The document provides guidance on using imaging for COVID-19, including when it is useful, what findings to look for on chest x-ray and CT scan, and why clinical history is important. It discusses that imaging is not recommended for screening but can help evaluate symptoms. Chest x-ray may show patchy, peripheral, bilateral opacities while CT scan commonly shows peripheral ground glass opacities. Radiologists need full clinical history to properly interpret imaging studies.
This document discusses the use of ultrasound in evaluating and treating COVID-19 patients. It provides guidelines on performing lung ultrasounds to identify signs of pneumonia like B-lines. Cardiac ultrasounds can also assess for complications like heart failure. The Lumify portable ultrasound system is recommended for its ability to image the lungs and heart at the bedside with single-use transducers for infection control. Ultrasound allows monitoring of COVID-19 patients during their two to four week hospitalizations and aids in determining when discharge is appropriate.
1. Several imaging modalities can provide detailed assessment of lung structure and function in asthmatic patients, including CT, MRI, PET, OCT, and EBUS.
2. Measurements from CT such as airway wall thickness, air trapping, and ventilation defects have been shown to correlate with disease severity and control.
3. Imaging measurements can serve as biomarkers to evaluate responses to new therapies like inhaled corticosteroids and anti-IL5 monoclonal antibodies, and determine if treatments are modifying the disease course.
This document summarizes a presentation by Dr. Eddy Fan on the limitations and concerns with the current ARDS definition. The presentation discusses how syndromes in critical care like ARDS require reliable definitions to conduct research and interpret clinical trials. However, the current AECC/Berlin definitions have limitations. Specifically, the criteria like chest x-rays and PAOP measurements have poor reliability. Additionally, factors like mechanical ventilation settings are not standardized when assessing oxygenation. The definitions also do not capture other important variables for clinicians. Overall, while the Berlin definition made improvements, its criteria need further validation and refinement.
This document summarizes the key debates from the SOA 2015 conference on ventilator-induced lung injury (VALI). It discusses the evidence from experimental, physiological, and interventional studies comparing higher (12 ml/kg) and lower (6 ml/kg) tidal volume ventilation strategies. Studies show that higher tidal volumes are associated with worse outcomes like increased ARDS development, mortality, and decreased lung harvest rates compared to lower tidal volumes. The evidence is analogous to the Charge of the Light Brigade military disaster where miscommunication led to heavy losses, similar to how misunderstandings of lung physiology formerly led to harmful ventilation practices.
This document provides a guide to COVID-19 testing. It discusses PCR testing and its sensitivity of over 85%. Sensitivity measures how often a test correctly identifies those with the disease, while positive predictive value depends on disease prevalence. Likelihood ratios are used to determine pre-test and post-test probability. Examples are given of using test results and likelihood ratios to determine the probability a patient has COVID-19. CT scans are not recommended for diagnosing COVID-19 due to their low sensitivity. Symptoms and risk factors should be used to determine pre-test probability to correlate with test results.
This document discusses the use of ultrasound in evaluating and treating COVID-19 patients. It provides guidelines on performing lung ultrasounds to identify signs of pneumonia like B-lines. Cardiac ultrasounds can also assess for complications like heart failure. The Lumify portable ultrasound system is recommended for its ability to image the lungs and heart at the bedside with single-use transducers for infection control. Ultrasound allows monitoring of COVID-19 patients during their two to four week hospitalizations and aids in determining when discharge is appropriate.
1. Several imaging modalities can provide detailed assessment of lung structure and function in asthmatic patients, including CT, MRI, PET, OCT, and EBUS.
2. Measurements from CT such as airway wall thickness, air trapping, and ventilation defects have been shown to correlate with disease severity and control.
3. Imaging measurements can serve as biomarkers to evaluate responses to new therapies like inhaled corticosteroids and anti-IL5 monoclonal antibodies, and determine if treatments are modifying the disease course.
This document summarizes a presentation by Dr. Eddy Fan on the limitations and concerns with the current ARDS definition. The presentation discusses how syndromes in critical care like ARDS require reliable definitions to conduct research and interpret clinical trials. However, the current AECC/Berlin definitions have limitations. Specifically, the criteria like chest x-rays and PAOP measurements have poor reliability. Additionally, factors like mechanical ventilation settings are not standardized when assessing oxygenation. The definitions also do not capture other important variables for clinicians. Overall, while the Berlin definition made improvements, its criteria need further validation and refinement.
This document summarizes the key debates from the SOA 2015 conference on ventilator-induced lung injury (VALI). It discusses the evidence from experimental, physiological, and interventional studies comparing higher (12 ml/kg) and lower (6 ml/kg) tidal volume ventilation strategies. Studies show that higher tidal volumes are associated with worse outcomes like increased ARDS development, mortality, and decreased lung harvest rates compared to lower tidal volumes. The evidence is analogous to the Charge of the Light Brigade military disaster where miscommunication led to heavy losses, similar to how misunderstandings of lung physiology formerly led to harmful ventilation practices.
This document provides a guide to COVID-19 testing. It discusses PCR testing and its sensitivity of over 85%. Sensitivity measures how often a test correctly identifies those with the disease, while positive predictive value depends on disease prevalence. Likelihood ratios are used to determine pre-test and post-test probability. Examples are given of using test results and likelihood ratios to determine the probability a patient has COVID-19. CT scans are not recommended for diagnosing COVID-19 due to their low sensitivity. Symptoms and risk factors should be used to determine pre-test probability to correlate with test results.
- Chest x-rays are not very sensitive for detecting early COVID-19 infections and changes seen can be subtle. CT scans are better for detection, especially in detecting ground glass opacities which are often peripheral and bilateral in early disease. Later in disease, consolidations and linear opacities may be seen. Ultrasound can detect B-lines, subpleural consolidations and thickened pleural lines which have been associated with COVID-19. Imaging is recommended for patients with moderate to severe COVID-19 and worsening respiratory status but is not routinely needed for mild or asymptomatic cases.
This document provides an overview of acute kidney injury (AKI). It begins with objectives of defining, staging and managing AKI, understanding referral criteria, highlighting less common intrinsic renal pathology, and understanding long term implications. It then outlines topics to be covered including perspectives on AKI, identification and definition, pathogenesis, guidelines, less common causes, dialysis and outcomes. It discusses perceptions of AKI between different specialties. It provides data on AKI incidence, risk factor assessment, investigations, treatment including fluids and renal replacement therapy. It discusses evidence and guidelines around these topics. It highlights long term outcomes of AKI including increased risk of chronic kidney disease and end stage kidney disease. Biomarkers for early detection of AKI
The document summarizes a case presentation on acute kidney injury (AKI) given at the ACE Dumaguete Doctors, Inc. Department of Internal Medicine Grand Rounds. It presents the case of a 77-year-old female who presented with hypogastric pain and was found to have mild anemia, leukocytosis, elevated serum creatinine and was diagnosed with chronic kidney disease. Her kidney function deteriorated after she underwent a right hemicolectomy for a colonic mass and she developed sepsis, leading to AKI. The discussion defines AKI, reviews its prevalence in hospital and ICU patients, and categorizes the etiologies of AKI into prerenal, intrinsic renal, and post
The document discusses pneumonia that requires admission to the intensive care unit (ICU). It notes that community-acquired pneumonia (CAP) can range from mild to severe, and involve multiple pathogens and antibiotic exposures. Viruses are detected in about 27% of CAP cases, with human rhinovirus and influenza being most common. Bacteria are found in 14% of cases, led by Streptococcus pneumoniae. The outcomes of patients with severe pneumonia admitted to the ICU have improved in recent years due to early administration of combination antibiotics and awareness of multidrug-resistant organisms and respiratory viruses as common causes. However, pneumonia remains associated with high mortality, especially if complications like septic shock or acute respiratory distress syndrome occur.
This document outlines the structure and approach for presenting and discussing a patient case, including defining the problem representation, generating a differential diagnosis, presenting pertinent history, exam findings, labs/imaging, investigations, diagnosis, and management. Key aspects include updating the problem representation and differential with each new piece of information, and separating the diagnostic "signal" from irrelevant "noise".
This document provides an overview of ocular anatomy and diagnostic techniques. It begins with introductory sections on vitreous anatomy, embryology, and stages of vitreous development. Subsequent sections cover diagnostic techniques including color photos, filters, and fluorescein angiography. Key points on interpreting fluorescein angiograms like early, mid, and late phase imaging and causes of hyperfluorescence and hypofluorescence are discussed. The document concludes with examples of anatomical structures and pathologies visualized on fluorescein angiography.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Acute Chest Syndrome
• Pneumothorax
• Tuberculosis
• Small Bowel Obstruction
• Intra-abdominal Abscess
• COVID-19
• Subcutaneous Emphysema
• Pneumoperitoneum
• Pneumomediastinum
• ECMO
• Pleural Effusions
• Cavitary Lung Lesions
The document discusses a case presentation at a morbidity and mortality conference. It involves a 70-year-old man who developed paralysis and numbness after a CO2 angiography procedure. He was initially diagnosed with anterior spinal artery syndrome from an air embolism, but later developed a fever and retroperitoneal abscess. He suffered respiratory failure and died despite resuscitative efforts. Cognitive biases and systems errors that may have affected the case are discussed. Debiasing strategies like teaching sessions and considering alternatives are proposed.
Ultrasound can be useful in the evaluation and diagnosis of patients presenting in shock. Integrating bedside ultrasound allows for a more accurate initial diagnosis and earlier treatment. The RUSH protocol assesses the heart, IVC, pericardial space and lungs to help classify the type of shock. Ultrasound findings of a dilated and collapsing IVC along with evidence of free fluid suggest the patient has hypovolemic shock likely due to internal bleeding.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Vijayan P Panirselvam, Advanced Acute Internal Medicine at Hospital Tengku Ampuan Rahimah, Malaysia.
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
This document summarizes pulmonary embolism (PE) diagnosis. It states that over 650,000 PE cases are diagnosed annually in the US, with a mortality rate of 30% that can be reduced to 3-10% with treatment. Computed tomography angiography (CTA) has become widely used as the primary diagnostic method, though some patients cannot undergo CTA due to contrast allergy or renal failure. Ventilation/perfusion (V/Q) scanning remains important and has significantly lower radiation exposure than CTA, making it preferable for some patients. Both CTA and V/Q scanning have limitations and neither has proven clearly superior to the other for PE diagnosis.
This document provides information on COVID-19 presentation and diagnosis. It discusses how the virus is transmitted via respiratory droplets, its pathogenesis by binding the ACE2 receptor, and typical symptoms like fever, cough and breathlessness. It outlines risk factors for severe disease like older age and comorbidities. Diagnostic tests involve PCR of respiratory samples and chest imaging showing patchy ground glass opacities. Prognosis is poor with increased oxygen needs, lymphopenia and elevated inflammatory markers.
Ultrasonography in Critically Ill PatientsGamal Agmy
This document discusses the use of chest sonography in critically ill patients. It notes that bedside chest radiography has limitations in critically ill patients. Chest sonography can help diagnose various lung conditions at the bedside including pulmonary consolidation, atelectasis, edema, effusions, and pneumothorax. It reviews the sonographic signs and patterns associated with these conditions. The document also discusses using lung ultrasound and IVC views to assess shock states and guide treatment. Overall, it promotes the use of bedside lung ultrasound as a valuable tool to complement radiography in critically ill patients.
Diagnostic imaging in COVID 19 pts in intensive care unitsmansoor masjedi
This document discusses the use of diagnostic imaging in COVID-19 patients. It presents a case study of a pregnant patient who was brought to the hospital for vaginal bleeding and underwent an emergency C-section. Though her initial chest CT and symptoms were normal, her condition deteriorated in the ICU. Ultrasound imaging of her lungs showed signs of pulmonary involvement that were concerning for COVID-19. The document emphasizes that lung ultrasound and CT scans can help in early diagnosis and monitoring of COVID-19, but clinical judgement is also needed. Imaging findings alone cannot replace a physician's knowledge and assessment.
This document summarizes the case of a 24-year-old patient with cyanotic heart disease who presented with breathlessness, fever, and a seizure. Examination found clubbing and cyanosis. Investigations including CT scan, ECG, and echo found features consistent with tetralogy of Fallot and a cerebral abscess. Aspiration of the abscess drained pus growing Pseudomonas. Patients with cyanotic heart disease are at higher risk for brain abscesses due to right-to-left shunting and low perfusion areas in the brain. Treatment involves aspiration of abscesses under local anesthesia and intravenous antibiotics for 6 weeks.
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Sean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team as they post these weekly educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics!
Nicolas Peschanski is an emergency physician in Rennes, France who has treated over 10,000 COVID-19 patients. He discusses the evolution of pre-hospital oxygen support guidelines during the pandemic. Initially, high-flow nasal cannula and non-invasive ventilation were used but were found to increase aerosolization risk. Studies showed COVID-19 causes atypical acute respiratory distress syndrome in some patients. Early intubation is now recommended for those requiring over 6L/min of oxygen. Boussignac CPAP may be suitable due to minimal air dispersion compared to other methods. The optimal pre-hospital oxygen support strategy must balance efficacy with limiting airborne virus spread.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Tuberculosis
- Button Battery Ingestion
- Constipation
- Hirschprung's Disease
- Aspiration Pneumonia
- Generalized Lymphatic Anomaly
- Pediatric Acute Respiratory Distress
A 67-year-old woman presented with respiratory symptoms and was diagnosed with COVID-19. One week later, she presented with worsening symptoms and was found to have a large hemorrhagic pericardial effusion causing cardiac tamponade. She underwent pericardiocentesis, draining 800ml of fluid. After the procedure, she developed signs of takotsubo cardiomyopathy. The case report discusses the rare presentation of cardiac tamponade secondary to COVID-19 infection and the subsequent development of takotsubo cardiomyopathy.
- Chest x-rays are not very sensitive for detecting early COVID-19 infections and changes seen can be subtle. CT scans are better for detection, especially in detecting ground glass opacities which are often peripheral and bilateral in early disease. Later in disease, consolidations and linear opacities may be seen. Ultrasound can detect B-lines, subpleural consolidations and thickened pleural lines which have been associated with COVID-19. Imaging is recommended for patients with moderate to severe COVID-19 and worsening respiratory status but is not routinely needed for mild or asymptomatic cases.
This document provides an overview of acute kidney injury (AKI). It begins with objectives of defining, staging and managing AKI, understanding referral criteria, highlighting less common intrinsic renal pathology, and understanding long term implications. It then outlines topics to be covered including perspectives on AKI, identification and definition, pathogenesis, guidelines, less common causes, dialysis and outcomes. It discusses perceptions of AKI between different specialties. It provides data on AKI incidence, risk factor assessment, investigations, treatment including fluids and renal replacement therapy. It discusses evidence and guidelines around these topics. It highlights long term outcomes of AKI including increased risk of chronic kidney disease and end stage kidney disease. Biomarkers for early detection of AKI
The document summarizes a case presentation on acute kidney injury (AKI) given at the ACE Dumaguete Doctors, Inc. Department of Internal Medicine Grand Rounds. It presents the case of a 77-year-old female who presented with hypogastric pain and was found to have mild anemia, leukocytosis, elevated serum creatinine and was diagnosed with chronic kidney disease. Her kidney function deteriorated after she underwent a right hemicolectomy for a colonic mass and she developed sepsis, leading to AKI. The discussion defines AKI, reviews its prevalence in hospital and ICU patients, and categorizes the etiologies of AKI into prerenal, intrinsic renal, and post
The document discusses pneumonia that requires admission to the intensive care unit (ICU). It notes that community-acquired pneumonia (CAP) can range from mild to severe, and involve multiple pathogens and antibiotic exposures. Viruses are detected in about 27% of CAP cases, with human rhinovirus and influenza being most common. Bacteria are found in 14% of cases, led by Streptococcus pneumoniae. The outcomes of patients with severe pneumonia admitted to the ICU have improved in recent years due to early administration of combination antibiotics and awareness of multidrug-resistant organisms and respiratory viruses as common causes. However, pneumonia remains associated with high mortality, especially if complications like septic shock or acute respiratory distress syndrome occur.
This document outlines the structure and approach for presenting and discussing a patient case, including defining the problem representation, generating a differential diagnosis, presenting pertinent history, exam findings, labs/imaging, investigations, diagnosis, and management. Key aspects include updating the problem representation and differential with each new piece of information, and separating the diagnostic "signal" from irrelevant "noise".
This document provides an overview of ocular anatomy and diagnostic techniques. It begins with introductory sections on vitreous anatomy, embryology, and stages of vitreous development. Subsequent sections cover diagnostic techniques including color photos, filters, and fluorescein angiography. Key points on interpreting fluorescein angiograms like early, mid, and late phase imaging and causes of hyperfluorescence and hypofluorescence are discussed. The document concludes with examples of anatomical structures and pathologies visualized on fluorescein angiography.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: March CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
• Acute Chest Syndrome
• Pneumothorax
• Tuberculosis
• Small Bowel Obstruction
• Intra-abdominal Abscess
• COVID-19
• Subcutaneous Emphysema
• Pneumoperitoneum
• Pneumomediastinum
• ECMO
• Pleural Effusions
• Cavitary Lung Lesions
The document discusses a case presentation at a morbidity and mortality conference. It involves a 70-year-old man who developed paralysis and numbness after a CO2 angiography procedure. He was initially diagnosed with anterior spinal artery syndrome from an air embolism, but later developed a fever and retroperitoneal abscess. He suffered respiratory failure and died despite resuscitative efforts. Cognitive biases and systems errors that may have affected the case are discussed. Debiasing strategies like teaching sessions and considering alternatives are proposed.
Ultrasound can be useful in the evaluation and diagnosis of patients presenting in shock. Integrating bedside ultrasound allows for a more accurate initial diagnosis and earlier treatment. The RUSH protocol assesses the heart, IVC, pericardial space and lungs to help classify the type of shock. Ultrasound findings of a dilated and collapsing IVC along with evidence of free fluid suggest the patient has hypovolemic shock likely due to internal bleeding.
This webinar is organized by MyICID and Institute for Clinical Research (ICR), NIH, Ministry of Health in conjunction with Neglected Tropical Disease Day 2022. The purpose of this webinar is to refresh and update our knowledge on Dengue fever, which has been overshadowed by COVID-19 since the beginning of the pandemic.
Presenter: Dr Vijayan P Panirselvam, Advanced Acute Internal Medicine at Hospital Tengku Ampuan Rahimah, Malaysia.
#dengue #WorldNTDDay #BeatNTDs #BestScienceforAll
This document summarizes pulmonary embolism (PE) diagnosis. It states that over 650,000 PE cases are diagnosed annually in the US, with a mortality rate of 30% that can be reduced to 3-10% with treatment. Computed tomography angiography (CTA) has become widely used as the primary diagnostic method, though some patients cannot undergo CTA due to contrast allergy or renal failure. Ventilation/perfusion (V/Q) scanning remains important and has significantly lower radiation exposure than CTA, making it preferable for some patients. Both CTA and V/Q scanning have limitations and neither has proven clearly superior to the other for PE diagnosis.
This document provides information on COVID-19 presentation and diagnosis. It discusses how the virus is transmitted via respiratory droplets, its pathogenesis by binding the ACE2 receptor, and typical symptoms like fever, cough and breathlessness. It outlines risk factors for severe disease like older age and comorbidities. Diagnostic tests involve PCR of respiratory samples and chest imaging showing patchy ground glass opacities. Prognosis is poor with increased oxygen needs, lymphopenia and elevated inflammatory markers.
Ultrasonography in Critically Ill PatientsGamal Agmy
This document discusses the use of chest sonography in critically ill patients. It notes that bedside chest radiography has limitations in critically ill patients. Chest sonography can help diagnose various lung conditions at the bedside including pulmonary consolidation, atelectasis, edema, effusions, and pneumothorax. It reviews the sonographic signs and patterns associated with these conditions. The document also discusses using lung ultrasound and IVC views to assess shock states and guide treatment. Overall, it promotes the use of bedside lung ultrasound as a valuable tool to complement radiography in critically ill patients.
Diagnostic imaging in COVID 19 pts in intensive care unitsmansoor masjedi
This document discusses the use of diagnostic imaging in COVID-19 patients. It presents a case study of a pregnant patient who was brought to the hospital for vaginal bleeding and underwent an emergency C-section. Though her initial chest CT and symptoms were normal, her condition deteriorated in the ICU. Ultrasound imaging of her lungs showed signs of pulmonary involvement that were concerning for COVID-19. The document emphasizes that lung ultrasound and CT scans can help in early diagnosis and monitoring of COVID-19, but clinical judgement is also needed. Imaging findings alone cannot replace a physician's knowledge and assessment.
This document summarizes the case of a 24-year-old patient with cyanotic heart disease who presented with breathlessness, fever, and a seizure. Examination found clubbing and cyanosis. Investigations including CT scan, ECG, and echo found features consistent with tetralogy of Fallot and a cerebral abscess. Aspiration of the abscess drained pus growing Pseudomonas. Patients with cyanotic heart disease are at higher risk for brain abscesses due to right-to-left shunting and low perfusion areas in the brain. Treatment involves aspiration of abscesses under local anesthesia and intravenous antibiotics for 6 weeks.
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Sean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team as they post these weekly educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics!
Nicolas Peschanski is an emergency physician in Rennes, France who has treated over 10,000 COVID-19 patients. He discusses the evolution of pre-hospital oxygen support guidelines during the pandemic. Initially, high-flow nasal cannula and non-invasive ventilation were used but were found to increase aerosolization risk. Studies showed COVID-19 causes atypical acute respiratory distress syndrome in some patients. Early intubation is now recommended for those requiring over 6L/min of oxygen. Boussignac CPAP may be suitable due to minimal air dispersion compared to other methods. The optimal pre-hospital oxygen support strategy must balance efficacy with limiting airborne virus spread.
Drs. Olson’s and Jackson’s CMC Pediatric X-Ray Mastery: October CasesSean M. Fox
Drs. Olson and Jackson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team and Drs. Nikki Richardson, Mary Grady, and Michael Gibbs as they post these educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology. This month’s topics include:
- Tuberculosis
- Button Battery Ingestion
- Constipation
- Hirschprung's Disease
- Aspiration Pneumonia
- Generalized Lymphatic Anomaly
- Pediatric Acute Respiratory Distress
A 67-year-old woman presented with respiratory symptoms and was diagnosed with COVID-19. One week later, she presented with worsening symptoms and was found to have a large hemorrhagic pericardial effusion causing cardiac tamponade. She underwent pericardiocentesis, draining 800ml of fluid. After the procedure, she developed signs of takotsubo cardiomyopathy. The case report discusses the rare presentation of cardiac tamponade secondary to COVID-19 infection and the subsequent development of takotsubo cardiomyopathy.
This document provides an overview of arrhythmias for medical residents. It outlines an approach to classifying arrhythmias based on rate, regularity, and QRS width. Specific arrhythmias covered include sinus bradycardia, atrial fibrillation, atrial flutter, AV nodal reentrant tachycardia, ventricular tachycardia, and various types of heart block. The document also discusses how to determine if a wide complex tachycardia requires cardioversion or defibrillation versus medical treatment. Examples of EKGs are provided for different arrhythmias.
This document provides an introduction to EKG interpretation and outlines the systematic approach of evaluating an EKG. It covers the key components to assess, including rate, rhythm, axis, conduction abnormalities, and morphology. Specific conditions are reviewed such as sinus rhythm, bundle branch blocks, AV blocks, ischemia, and infarction. Examples are provided throughout to demonstrate application of the principles. The overall goal is to understand the fundamentals of the EKG and systematically analyze it following the standard approach of rate, rhythm, axis, conduction, morphology.
This document provides an overview of congestive heart failure, including definitions, types, classification, time course, and treatment strategies. It defines CHF as a syndrome most commonly caused by cardiomyopathy. It describes types as right or left heart failure, and with reduced or preserved ejection fraction. Treatment objectives for acute CHF are to decrease congestion and increase perfusion, while chronic CHF aims to slow functional decline. Key medications that improve mortality in chronic CHF include ACE inhibitors, beta blockers, aldosterone antagonists, and ARNI.
This document discusses key concepts for understanding medical tests, including sensitivity, specificity, predictive values, and how to construct a contingency table. It begins by defining sensitivity as the percentage of true positives among those with the disease, and specificity as the percentage of true negatives among those without the disease. Prevalence affects the numbers in the contingency table. Positive and negative predictive values depend on prevalence in addition to sensitivity and specificity. Examples are used to illustrate these concepts for different diseases and testing scenarios.
This document provides an overview of an evidence-based medicine seminar. It discusses using medical literature to help make better clinical decisions. The learning objectives are to understand EBM, ask clinical questions, understand different types of medical literature and validity, apply Bayes' theorem to diagnosis, understand metrics for treatment effects, and access secondary sources. It emphasizes using a structured approach to ask, acquire, assess, and apply evidence to answer clinical questions.
This document provides guidance to residents on productive scholarly work and mentorship. It outlines the scholarly activity requirement, importance of mentorship, timeline for research projects, and types of projects residents should consider. These include case reports, quality improvement projects, retrospective research, reviews, editorials, and education/teaching projects. Choosing a project aligned with career goals and that has support from a mentor will maximize the chances of a successful scholarly experience.
This document discusses the fundamentals of using vasopressors. It outlines the steps to determine when to start vasopressors: 1) Is the patient's blood pressure too low? 2) Why is the blood pressure low? 3) How to raise the blood pressure? Norepinephrine is generally the first-line vasopressor. Adjuncts like vasopressin and steroids may be considered if norepinephrine dose is high. Peripheral intravenous lines can be used for vasopressors in the short term but central lines are preferable at higher doses due to risk of extravasation from peripheral lines.
The document provides guidance for medical residents on handling on-call duties, including tips for sign-out, answering calls, and protocols for managing the five most common and five scariest call scenarios. It outlines approaches for prioritizing tasks, responding to and triaging calls, and standardized processes for issues like insomnia, nausea, pain, constipation, high blood pressure, NPO restrictions, patients leaving AMA, abnormal heart rhythms, and managing insulin. The goal is to equip residents with effective strategies and decision-making frameworks for their on-call responsibilities.
This document discusses SARS-CoV-2 transmission and characteristics. It addresses how the virus can spread through small aerosols or large droplets, and the protective measures appropriate for each. It also examines the virus's ability to spread before symptoms appear and challenges for contact tracing. Additionally, it covers the reproductive number of the virus and importance of identifying mild and asymptomatic cases.
This document discusses challenges related to rationing care and crisis standards during the COVID-19 pandemic. It presents two cases where a hospital is at capacity and needs to decide whether to remove a patient from a ventilator or withhold intubation to reallocate the ventilator to other patients with better prognoses. It also discusses the ethics of prioritizing the needs of individual patients versus the wider population and proposes establishing crisis triage teams to make difficult resource allocation decisions impartially. The document further examines precedents for rationing healthcare resources like dialysis and transplants as well as who should receive priority for scarce COVID vaccines. It also outlines Utah's crisis standards of care plan implemented by the governor during public health emergencies
This document discusses the analysis and management of pleural fluid and pancreaticopleural fistulas. It outlines criteria for distinguishing transudative, exudative, and lymphatic pleural effusions. It notes that amylase-rich pleural fluid could indicate a pancreatic or cancerous origin, and diagnostic testing of pleural fluid has about a 50% yield for detecting cancer. Management options for pancreaticopleural fistulas include observation for spontaneous resolution in 40-60% of cases within 6 weeks, octreotide to lower output, enteral feeding, and stent placement which can resolve the fistula in 55-90% of cases.
A 74-year-old woman on immunosuppressive medications for oral lichen planus presented with worsening respiratory failure after being treated for hypercalcemia. Initial tests showed increased oxygen needs and abnormal chest x-ray. She was diagnosed with Pneumocystis jirovecii pneumonia (PJP) based on a positive PCR test of her lungs. PJP is a fungal infection that causes pneumonia in immunocompromised patients. While her symptoms began with hypercalcemia, it is possible the underlying cause was an atypical infection like PJP leading to abnormal vitamin D activation. She was treated successfully for PJP with antibiotics and steroids.
This document describes efforts at the University of Utah and George E Wahlen VA Medical Center to decrease time to treatment for acute stroke patients. It outlines the previous disorganized stroke response process and near misses. The new standardized "Brain Attack" order set and protocol aims to promptly activate the on-call neurology team, contact the radiology reading room for after-hours imaging, and streamline the workflow to reduce delays. It provides an overview of the updated stroke response steps to recognize symptoms, activate the order set, perform assessments, image interpretation, and determine treatment. The goal is to improve reliability and allow for potential reperfusion therapies.
The Effect of OSA Severity and CPAP Adherence on Weight Regain After Bariatri...Brian Locke
This study examined whether weight regain after bariatric surgery is correlated with the severity of obstructive sleep apnea (OSA) or adherence to continuous positive airway pressure (CPAP) therapy. The study reviewed data from 116 patients who underwent bariatric surgery and had preoperative OSA testing. On average, patients lost over 35 kilograms initially but regained around 8 kilograms. There was no significant difference in weight regain between those who used CPAP and those who did not. Additionally, the severity of preoperative OSA was not correlated with the amount of initial weight loss or subsequent weight regain.
University of Utah Internal Medicine - Journal Club CurriculumBrian Locke
This document describes changes made to a medical residency journal club to make it more useful and enjoyable for trainees. The changes included: 1) Framing discussions around a clinical practice guideline and supporting literature as they relate to a patient case; 2) Having two residents critically appraise the guideline and literature using worksheets; 3) Creating facilitator guides to help prepare teaching points for different study designs; and 4) Repeating the same topic for successive resident cohorts. A survey found residents rated the new format as more effective for learning across different domains compared to the traditional format.
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
(June 12, 2024) Webinar: Development of PET theranostics targeting the molecu...Scintica Instrumentation
Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
ESA/ACT Science Coffee: Diego Blas - Gravitational wave detection with orbita...Advanced-Concepts-Team
Presentation in the Science Coffee of the Advanced Concepts Team of the European Space Agency on the 07.06.2024.
Speaker: Diego Blas (IFAE/ICREA)
Title: Gravitational wave detection with orbital motion of Moon and artificial
Abstract:
In this talk I will describe some recent ideas to find gravitational waves from supermassive black holes or of primordial origin by studying their secular effect on the orbital motion of the Moon or satellites that are laser ranged.
This is on the CLINICAL USE of imaging – I’m not qualified to actually talk about the nuances of interpretation themselves… only how you should use the imaging.
Even if they give you the report, it comes down to how to interpret it and integrate with decision making. => A little deeper dive in towhen imaging can help in the diagnosis.
Goal of practice: to synthesize knowledge around what the findings actually mean, especially for CT and US. CXR – just need to know this.
And know at least 1 reason why Brian hates iCentra.
Note: clinically correlate = pre-test probability
As you’ll hear, “we don’t know the sensitivity” is the common answer to how good this test is… unfortunately, we need to make decisions now – so we’re still using the test even without knowing. Here’s ‘going beyond that we don’t’ know the sensitivity’
Unfortunately, I’m not going to give an algorithm, because it’s going to be wrong.
This started the idea that maybe because sensitive tests are for screening (more on this) and this is very sensitive in the study (98% by repeat RT-PCR testing), then we should use this for screening.
However, 2 problems: 1 is selection bias (only some people got CT scans, and we don’t know why). “One limitation of their study was selection bias. Patients in the cohort were selected to undergo CT on the basis of unknown clinical factors that may have distinguished them from similar patients who did not undergo CT. “
The other has to do with test characteristics
CT scan – details of Luke Oakden-Raynor’s presentation, and summary of the society recommendations - https://lukeoakdenrayner.wordpress.com/2020/03/23/ct-scanning-is-just-awful-for-diagnosing-covid-19/
SENSITIVITY = Get people WITH the disease. In what proportion is the new test correct?
SPECIFICITY = Get people WITHOUT the disease. In what proportion is the new test correct?
PPV = Get people WITH a positive test. In what proportion is the test correct?
NPV = Get people WITHOUT a positive test. In what proportion is the test correct?
Sensitivity / Specificity = mostly measure how good the test is.
----
Review this only to highlight that these are best at the population level – likelihood ratio is better individual.
SPecificity rules in, SeNsitivity rules OUT – not exactly true. But we’ll return to that.
Sensitivity & Specificity = mostly measure how good the test is.
Of course this is not directly what we’re interested in, as two other key pieces of information before it’s used: how reliably the sample is collected, and is the virus in the fluid sampled during the disease.
PPV/NPV depends on a population prevalence, and gives us an average across the population = can give population level information, but difficult to apply to individual patients, who likely have characteristics that differ from the ‘average’ in a population.
https://calculator.testingwisely.com/playground/5/90/90/positive
Note: this is all done in odds
Reason to use this (vs sens spec): it itemizes the test as just 1 data point out of many that you might consider.
Pretest -> if it’s your first test, this might be the population prevalence (if screening). If you’re using this as a test, it might be the post-test after, say, a negative PCR.
Note: whats the utility of bayes? Using a normative theory illustrates many of the pitfalls we might fall in to.
SPecificity rules in, SeNsitivity rules OUT – not exactly true.
Example:
Another source: pooled sensitivity of 94% and specificity 37%
Princess cruise ship who had COVID-19, CT findings were observed for 80% versus 46% of patients with and without symptoms, respectively [8]
These +LR and –LR are weak sauce. Your decision to test… maybe not all that influenced by CT findings?
The rule of 100.
SPecificity rules in, SeNsitivity rules OUT – not exactly true.
Because if sensitivity + specificity sums to 100, no information is added by the test. (LR = 1).
Can see this a few ways:
Coin flips (weighted coin flips)
Math for LR formula
Visualized in chart:
Sensitivity & Specificity = mostly measure how good the test is. LR further away from 1 are ‘better tests’ = give you stronger information. LR green zone.= further from 1
CT FOR SCREENING, falls in to the yellow area – not very strong evidence.
Imaging does have a role: in supporting or refuting specific hypotheses.
50 healthy F w 1 wk of SOB, my ddx includes PE, Bact Pna, or COVID. If a CXR is INCONSISTENT with some of these diagnoses, it makes it much less likely that is the diagnosis. (Eg no consolidation = I shouldn’t attribute hypoxia to that). More formally, this happens if the finding occurs more often in 1 diagnosis than the other (even though it may not be that helpful in all comers).
Key:
Myalgia, fever, malaise, 1 week.
Imaging should be hypothesis testing
It’s usefulness depends on your differential diagnosis, and differential likelihood of the finding among the different considerations.
Differential presence - e.g. if the imaging finding is inconsistent, useful. If the findings are differentially present among ddx
Imaging is unlikely to help you at all for COVID vs other respiratory illness, but can be especially helpful for excluding PE, CHF, etc.
So, focus really needs to be on the findings specific to COVID compared to OTHER ITEMS ON THE DDx. SO GIVE THE HISTORY WHEN ORDERING – the test is not useful without it. They can help interpret the relative frequency of the findings.
As I demonstrated earlier, CT (and thus, by extension, CXR which certainly has worse characteristics) is NOT sufficient to provide useful information outside of the context of a hypothesis.
Opacity v lucency (Task 1: identify whiteness that shouldn’t be there)
Consolidation is more of a measure of the texture and hardening of the lungs.
Infiltrate = something in the airspaces (somewhat imprecise terms)
Note that patchy opacity and multifocal opacity do NOT mean the same thing.
Example: yes/no
DDx = COVID vs other URI (no dyspneic)
Atelectasis vs Air-space opacity
Volume loss = normal volume
Ipsilateral shift = no shift
Linear or Wedge shaped = lobar / segmental / multifocal
Apex is at hilum = no centered at hilum
Subtypes of atelectasis:
Resorptive = because of obstruction or mucus plug
Passive = PTX or Effusion
Compressive = nearby mass lesion
Scarring
Adhesive
Gravity-dependent atelectasis: Example Above
Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 7312
very commonly seen in the posterior lung bases on CT, particularly in elderly individuals.
Atelectasis vs Air-space opacity
Volume loss = normal volume
Ipsilateral shift = no shift
Linear or Wedge shaped = lobar / segmental / multifocal
Apex is at hilum = no centered at hilum
Subtypes of atelectasis:
Resorptive = because of obstruction or mucus plug
Passive = PTX or Effusion
Compressive = nearby mass lesion
Scarring
Adhesive
Gravity-dependent atelectasis: Example Above
COVID?
COVID?
What are GGOs? How is it different than consolidation?
Radio-pathological correlate: What is it, How do you identify it
GGO = still can see the architecture under, partially filled airspace
Consolidation = cannot see architecture under
3 categories: found in COVID, found in COVID and alternatives, not found in COVID
Peripheral, bilateral GGO’s with or without consolidation or intralobular lines (=crazy-paving)
(hilar would be less typical -> more suggestive of E-vali)
Multifocal Ggos. Reverse halo sign = organizing pneumonia in later disease.
However, a significant portion of cases have opacities without a clear or specific distribution (8). A predominant perihilar pattern was not reported => E-vali
CT pattern resembling organizing pneumonia, notably peripheral ground-glass opacities (GGO) and nodular or mass-like GGO that are often bilateral and multilobar (11). However, additional imaging findings have also been reported including linear, curvilinear or perilobular opacities, consolidation, and diffuse GGO, which can mimic several disease processes including other infections, inhalational exposures, and drug toxicities
Bronchial wall thickening, mucoid impactions, and nodules (“tree-in-bud” and centrilobular) seen commonly in infections, are not typically observed (8). Lymphadenopathy and pleural effusion have been rarely reported
A slight majority of patients had a negative CT during the first two days after symptom onset with GGO usually developing between day 0 and 4 after symptom onset and peaking at 6-13 days
A peripheral distribution of GGO was found to correctly distinguish COVID-19 from other viral causes 63-80% of the time. However, the authors did not include high numbers of influenza-A or any noninfectious causes such as drug reaction, which could degrade radiologists’ performance.
RSNA citation: