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David Furfaro Profile picture
David Furfaro
@david_furfaro
Instructor in Medicine BIDMC / HMS. Columbia PCCM fellowship, Osler residency, Harvard Med Alum. Janeway ACS. Opinions are my own and not for medical advice.
Jul 6, 2020 • 13 tweets • 6 min read
1/ A Tweetorial on ventilator waveforms and vent dysynchrony. Share any videos of vent dysynchrony if you have them!

@cardionerds @Sam_Brusca @CPSolvers @DxRxEdu @WApplefeld @AnnaPodolanczuk @OslerResidency @sanjayvdesai @ATSCritCare @ColumbiaCCM @iwashyna @DrDaleNeedham 2/ A 40s M is intubated for #Covid-19 ARDS. He has been dysynchronous with the vent so to maintain lung protective ventilation he was on propofol, fentanyl and midazolam. His sedation is being weaned (still RASS -5) and the RN calls for vent dysynchrony. Here is his vent:
May 13, 2020 • 8 tweets • 4 min read
1/ Short case focusing on CXR findings and a pulmonary differential (taking a break from #COVID19)

50s F admitted after a fall with a femur fracture, found to have hypoxemia. Chest X-ray is shown below.

@cardionerds @DxRxEdu @thecurbsiders @tony_breu @CPSolvers @sanjayvdesai 2/ What do you see on the Chest X-ray to help explain the patient's hypoxemia?
Apr 25, 2020 • 14 tweets • 4 min read
1/ A case and tweetorial as a reminder that even in the age of #covid-19 general internal and critical care medicine is important!

A 60s man was dx with Covid and sent. 3 days later he developed nausea, vomiting, lethargy, and confusion and his wife called EMS. 2/ In the ED, he was tachypneic, diaphoretic and altered with increased work of breathing. T 37.4 HR 115 BP 149/99 RR 30, O2 sat 98% on RA.
Exam: confabulating, diaphoretic, pupils dilated and reactive, labored breathing with accessory muscles, extremities cool with no edema.
Apr 21, 2020 • 20 tweets • 13 min read
1/20 Tweetorial about Lung Protective Ventilation and Driving Pressure motivated by the complex vent management in #Covid-19. Enjoy!

Note- all in Volume Control

@cardionerds @CPSolvers @thecurbsiders @DxRxEdu @AnnaPodolanczuk @BBroderickMD @sanjayvdesai @sanjum @DrDaleNeedham 2/Covid causes ARDS. The cornerstone of ARDS management is lung protective ventilation → reduce mechanical stress on the lung → minimize ventilator-induced lung injury. The landmark ARMA trial showed lower tidal volume ventilation helps in this effort

nejm.org/doi/full/10.10…
Jun 17, 2019 • 10 tweets • 5 min read
1/ Enjoy another tweetorial from a recent case:
A man in his 40s with OSA and GERD presents with dyspnea, and headaches.
@JohnsHopkinsDOM @OslerResidency @thecurbsiders @CPSolvers @tony_breu @DxRxEdu @Dr_DanMD @AmitGoyalMD @medrants @sanjayvdesai 2/ He reports DOE sometimes associated with chest pain. He has worsening dyspnea and a headache when lying flat, and when bending forward to tie his shoes. On exam, he has a ruddy complexion and facial swelling. Lungs are CTAB and CV exam reveals distant heart sounds.