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Case discussion: why acidosis?
i did a robot nephrectomy and i kept my patient intubated at the end due to respiratory acidosis. she is elderly with the usual hypertension, DM on insulin, but also with bad pulmonary disease, a component of COPD and severe reduced dlco. on home o2 2L. room air saturation 79-84% surgery uneventful. 400 ebl. 6 hour case in lateral position. 2.5L fluid. On emergence, following instructions, having minute ventilation of ~5L, (RR 16, TV ~350-400), with no vent support, thru a 7.0 tube... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 11, 2024 Category: Universities & Medical Training Authors: waterbottle10 Tags: Anesthesiology Source Type: forums

VIV TMVR with Sapien 3
80 y/o s/p cabg 20 years ago. Redo sternotomy for severe Mitral regurgitaiton 15 years ago. Other hx: Bil Fem-pop bypass, h/o stroke, severe COPD and severe pulm htn on ATC O2. Chronic pain, CKD, etc. Presented at valve conference for failure of mitral bpv. Mean gradient of 15 mmHg. It was decided that we would proceed with VIV TMVR with a Sapien 3. On paper, it sounded like a bad idea. Once I met the patient, it was clear to me she wanted this done as her severe MS was going to... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 12, 2024 Category: Universities & Medical Training Authors: sevoflurane Tags: Anesthesiology Source Type: forums

Secondary Polycythemia
New attending here. Hoping to get some advice from those of you practicing for a while. I just started a job in a somewhat rural setting. I get a lot of Heme referrals from PCPs, pulmonologists, etc for patients for polycythemia. These are almost always known tobacco abuse cases, COPD, etc. We were always taught in training to treat the underlying cause, but the referring docs and patients expect to be treated with therapeutic phlebotomy. Some of them have had this issue for years and... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - February 25, 2024 Category: Universities & Medical Training Authors: DoctorDontStop Tags: Hematology / Oncology Source Type: forums

Gabapentin and COPD exacerbation
Saw a few articles on this. I haven't really noticed any of my patients with COPD go into an exacerbation. Has anyone experienced this ? https://www.jwatch.org/na57032/2024/01/25/gabapentin-and-pregabalin-are-associated-with-severe-copd (Source: Student Doctor Network)
Source: Student Doctor Network - February 4, 2024 Category: Universities & Medical Training Authors: soxman Tags: Pain Medicine Source Type: forums

Chronic cough question from Pulmonologist to GI doctors
Hello GI doctors I have an honest question about community GI setups regarding getting esophageal manometry and 24 hour pH probe Bravo studies. As a pulmonologist I see a lot of chronic cough. After I have gone through the checklist of asthma/COPD/bronchiectasis/structural lung disease and done all of my PFTs, FENOs, bronchoprovocation testing, and CT chests, I am often still confronted with GERD I barium esophagrams and at times I get lucky with GERD but this is not always the case... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 22, 2023 Category: Universities & Medical Training Authors: NewYorkDoctors Tags: Gastroenterology Source Type: forums

Early stage NSCLC SBRT/hypofrac
Wanted to review how you guys would approach this Got an elderly guy, GOLD 4 COPD, FVC 1.8L, 45% predicted, FEV1 860cc, 28% predicted, FEV1/FVC ratio 47%, with a peripheral early stage NSCLC, about 1.5cm, close to the chest wall, biopsy proven, PET negative, MRI brain negative. No matter what we did, tumor movement was 2cm+ on 4D, even after re-sim, plate/belt, education, etc. I've heard off hand that if movement >1cm you should not do SBRT, others say it is OK if it is a small target... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - August 12, 2023 Category: Universities & Medical Training Authors: Radonky Tags: Radiation Oncology Source Type: forums

Bad Wegener's and Lung RT
69 yo man with COPD and ILD with Wegeners Granulomatosis (GPA) on 2-3L O2 at rest and 3-4L on exertion gets rituxan infusions and on chronic steroids for the GPA had incidentally found 3.5 cm perihilar mass that is touching the aorta from about 2-5 o'clock. Biopsy positive for squamous cell carcinoma. Staged T4N0. Lung function is bad but sounds like he's been stable for over a year since starting rituxan in additionto the chronic steroids. Was just referred to us in RT and referred to med... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 12, 2023 Category: Universities & Medical Training Authors: Haybrant Tags: Radiation Oncology Source Type: forums

Re: Do not diagnose or routinely treat asthma or chronic obstructive pulmonary disease without pulmonary function testing
(Source: BMJ Comments)
Source: BMJ Comments - April 8, 2023 Category: General Medicine Source Type: forums

Dispoing the mild copd & chf exacerbations, and the ambulatory sat
Hey all, EM resident here. How often do you experienced people use the ambulatory sat to dispo your patients? For example, in the dyspneic patients (with no c/f ACS, PE, effusion/tamponade etc etc, via testing, clinical scores, pocus), perhaps an old person with extensive comorbids comes with a mild copd or CHF exacerbation but who were satting low 80s by EMS, treated/worked up and now are sitting up, satting well with no new o2 requirement, and talking to you in full... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - March 31, 2023 Category: Universities & Medical Training Authors: ahgykson Tags: Emergency Medicine Source Type: forums

Re: Do not diagnose or routinely treat asthma or chronic obstructive pulmonary disease without pulmonary function testing
(Source: BMJ Comments)
Source: BMJ Comments - March 27, 2023 Category: General Medicine Source Type: forums

Chronic disease management
Hello everyone, as someone from abroad can someone sum up all chronic diseases that are managed in american primary care ? I couldnt find any precise information about it on the net. I know you manage hypertension, dyslipidemia, type 2 diabetes, COPD, astma, chronic kidney disease, hypothyreidism, coronary disease. What am I missing. I know it can differ from place to place but what diseases all family doctors manage ? Thank you (Source: Student Doctor Network)
Source: Student Doctor Network - November 6, 2022 Category: Universities & Medical Training Authors: Lumbago90 Tags: Family Medicine Source Type: forums

Inform new product development for COPD care
Please delete if not allowed Our client is interested in exploring opportunities around supporting COPD patients through remote patient monitoring. We are seeking to learn more about primary care provider's experience with COPD patient care, and get feedback on our product concepts to shape our decisions moving forward. The consultation will be 90 minutes during the week of Oct. 24th. If interested, please complete the screener below as soon as possible, by this Friday, Oct. 21st. We offer... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 20, 2022 Category: Universities & Medical Training Authors: scstar Tags: Family Medicine Source Type: forums

Is xanax contraindicated in Asthma / Copd exacerbation
Is there any data that restricts the use of low dose xanax (0.5mg) in mild asthma exacerbations (not requiring o2) Can they still take to help them sleep. Is it a complete contraindication? (Source: Student Doctor Network)
Source: Student Doctor Network - September 18, 2022 Category: Universities & Medical Training Authors: Cadet133 Tags: Pulmonary / Critical Care Medicine Source Type: forums

Hypertension after Induction - Case Discussion
Hey guys I had a weird occurrence the other day and had to cancel a case. There probably aren't many explanations for what happened but I've been surprised by input on these forums before. Patient is a 68 y/o female, 70kg, with a Hx of mild COPD (on stiolto), Hypertension, Hypothyroidism, and sleep apnea. She is scheduled for bilateral mastectomy with sentinel nodes for a 2 cm mass in the right breast, invasive lobular carcinoma. Hx both cataracts done in past 2 years. Hx hysterectomy and... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - July 22, 2022 Category: Universities & Medical Training Authors: DrOwnage Tags: Anesthesiology Source Type: forums

nebulizers
so during covid times, for some time our hospital had converted from using nebulizers regularly to using MDIs and/or nebs on pts ok closed circuit devices such as NIPPV (bipap) or ventilators for covid positive patients and non-covid patients just bc of this risk of aerosolization Although omicron is certainly surging and a risk, ive had a few pts come in for copd exacerbations, COVID negative, and some of our RTs are still very much afraid of dispensing nebulizers out of fear of... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 31, 2021 Category: Universities & Medical Training Authors: acdu1411 Tags: Internal Medicine and IM Subspecialties Source Type: forums