Pulmonology&nbsp;&nbsp;&nbsp;

Do you maintain a strict platelet threshold of >50k when performing a lumbar puncture, or are there situations in which you feel comfortable with a lower threshold?

While many US guidelines have supported a threshold of > 50k, there does not appear to be robust data to support it. Notably, the 2025 AABB and ICT...

How do you manage daytime somnolence without a clear cause?

E.g., negative sleep study, good sleep hygiene, no offending medications, no psychiatric disorder.

In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD?

How frequently do you monitor osmolarity?

What is the role of inebilizumab in the maintenance treatment of IgG4-related disease?

Are there situations when you would choose it over Rituximab?

How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?

4 Answers available

What are your vaccine recommendations while patients are on biologics?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

Under what circumstances do you recommend POCUS guidance for lumbar puncture?

What is your approach to helping parents manage sleep disturbances in patients with autism spectrum disorder?

How do you sequence pharmacologic treatments for primary insomnia?

Do you routinely use pupillometry for serial neurologic examinations in the ICU, especially for patients at risk for transtentorial herniation?

When do you usually introduce conversations regarding tracheostomy placement in patients with refractory status epilepticus, or other conditions where one may anticipate delayed awakening?

Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?

For example, would you consider this method in an ESRD/HD patient with antiphospholipid syndrome who had a major bleed requiring reversal of warfarin ...

4 Answers available

Do you obtain an MSLT or start empiric therapy with modafinil in patients with residual excessive daytime sleepiness despite optimal adherence to PAP therapy?

In patients with an average of less than 5 respiratory events per hour, adequate sleep duration and hygiene were confirmed on the sleep log, absent ca...

5 Answers available

How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?

Do you use or recommend clinical severity scores or other parameters in helping prognostication in patients with refractory status epilepticus?

What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?

Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach?

What is your diagnostic approach to patients referred for central sleep apnea on PSG but normal overnight EEG and MRI?

What postural change in FVC is suggestive of respiratory muscle weakness?

What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?

Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...

How do you workup patients with neuropathy suspected to be secondary to sarcoid?

Is a biopsy or EMG helpful in confirming the etiology? What is the best treatment for sarcoid neuropathy?

Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?

Do you utilize phrenic nerve EMG in patients with diaphragmatic issues?

When do you consider ketamine to treat nonconvulsive status epilepticus?

Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?

3 Answers available

Do you favor the use of maximal inspiratory/expiratory pressure measurement or supine spirometry in the evaluation of a patient with suspected respiratory muscle weakness?

What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?

For example, in the setting of TBI, how do you guide the duration of the medical treatment?

In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?

In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...

In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?

What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...

Do you use sitting vs supine spirometry to consider tracheostomy in a patient with Amyotrophic Lateral Sclerosis?

How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?

For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...

5 Answers available

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?