Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
How do you recommend incorporating B-lines on lung POCUS as part of evaluating a patient's volume status?
Great question! As you allude to in your question, it is important to address this problem holistically in the context of the patient's history, exam, labs, and other imaging. I find that this happens all of the time, and here is how I typically break them down when applying lung ultrasound. 1) 1-2 ...
How many proctored robotic assisted bronchoscopies does it take to become proficient at it?
Robotic-assisted bronchoscopy has made navigation to nodules significantly easier, and the platforms are relatively user-friendly in the sense of learning to use them. I do think that there are a ton of nuances and even after doing >500 I still learn new things. Further, and perhaps most importantly...
At what initial sodium level do you recommend strict avoidance of overcorrection (e.g., no more than 6 mEq/L in 24 hours) in patients with hyponatremia?
Less than 120.
What is your approach to follow up after embolization of pulmonary AVM in patients with HHT?
After closure of all PAVMs with feeding artery >2-3 mm diameter, I check a contrast echo (TCE) and CTA chest about 6 months later to assure that the AVM are still closed. Right-to-left shunt on TCE can be graded 0-3 using the system of Mager and colleagues. On CTA you are looking to see if all PAVM ...
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...
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 ...
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...