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Need some Jedi Advice
So Monday have a 90 yo severe COPD pt (FEV1 40%) for Total shoulder. Pulmonary recommends the case done under regional! My experience is she probably will not tolerate wacking the phrenic. May be worth a shot as if she doesn't tolerate the ISB I will just intubate (as I would have for GA anyway). Think Mepi w cath or single shot bupi for a good dense block (with the potential for 24 hour post op ventilation if she doesn't breath well)? Or ignore my thoughts nd tell me your regimen!... Need some Jedi Advice (Source: Student Doctor Network)
Source: Student Doctor Network - December 5, 2016 Category: Universities & Medical Training Authors: turnupthevapor Source Type: forums

Case 5
Case #5 (attribution to follow) Link to case 4 48 year old renal transplant recipient with a history of COPD, T2DM, hyperlipidemia admitted to the VA directly from the outpatient resident clinic with a K+ of 8.5 mEq/L. Patient was complaining of nausea, poor oral intake, and mild diarrhea at the time of presentation. Medications: cyclosporine, KCl, lisinopril, sprironolactone. He is... Case 5 (Source: Student Doctor Network)
Source: Student Doctor Network - August 21, 2016 Category: Universities & Medical Training Authors: sozme Source Type: forums

Case from yesterday
Hey all, had a case yesterday that I want to hear from you all about. 75 year old male marine Vet, h/o severe COPD on home oxygen and several meds (albuterol neb 4x/day, symbicort, spiriva, daliresp, a few weeks ago started on prednisone taper down to 5 mg/day), h/o MI and severe PVD, h/o PE on Xarelto (last taken a little less than 2.5 days prior), IDDM, a hint of dementia and anxiety, comes in for a hip fracture after falling. You see him on oxygen, sitting in bed, speaking in somewhat... Case from yesterday (Source: Student Doctor Network)
Source: Student Doctor Network - August 6, 2016 Category: Universities & Medical Training Authors: Urzuz Source Type: forums

Oxygen supplementation in COPD and V/Q mismatch
I understand COPD patients are mainly dependant on the PO2 levels for the respiratory drive and high flow oxygen supplementation can cause decreased stimulation of peripheral chemoreceptors leading to decreased ventilation. I came across a statement saying high flow oxygen supplementation INCREASES the physiological dead space, leading to increased V/Q mismatch. How does this happen? From my understanding, physiological dead space represents the alveoli that are ventilated but poorly... Oxygen supplementation in COPD and V/Q mismatch (Source: Student Doctor Network)
Source: Student Doctor Network - August 6, 2016 Category: Universities & Medical Training Authors: Paramyxovirus Source Type: forums

COPD 50-50 club
Is there any significance to this moniker aside from the shock factor of PaO2 50 mmHg and PaCO2 50 mmHg? Is the acute management of an exacerbation still the same with a target SpO2 of 88-92% and PaO2 of 60-70 mm Hg? (Source: Student Doctor Network)
Source: Student Doctor Network - July 4, 2016 Category: Universities & Medical Training Authors: Jabbed Source Type: forums

DNR without DNI?
Do you guys typically offer to make patients DNR without also making them DNI? I'm not talking about patients who have conditions that are likely reversible such as pneumonia. Mainly asking about patients with many comorbidities who would be unlikely to be extubated if they were ever intubated or have advanced dementia/COPD/CHF. I've always felt that CPR and intubation cross a certain line and if they are unlikely to bring the patient back to a reasonable baseline, they should not be offered... DNR without DNI? (Source: Student Doctor Network)
Source: Student Doctor Network - June 16, 2016 Category: Universities & Medical Training Authors: smartparts Source Type: forums

Today's Anesthesia Consult
70 yo obese (120kg) male with schizophrenia, 4pk/day smoking history times 40yrs, ex-miner without respiratory precautions, and HTN. HE is scheduled for a colectomy secondary to recurrent polyp which has changed color but is not yet cancer per GI. Airway is a Gr III with large full beard as well. Sitting in the pre-op clinic he is SOB and has to take a couple big breaths before answering questions. He has been sitting for an hour. Work up includes PFT's which show severe COPD and... Today's Anesthesia Consult (Source: Student Doctor Network)
Source: Student Doctor Network - May 18, 2016 Category: Universities & Medical Training Authors: Noyac Source Type: forums

Severe pulmonary hypertension for elective surgery.
Pt is 73yo M with severe pulm htn scheduled for hernia repair. Pt has hx of COPD, CAD, and a-fib. Heart cath from a month ago shows pulmonary artery pressure in the 60s and about 60% stenosis of LAD that did not meet criteria for intervention. Echo showed nl LV EF, moderate TR, and severe pulm HTN. Pt can climb a flight of stair, but occasionally uses 2L O2 at home. Pt went to see cardiologist prior to procedure, who wrote a note saying patient is at high risk for general anesthesia and... Severe pulmonary hypertension for elective surgery. (Source: Student Doctor Network)
Source: Student Doctor Network - May 13, 2016 Category: Universities & Medical Training Authors: Chloroform4Life Source Type: forums

pulse oximetry with poor perfusion
Had a 90 yr old for elective lap chole other day. Chronic rate controlled A fib, not anticoagulated, moderate COPD, HTN, DM 2, normal weight, pretty active per wife. Patient rolled into OR, could not get a SpO2 reading. We have the non disposable pulse ox probes, and and initially tried multiple fingers and toes, no reading. Placed upper bair hugger, waited several minutes and nurse massages the guys hands, no luck. Tried probe on both ears with ear probes no luck. PA runs to ER where they... pulse oximetry with poor perfusion (Source: Student Doctor Network)
Source: Student Doctor Network - April 15, 2016 Category: Universities & Medical Training Authors: Colba55o Source Type: forums

Spinal and intraop heparin use
Pt present for femoral endarterectomy and has bad copd. Normal preop coags and not on blood thinner. spinal. Give 5000 unit heparin intraop. Problem? (Source: Student Doctor Network)
Source: Student Doctor Network - April 7, 2016 Category: Universities & Medical Training Authors: Chloroform4Life Source Type: forums

Sevoflurane or Desflurane for COPD?
Which one would you use for a pt. with COPD? (Source: Student Doctor Network)
Source: Student Doctor Network - April 5, 2016 Category: Universities & Medical Training Authors: Dr-Junior Source Type: forums

Recent Case
Figured I would share this recent case. 61yo M with history of ESLD, HRS and ESRD on MWF dialysis, Afib (rate controlled, but not on anticoagulation) and COPD on 3L of home O2. Fell at his nursing home and broke his hip. Ortho has him booked for a hemi-arthroplasty. INR is 2.0 and PLT count is 67. Hgb is 7.5. Patient is being given Vitamin K to reverse INR prior to scheduled case tomorrow. What's your plan? (Source: Student Doctor Network)
Source: Student Doctor Network - April 4, 2016 Category: Universities & Medical Training Authors: Ronin786 Source Type: forums

Re: Diagnosing chronic obstructive pulmonary disease
(Source: BMJ Comments)
Source: BMJ Comments - December 25, 2015 Category: Journals (General) Source Type: forums

Vest For Donation
I know someone who has a barely used vest to donate. Her mother passed away about a month ago from a non-CF lung condition, it was her vest. It hasn't been used in over a year and her mother only used it for about 2 weeks so it is in excellent condition. She would like to donate the vest to someone with CF. It is made by RespirTech and purchased in March 2011. Here is the information she provided: Item 500008-000/HFCWO Air-pulse Generator System. Serial No. UD03M12. InCourage System Jacket kit size 40. Everything is included in kit - Filter, fuse, cord hose and case. Boxed and ready to go. The website is: inCourage® ...
Source: Cystic Fibrosis Families Forum - June 27, 2015 Category: Respiratory Medicine Authors: Rosie55 Tags: Families Source Type: forums

Hi All. Throwing this out there to see if anyone can help. Still no CF diagnoise.
Hi Everyone. Well, I had a ambry Pancreatitis Genetic panel done. Any one else, with pancritis problems, Cf etc, which know of theses mutations. G576A, (likely pathogenic) And R668C. (Variant of unknown Significance) Got as far as a CRMS Diagnose. Told neither of these are CF causing. I don't get this as I am still in limbo, The two high sweat test> 84, and 90. To make this short as I always write a book here, I do have good FVC. Low DLCO. (which I think is heart related) Chronic Asthma, Chronic Sinusitis, Allergies, Chronic Bronchitis, Failure to thrive, malnusorption disorder (most all my life) Chronic Pancri...
Source: Cystic Fibrosis DNA and Mutations Forum - May 30, 2015 Category: Respiratory Medicine Authors: madmax33 Tags: DNA and Mutations Source Type: forums