admission Daily presentation Common questions generated by this teaching Chapter 26: Code status Common misconceptions and mistakes Approach to code status Common questions generated by this teaching Chapter 27: Advanced care planning and the family meeting Common misconceptions and mistakes Advanced care planning Establishing a surrogate decision maker The family meeting (helping loved ones accept futility) Special situations Common questions generated by this teaching Chapter 28: Pulmonary and critical care pearls Respiratory mechanics and sounds: (Fig. 28.1) Smoking cessation Bronchiectasis Atypical and typical pneumonia (definitions and things to consider) Troubleshooting poorly controlled obstructive lung disease (asthma and copd) Tracheostomy Evaluation of the presumed exudative effusion (Fig. 28.2) Rounded atelectasis (Fig. 28.3) Compassionate Terminal Extubation Index Table of Contents Section 1 Pulmonary 1. Approach to Oxygenation, Hypoxemia and Hypoxemic Respiratory Failure 2. Ventilation and Hypercapnic Respiratory Failure 4. The Chest Radiograph 5. Evaluating Chronic Dyspnea, Dyspnea on Exertion and Exercise Limitation 6. Heart Failure for the Pulmonary Critical Care Physician 7. Pulmonary Hypertension 8. Exacerbation of Obesity Hypoventilation Syndrome 9. Lung Cancer 10. Aspergillus Lung Disease 11. Oral Anaerobic Lung Infection, Aspiration Pneumonia, Lung Abscess and Empyema 12. Chronic Cough 13. Cough Syncope 14. Bronchiectasis 15. Sarcoidosis 16. Acute Venous Thromboembolic Disease 17. Pneumothorax (PTX) and Bronchopleural Fistulas (BPF): Air in the Pleural Space 18. Smoking Cessation 19. Diffuse Parenchymal Lung Disease and Its Mimics Section 2 Critical Care 20. Shock 21. Invasive Mechanical ventilation 22. Non-Invasive Ventilatory Support with BIPAP 23. Tracheostomy 24. hemoptysis 25. Salt and Water: The Physiology of Volume and Tonicity Regulation 26. Diabetic Emergencies 27. The Obtunded Inpatient with Normal Vital Signs 28. Bedside Presentations in the ICU 29. Code Status 30. Advanced Care Planning and the Family Meeting- 31. Compassionate, Terminal Extubation 32. ICU Pearls This is a unique point-of-care manual that provides essential information on managing inpatients and outpatients with common, serious respiratory and internal medicine presentation and problems. Easy-to-follow diagnostic and therapeutic algorithms are accompanied by case-based illustrations encountered on a daily basis by attendings, fellows, residents, and students. The bulleted format, concise approach, and familiar examples provide a framework for effective teaching, learning, and patient care