Pulmonary and critical care pearls
Respiratory mechanics and sounds: ( Fig. 28.1 ) • Inspiration: • Active process in which diaphragmatic contraction generates negative intrathoracic pressure, sucking air into the conducting airways • Exhalation: •…
Advanced care planning and the family meeting
Common misconceptions and mistakes • Parsing out critical care into its individual interventions, asking surrogates what they think their loved one would want (eg, triple-lumen catheter [TLC] placement, nasogastric [NG]…
Diabetic emergencies
Common misconceptions and mistakes • Extreme hyperglycemia always implies profound dehydration and is pathognomonic for a hyperosmolar-type presentation • Diabetic ketoacidosis (DKA) always requires aggressive fluid resuscitation • Attributing ketoacidosis…
Code status
Common misconceptions and mistakes • Advising your patients to avoid resuscitation based on your assessment of the severity of their baseline cardiopulmonary disease and your “certainty” that resuscitation attempts would…
Bedside presentations in the ICU
Common misconceptions and mistakes • Giving three complete, separate physical examinations when presenting a single new admission (emegency department [ED] examination, intensive care unit (ICU) admit examination, and the current…
The obtunded inpatient with normal vital signs
Common misconceptions and mistakes • All unarousable patients should be immediately intubated because “they are not protecting their airway” • Failing to realize that only a finite number of processes…
Salt and water: the physiology and regulation of volume and tonicity
Common misconceptions and mistakes • Behaving as if humans are “brittle” with regard to volume status—namely that they transition quickly from total body volume overload to volume depletion (in a…
Hemoptysis
Common misconceptions and mistakes • Believing that a double-lumen tube is the preferred airway in a patient with massive hemoptysis • Failing to treat patients with bronchiectasis and hemoptysis with…
Liberation from mechanical ventilation
Common misconceptions and mistakes • Labeling a patient as “failure to wean” because of a rapid shallow breathing pattern (ie, increased rapid shallow breathing index [RSBI]) during spontaneous breathing trial…
Noninvasive ventilatory support with bilevel positive pressure ventilation
Common misconceptions and mistakes • Believing that somnolence makes a trial of bilevel positive pressure ventilation (BiPAP) unsafe • Believing that any hemoptysis, regardless of the volume or context, makes…
