Husband, Father, and physician. Interested in pulmonary HTN, & mechanical ventilation, coffee addict, tweets are my own
Apr 17, 2023 • 12 tweets • 8 min read
This topic is very important, and controversial. Intermediate high risk PE is tough, as the mortality benefits evidence of CDT compared to AC alone its not strong, Therefore, I believe PERT is very helpful.
A large meta-analysis showed the mortality of Submassive (Intermediate high risk) PE is 2.8% and other study showed the mortality ranges from 1.8-10%.
We are dealing with Pts in the red circle 🔴 (before shock but more than low risk)
Jan 7, 2023 • 22 tweets • 11 min read
How do you titrate your PEEP in moderate to severe ARDS Patients?
2004 alveoli trial
DOI: 10.1056/NEJMoa032193
549 Pts.
TV ~ 6 ml/kg
Pplat (24-27)
Low PEEP 8.3±3.2 cmh2o (death 24.9%)
High PEEP 13.2±3.5 cmh2o (death 27.5%)
Result= no significant difference between high or low PEEP
Nov 17, 2022 • 12 tweets • 7 min read
GOLD international COPD conference
The conference was great
What’s new?
Definition;
COPD is a Heterogenous lung condition characterized by chronic resp symptoms due to abnormalities in the airway (bronchitis, bronchiolitis, emphysema) that cause persistent airflow obstruction
(2018 def in the pic)
Sep 22, 2022 • 14 tweets • 6 min read
65 yo/f with PMH of recently diagnosed SCLC s/p chemotherapy last session 1 month before presentation who was presented to the ER due to worsening SOA, Cough and after evaluation found to be tachypnic and tachycardiac
CXR showed mild enlargement of the cardiac shadow, obliteration of the right CP angle and bilateral central reticular pattern suggestive of pulmonary edema. Right mediport.
Jun 2, 2022 • 13 tweets • 5 min read
Another Pt with HFrEF < 20%, and AKI on GDMT and 40 mg Lasix BID on PE he has Bil LE 2+ edema, no respiratory distress. Would you just increase his Lasix or work on improving his LV contractility, afterload with keeping the same preload control?
May 31, 2022 • 10 tweets • 6 min read
🤯🤯 The plan was written (stop Lasix for 2 days and then re-evaluate) their rational is the patient is clinically dry and his creatinine is up?!!!!!!!!😓 these images was taken while Pt on Debutamin
Jul 24, 2021 • 10 tweets • 4 min read
Thank you for your response. As you can see, it's spread out almost equally.
Heart-lung interaction is critically important to understand;
The heart & lungs occupying the thoracic cavity, therefore, Pr changes inside the thoracic cavity can affect the venous return (Vr)
Transmular pressure is the pressure difference between the inside & the outside of the cavity i.e the RA transmural pressure = RA-Ppl(We are assuming the pericardium is normal)
Then venous return depends on volume, pleural pr (Ppl), RA pr, transmural pr, elasticity & compliance
Nov 25, 2020 • 8 tweets • 3 min read
Fluid assessment:
• Pt in shock
1-how narrow is the Pt therapeutic index
2-will fluid administration be harmful
3-will I help the Pt by giving fluid
1-How narrow is the Pt therapeutic index🤔
Obtain good History.
Use the POCUS to evaluate which type of frank-starling curve your patient have?
A-Normal cardiac function and contractility
B-Mild impairment
C-Significant impairment
Sep 14, 2020 • 26 tweets • 5 min read
This thread for people who are interested in CRRT and critical care 😓🤦🏽♂️
Basics about RRT;
Convection: It depends on Hydrostatic pressure (HP)
Diffusion: it depends on solutes gradients
Aug 5, 2020 • 17 tweets • 3 min read
What’s the main mechanism behind hypoxia in pulmonary embolism?
As @ParijatSen11 Redistribution of the blood flow secondary to pulmonary embolism increases in flow to areas with normal ventilation which leads to hypoxia
