We are excited to announce that our first video episode is out!!!
Watch and learn about the PREOXI Trial, discussing methods for pre-oxygenation for intubation with
@JonathanCaseyMD
@VUMCLung
and
@KevinGibbsMD
@WakePCCM
!
Ever wonder why we default to a PEEP of 5? Or what “optimal PEEP” really means?
🔹🔹Listen now to our PEEP in ARDS Roundtable discussion and find out!!🔹🔹
Here is our infographic for titrating PEEP in patients with ARDS, and listen for more 🔥🔥
➡️🔗
🚨🚨We have three patients today all with pneumothorax, Barry, Larry, and Carrie.
Listen to our consultants walk you through how to manage each of them. Here is a cheat sheet so you can expertly manage the next patient with pneumo you see 🫁🩻
➡️🔗
We are back with our first
#RadiologyRounds
of the new academic year🫁
We have a young, immunocompetent man presenting with fever, weight loss and abdominal pain.
🫁 Need a system for interpreting Right Heart Catheterization results? Not sure about vasoreactivity?
Befuddled by Qp/Qs?
Check out this infographic and listen to our episode today to revisit a
#RadiologyRounds
case and learn all about RHCs 🦢 〰️🌊
🔗➡️
We have another
#RadiologyRounds
for you this week, brought to you by our newest Contributor
@thematttsai
. Thrilled to have you on the team Matt!!
This patient presented to the ED two days ago and returns now with acute onset shortness of breath.
📟🎶
Do you wake up in a cold sweat thinking about intubating an asthmatic patient?
Have no fear, just listen to the next episode in our Top Consults series on Severe Asthma Exacerbations
See below infographics on Auto-PEEP and Severe Asthma
🔗➡️
As we approach the end of the year, we know that the hospital and clinic keep on rolling, so here is a CXR and pulmonary differential based
#RadiologyRounds
if you're on for the holiday blocks
A woman in her 50s has hypoxemia after being admitted with a femur fracture
We are back with another
#RadiologyRounds
for you 🫁
A middle-aged male presents with sub-acute fatigue, fevers and dyspnea on exertion. His admission labs are notable for severe neutropenia (ANC < 500)
1/ 🚨🚨 It is Tuesday and time for another
#RadiologyRounds
! 🫁🩻 This week we'll take a look at multiple imaging modalities. Let's start with the initial CXR
🔊 New fascinating case out today on our latest Fellows' Case Files Episode:
A young man in his 40s presents to the clinic with 3 months of progressive dyspnea and fatigue following a COVID-19 infection, found to have diffuse crackles on exam. Here is his CT scan:
As you listen to today's episode, make sure to check out our two infographics on COPD Classification and Evaluation, Severe Emphysema, and General Principles for Surgical and Bronchoscopic Lung Volume Reduction
🚨For today's
#RadiologyRounds
we have a combined Radiology and Ventilator imaging rounds!
You're in the ICU caring for a young patient on a ventilator when you are called to the bedside for a desaturation:
🚨
We are introducing a new feature at Pulm PEEPs!
Tomorrow we are launching our Rapid Fire Journal Club. These are brief episodes (5-10 minutes) accompanied by an infographic discussing practice-changing trials in PCCM.
We are focusing on pulmonary trials to start!!
We have another
#RadiologyRounds
for you today 🫁You are seeing a new patient in clinic with dyspnea who brings in prior CT chest imaging. A representative coronal image is shown.
Wow great thoughts by everyone on this case! For a reminder, a man in his 40s has progressive dyspnea and fatigue after a mild COVID infection and this CT scan:
Many of you rightly pointed out
🔹Septal thickening
🔹Reticular infiltrates
🔹Pleural involvement and effusions
🔹GGOs
1/ 🚨 Check out this
#RadiologyRounds
and Tweetorial on a post-procedural complication authored by our newest contributor and fantastic educator
@Huzaifahsmd
A 60F Filipino heavy smoker p/w 4 weeks of dyspnea. ROS + night sweats and fevers. Exam with ⬇️ BS and dullness L base
Our patient had an elevated VEGF-D level, a renal angiomyolipoma identified on CT abdomen and imaging with diffuse cystic lung disease confirming her diagnosis of LAM.
Make sure to check out the
@OnePagerICU
below on cystic lung disease as another great resource
1/Time for another
#RadiologyRounds
! All our prior RR and episodes are available at
This is a middle aged patient who presents with dyspnea, fevers, and night sweats.
💠💠 Some amazing pearls from UMD Fellows' Case Files!
Spoilers ahead!!! This case had lots of twists and turns so be sure to listen to hear how the differential changed at each stage.
Here are some high yield points on Auto-Immune Pulmonary Alveolar Proteinosis!
We're back with another
#RadiologyRounds
by Pulm PEEPs Associate Editor
@TessLitchman
@BWHPulmCCM
An immunosuppressed 65-year-old man presents with neutropenic fever. He is started on empiric broad spectrum anti-biotics with vancomycin and zosyn. Serum beta-D-glucan is positive
A
#RadiologyRounds
case with 3 different imaging modalities!
A 65+ year old man never smoker, former marathoner has had 2-3 years of progressive non-productive, incessant cough with decreasing exercise tolerance. Some select CT scan slices are below:
We are excited to bring you another
#RadiologyRounds
which applies some of the knowledge from our most recent episode.
A patient in her 20s presents with shortness of breath at rest, left sided pleuritic chest pain and increase in cough and sputum production.
💠
@WesElyMD
and
@DrDaleNeedham
want you to think daily in the ICU about what you can be doing (or removing!) to keep your patients awake, mobile, and oriented to prevent PICS‼️
The 1st step is learning about PICS. Listen now
🔗➡️
See our infographics⬇️
Some imaging pearls from today's episode
🫁 In the right clinical context, prone imaging can help distinguish reticular changes from atelectasis that may be seen in the supine position
🚨🚨 Knowledge 💣💣 coming
Extremely excited to release tomorrow our episode on Post-Intensive Care Syndrome (PICS) with
@DrDaleNeedham
and
@WesElyMD
. This is a HUGE issue for all ICU patients and providers and a can't miss episode!!
🎧 We are excited to bring you our latest episode where we meet the Glaucomfleckens. Want to know where the name came from, who is the favorite medical character, or what advocacy work
@LGlaucomflecken
and
@DGlaucomflecken
are doing, listen in today 🎧
In our Rapid Fire Journal Club we'll explore the evidence behind common practices in 10 min or less ( focusing on pulm 🫁 to start)
Today,
@thematttsai
walks us through the REDUCE trial and why 5 days of prednisone for COPD is common practice
🔗➡️
Time for another
#RadiologyRounds
🫁
A woman in her 30s with no past medical history presents with acute dyspnea, fever and a non-productive cough.
She has no sick contacts or recent travel. She is not on home medications and smokes cigarettes and occasionally vapes.
We have a
#RadiologyRounds
from the pulmonary clinic this week! 🫁
A woman in her 80s presents to the clinic with a progressive, dry cough. She has had some associated dyspnea and weight loss. Here is her chest X-ray 🩻
Tuesday is time for another
#RadiologyRounds
! Time for some CXR reading and a differential diagnosis mnemonic
Two women presented to the hospital with similar presentations. They are both in their 80s with multiple weeks of cough, fever, and fatigue. Here are the CXRs
Time for another
#RadiologyRounds
! This case is brought to you by our Associate Editor
@pulmtoilet
!
A 55 year old man presents to the hospital with progressive dyspnea and a chronic cough. Here is his initial CXR. How would you describe it (let us know in the comments!!)
🚨Are you worried a patient might have shock? Evaluate to see if they’re on the
@msiuba
Shock BUS 🚌🚍!!!!
Today we hear from
@msiuba
@nickmmark
and
@MHayes_MD
about the approach to undifferentiated shock. Hear about the Shock BUS, POCUS and more!
Our last few
#PulmPEEPs
radiology rounds have been CT-centric, so today we’re going back to some useful CXR signs!
Our patient is admitted to the ICU for hypoxemia and has poor compliance and low P:F ratio after intubation
📢We are so excited for our upcoming episode where we will be joined by three amazing educators and intensivists. Join us as we will go through a practical approach to the evaluation of undifferentiated shock. Make sure to tune in on Tuesday 🎙️
@nickmmark
@MHayes_MD
@msiuba
Upcoming topics in 2023:
✴️ Pleural effusions 101
✴️ Empyema
✴️ Malignant effusions
✴️ Hypoxemia in cirrhosis
✴️ Lung + diaphragm protective ventilation
✴️ Future of ARDS research
✴️ Anti-fibrotics in ILD
✴️ Lung Nodules 101
✴️ Case files
What else do you want to hear about?!
We hope you enjoyed our case files this week! This patient ended up having anti-synthetase syndrome. In inflammatory myopathies, the antibody profile can help you predict the associated findings.
For our Top 7, we are bring back one of our most viewed
#RadiologyRounds
of this academic year.
A young, immunocompetent man presented with fever, weight loss, and abdominal pain. CT chest imaging was performed with a representative image shown below
We are excited to bring you another
#RadiologyRounds
We have a middle-aged immunocompromised male presenting with neutropenic fevers, progressive cough and dyspnea. He has no sick contacts or recent travel.
🚨🚨See our infographic about approaching new pleural effusions made with
@miraonthewallMD
and Ylinne Lynch at
@uwpccm
Listen to our full episode for even more details:
Coming next week our pleural series continues with an episode on empyema!
@dfellerk
Dr. Robert Bartlett with absolute core physiology teaching
✴️✴️ it’s all about O2 delivery (DO2) and O2 consumption (VO2) ‼️‼️
We should be thinking / talking / teaching about this for all shock patients not just with ECMO!
For "
#RadiologyRounds
" today, we won't be looking at any imaging, but we'll be looking at some vent wave forms and examining dysynchrony! This is a re-booted
@david_furfaro
Tweetorial.
I hope you enjoy and this is an open invitation for all dysynchrony waveforms!🫁🚨
1/ 🫁 🩻 It’s Tuesday and time for another
#RadiologyRounds
!!
A 65 year old woman with a 35 pack year smoking history presents to clinic with progressive dyspnea. Her PFTS show mild obstruction. Here is her CT
As you listen to our episode today and think of an approach to electrolyte imbalances, check out our infographics on Severe Hypokalemia and learn why Hypokalemic Periodic Paralysis is important to have on your differential 🧪 🫘
➡️ Infographics brought to you by
@luke_hedrick
🚨🚨🚨 BREAKING PULM PEEPS NEWS 🚨🚨🚨
📢 We are extremely excited to announce our new episode series : Pulm PEEPs Fellows’ Case Files‼️
In each episode, we will have a fellow and the Program Driector from an institution come discuss a fascinating case they’ve seen
💠 The first episode in our COPD series with
@ATSCPAssembly
is out now!!💠
Drs Labaki
@MichiganPulmCC
and Wise
@HopkinsPCCM
cover diagnosing COPD, what not to miss, and choosing therapy
🚨🚨See infographics for an overview and listen for more 💎
🔗➡️
You see GREEN fluid from your thoracentesis. What are you thinking???
The fluid studies were consistent with an inflammatory exudate with 81% neutrophils, 4% lymphocytes, glucose < 20, pH 6.8, LDH 10,389, and ADA level of 157
For all those at
#CHEST2023
here is a fun Radiology Rounds to wake up to (or maybe you're still up 🥳). This comes from our outstanding Associate Editor
@TessLitchman
@BWHPulmCCM
and has a can't miss imaging pearl! 🦪
If you've seen a similar case please share with us!
We are excited to start the month off with a new
#RadiologyRounds
🫁
A young adult man in his 20s presents with dyspnea on exertion, productive cough, intermittent wheezing and general fatigue. A chest x-ray was obtained as part of his work-up.
🚨🚨SPOILER ALERT🚨🚨
If you want to think through this week’s episode on your own stop reading and listen now
🔗➡️
Once you’re done, check out this infographic on all you need to know about pulmonary histoplasmosis!
What are tree-in-bud opacities? They are findings seen on CT chest suggesting bronchial dilation, inflammation and bronchial filling with fluid, mucus or pus that can be caused by infections and non-infectious etiologies.
We are excited to share new content with you every Tuesday. Today we introduce our
#RadiologyRounds
tweetorials where we share high-yield images and teaching points with you from cases we have encountered.
Once you are done listening to this week's episode, check out our infographics on an approach to pulmonary renal syndromes 👇
🫁 Infographics by Associate Editor
@TessLitchman
A year ago today we introduced
@PulmPEEPs
as a way to share pulmonary and critical care content that can be accessed anytime, anywhere. We sincerely thank our amazing guests and contributors who have helped make this possible, and look forward to the next part of our journey 🙌
Time for another
#RadiologyRounds
! This case is authored by PulmPEEPs associate editor
@TessLitchman
. Great teaching ✴️ ahead!
A woman in her 20s presents w/ 3 months of malaise, diarrhea, weight loss and dyspnea. She is hypoxemic to 72% on ambient air. Here is her imaging
🚨You have a patient with persistent dyspnea and cough, wheezing on exam and this CXR and CT. On labs the CBC shows an eosinophilia.
Do you have a system for working through this?
Listen now to our VV-ECMO Roundtable episode to hear about how VV-ECMO works, physiologic targets, how to think about 🫁 protective ventilation, and to dive in to the data:
To go along with the episode, here is a thread on some key ECMO concepts
Evaluating a patient with suspected interstitial lung disease is a challenge for all clinicians seeing pulmonary 🫁 patients from medical students to attending physicians. This week for
#RadiologyRounds
we’re looking at CT findings for a patient undergoing DOE work up 🩺
In our episode today on undifferentiated shock with
@MHayes_MD
@nickmmark
@msiuba
we spent some time discussing POCUS for cardiac output / stroke volume . Please see this amazing 🧵from
@Pocus101
about this topic!
Does Measuring Cardiac Output ❤️ with
#POCUS
seem confusing 😕? Let's Demystify that today 😀!
1⃣Measure LVOT Diameter
2⃣Measure LVOT VTI
3⃣Measure HR
4⃣Calculate SV and CO
5⃣FREE Pocket Guide PDF!
✅New Blog Post & PDF
🔗👉
#medtweetorial
👇(1/n)
💎Here is one system for evaluating the echo in a patient with suspected pulmonary hypertension from today's episode!💎
@ebrosenzweig
, Catherine Simpson
@HopkinsPCCM
and Cyrus Kholdani
@BIDMC_Medicine
tell us how to evaluate a new pt with ? of PH
🔗➡️
For our Top 3, we bring back our Undifferentiated Shock Roundtable Episode where we reviewed basics about defining shock, advanced POCUS techniques, and initial management.
🔗
We are back with another
#RadiologyRounds
! This week's case comes from our Associate Editor
@luke_hedrick
A portable film is obtained on a 65 yo woman with COPD presenting with progressive dyspnea and cough.
We have you covered!! Here is a simple breakdown for thinking through eosinophilia in a patient with respiratory symptoms.
Listen to our Fellows’ Case Files from today to hear more!
🔗➡️
Today’s
#RadiologyRounds
is a reminder that pulmonary care extends beyond the lungs! Although we’ll have a CT chest too 😉
A 70F with a dx of seronegative RA presents with progressive dyspnea. PFTs show a moderate restrictive defect and moderately reduced DLCO. Here is the CT:
We are extremely excited to be launching the new year with a star studded Roundtable about PEEP titration in ARDS.
We are joined by experts in the field Drs. Roy Brower, Elias Baedorf-Kassis
@SarinaKS
@toddrice_ICU
to discuss all things PEEP. Be sure to listen in tomorrow!
🔊🔊The first episode in our Fellows’ Case Files series is out tomorrow!!!
This is an incredible case from
@fahidalghanim
and
@vanholdenmd
at
@UMdPCCM
@UMInternalMed
The goal of the series is to amplify fellows’ work, and learn from dedicated PCCM educators around the US
📟🔔📟🔔📟🔔
HELP, my patient is coughing up blood!!
Listen to our first Top Consults episode and learn everything you need to know about HEMOPTYSIS.
Whether you’re calling or answering the consult, this episode will give you all the info you need!
🔗➡️
A patient with pneumonia and ischemic cardiomyopathy was intubated for hypoxemic respiratory failure. They’ve improved and been on minimal vent settings, but repeated SBT failures
What better way is there to celebrate Valentine's Day than a new
#RadiologyRounds
?! We think it is time for a Lung-centered holiday, but until then, enjoy this case.
Time for
#RadiologyRounds
!
This week we have a man in his 70s with CLL s/p treatment now in remission. He had fevers, a dry cough, and malaise that initially improved outpatient with antibiotics but have now recurred.
It is Tuesday and we have another
#RadiologyRounds
we can't wait to share with you 🫁 Follow along and see if you select the right answer as we go through different presentations of sarcoidosis and pick your answer to ⁉️What stage is it ⁉️
April is Sarcoidosis Awareness month and a diagnosis that should always be considered with apical lung disease. We want to help spread awareness this month with
@saysarcoidosis
It is Tuesday, so even though it is
#ATS2022
, here is a quick
#RadiologyRounds
!
An octogenarian with PMH of CAD s/p CABG, and COPD presents with acute onset chest pain, dyspnea, and lightheadedness, and is found to be hypoxemic and tachycardic with normal BP. Here is the CXR:
We’re very excited for our first episode in our collaboration with
@ATSCPAssembly
. We’re joined today by Drs. Sonye Danoff, Shweta Sood, and
@jskim8223
to for a Top Consults episode about the diagnostic work up for new ILD!! 🫁🩺 🧪🧬
🔗➡️
🚨spoilers ahead from todays episode 🚨
Neuromuscular weakness can be an occult cause of respiratory failure that often goes unnoticed and can coexist with other conditions . 👇for infographic on signs, symptoms, and tests for neuromuscular weakness from
@UMMC_pulmcc
@Mersea12