Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
What are your go-to options for managing ICU delirium in patients with contraindications to antipsychotics?
Evidence for Ramelteon (Yu et al., PMID 36726202)Delirium with behavioral disturbances Depakote Clonidine Propranolol, especially with TBI Non pharmacological Make sure they're closer to the nursing station. Constant re-orientation. Shades open during the day and close at night. Bring anything they ...
What strategies do you employ to minimize the risk of cardiovascular collapse when intubating a patient with severe pulmonary hypertension?
Intubating patients with pulmonary hypertension is a challenging medical and critical care situation. Generally, I try to apply principles of right ventricular optimization of care before I proceed with endotracheal intubation. Intubating patients with pulmonary hypertension is a challenging medical...
How do you balance diagnostic stewardship and high value cost-conscious care when working up a patient with newly diagnosed HIV/AIDS admitted to the ICU with shortness of breath who most likely has PJP pneumonia or cryptococcal infection but is at risk of multiple other pathogens?
This is an excellent question, which is very based on the patient's clinical presentation as well as the resources you have available to you in your setting, particularly how long it takes for test results to come back. One aspect that should be considered in patients with advanced HIV is that they ...
What is your approach to managing rash associated with pirfenidone?
I don’t think "permanently discontinue" is the first step here. Rash commonly occurs in conjunction with sun exposure, which can be prevented with skin covering and high SPF sunscreen, but sometimes it is a different phenomenon (i.e., a true allergy, which does require discontinuation).If the photos...
Do you routinely integrate the use of a multiplex PCR panel in the evaluation and diagnosis of patients suspected of having VAP?
In our hospital, we use emperic treatment till we get the sputum culture results.
What is your approach to scheduling and then weaning nebulizers in patients admitted with acutely exacerbated asthma or COPD?
In hospitalized patients with acute asthma or COPD exacerbations, my approach to nebulizers is front-loaded and reassessment-driven. I start by gauging the severity and the patient’s ability to use an inhaler. pMDI with a spacer is preferred for most patients, but nebulizers are reasonable early on ...
How do you approach a patient with recurrent VTE who develops VTE again after reduction of apixaban to 2.5 mg bid?
Several factors play into this decision for me. Is the patient obese? Obese patients tend to give me pause for dose-reduction of DOACs. As such, half-dose apixaban may have been relatively underdosed for an obese patient and I would not call it DOAC failure, rather I would increase the dose to usua...
Do you use anticoagulants in the management of patients with pulmonary veno-occlusive disease (PVOD)?
Not enough research
What is your approach to the management of a newly acquired Pseudomonas aeruginosa infection that was not eradicated with initial treatment in a patient with CF?
I think this is a situation where shared decision making with patient is required; in general, would aim for second round of eradication with different antibiotic (for example if tobramycin was used first, inhaled aztreonam would be next) or consideration of a second month; however, chances of eradi...