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A Losartan Dream for COPD

Critical Care Now

The Pre-brief Working in a Pulmonary Function Lab plus providing in-patient care within the hospital, I see patients every day that have been diagnosed with chronic obstructive pulmonary disease (COPD). These patients frequently ask if they can be cured of COPD. COPD continues to be a problem for many adults.

COPD 52
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BPAP vs AVAPS for Hypercapnic Respiratory Failure in the ED

RebelEM

Balkan Med J 2021. AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e Balkan Med J 2021. Cureus 2021. Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. AVAPS: 0.07

COPD 133
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Serial PoCUS for ED Patients with Acute Dyspnea: Is More Actually Better?

RebelEM

It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3]. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea.

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TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital Cardiac Arrest

RebelEM

It’s important to be able to initiate these treatments while also creating the opportunity to investigate possible therapeutic interventions for these patients within the confines of a well designed trial. Epub 2021 Feb 8. 2021 Feb 18. Resuscitation. link] Petran J, et al. Brazilian journal of anesthesiology (Elsevier).

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What are time-limited trials in critical care?

PulmCCM

3 days for anoxic encephalopathy to regain pupillary responses after cardiac arrest, 4-7 days for a DNR/DNI patient to receive NIPPV for COPD exacerbation, etc.) But there’s no alarm that beeps when well-intentioned care with an indeterminate prognosis crosses into something else, something darker. 2021 Jun 1;181(6):786-794.

COPD 45
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Diagnostics and Therapeutics: Managing Pneumothorax

Taming the SRU

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Published 2021 Jun 24. Institutional resources and specialty services may further dictate the management of PTX. Respir Med. 1998;92(5):757-761. Eur Respir J.

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POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

RV chamber size alone is not enough information to rule-in a PE as RV cavity enlargement can be visualized in other conditions such as pulmonary hypertension, RV infarct, COPD and cardiac arrest from multiple causes. If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well.