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Southwest Pulmonary and Critical Care Fellowships

Critical Care

Last 50 Critical Care Postings

(Most recent listed first. Click on title to be directed to the manuscript.)

July 2024 Critical Care Case of the Month: Community-Acquired
   Meningitis
April 2024 Critical Care Case of the Month: A 53-year-old Man Presenting
   with Fatal Acute Intracranial Hemorrhage and Cryptogenic Disseminated
   Intravascular Coagulopathy 
Delineating Gastrointestinal Dysfunction Variants in Severe Burn Injury
   Cases: A Retrospective Case Series with Literature Review
Doggonit! A Classic Case of Severe Capnocytophaga canimorsus Sepsis
January 2024 Critical Care Case of the Month: I See Tacoma
October 2023 Critical Care Case of the Month: Multi-Drug Resistant
   K. pneumoniae
May 2023 Critical Care Case of the Month: Not a Humerus Case
Essentials of Airway Management: The Best Tools and Positioning for
   First-Attempt Intubation Success (Review)
March 2023 Critical Care Case of the Month: A Bad Egg
The Effect of Low Dose Dexamethasone on the Reduction of Hypoxaemia
   and Fat Embolism Syndrome After Long Bone Fractures
Unintended Consequence of Jesse’s Law in Arizona Critical Care Medicine
Impact of Cytomegalovirus DNAemia Below the Lower Limit of
   Quantification: Impact of Multistate Model in Lung Transplant Recipients
October 2022 Critical Care Case of the Month: A Middle-Aged Couple “Not
   Acting Right”
Point-of-Care Ultrasound and Right Ventricular Strain: Utility in the
   Diagnosis of Pulmonary Embolism
Point of Care Ultrasound Utility in the Setting of Chest Pain: A Case of
   Takotsubo Cardiomyopathy
A Case of Brugada Phenocopy in Adrenal Insufficiency-Related Pericarditis
Effect Of Exogenous Melatonin on the Incidence of Delirium and Its
   Association with Severity of Illness in Postoperative Surgical ICU Patients
Pediculosis As a Possible Contributor to Community-Acquired MRSA
   Bacteremia and Native Mitral Valve Endocarditis
April 2022 Critical Care Case of the Month: Bullous Skin Lesions in
   the ICU
Leadership in Action: A Student-Run Designated Emphasis in
   Healthcare Leadership
MSSA Pericarditis in a Patient with Systemic Lupus
   Erythematosus Flare
January 2022 Critical Care Case of the Month: Ataque Isquémico
   Transitorio in Spanish 
Rapidly Fatal COVID-19-associated Acute Necrotizing
   Encephalopathy in a Previously Healthy 26-year-old Man 
Utility of Endobronchial Valves in a Patient with Bronchopleural Fistula in
   the Setting of COVID-19 Infection: A Case Report and Brief Review
October 2021 Critical Care Case of the Month: Unexpected Post-
   Operative Shock 
Impact of In Situ Education on Management of Cardiac Arrest after
   Cardiac Surgery
A Case and Brief Review of Bilious Ascites and Abdominal Compartment
   Syndrome from Pancreatitis-Induced Post-Roux-En-Y Gastric Remnant
   Leak
Methylene Blue Treatment of Pediatric Patients in the Cardiovascular
   Intensive Care Unit
July 2021 Critical Care Case of the Month: When a Chronic Disease
   Becomes Acute
Arizona Hospitals and Health Systems’ Statewide Collaboration Producing a
   Triage Protocol During the COVID-19 Pandemic
Ultrasound for Critical Care Physicians: Sometimes It’s Better to Be Lucky
   than Smart
High Volume Plasma Exchange in Acute Liver Failure: A Brief Review
April 2021 Critical Care Case of the Month: Abnormal Acid-Base Balance
   in a Post-Partum Woman
First-Attempt Endotracheal Intubation Success Rate Using A Telescoping
   Steel Bougie
January 2021 Critical Care Case of the Month: A 35-Year-Old Man Found
   Down on the Street
A Case of Athabaskan Brainstem Dysgenesis Syndrome and RSV
   Respiratory Failure
October 2020 Critical Care Case of the Month: Unexplained
   Encephalopathy Following Elective Plastic Surgery
Acute Type A Aortic Dissection in a Young Weightlifter: A Case Study with
   an In-Depth Literature Review
July 2020 Critical Care Case of the Month: Not the Pearl You Were
   Looking For...
Choosing Among Unproven Therapies for the Treatment of Life-Threatening
   COVID-19 Infection: A Clinician’s Opinion from the Bedside
April 2020 Critical Care Case of the Month: Another Emerging Cause
   for Infiltrative Lung Abnormalities
Further COVID-19 Infection Control and Management Recommendations for
   the ICU
COVID-19 Prevention and Control Recommendations for the ICU
Loperamide Abuse: A Case Report and Brief Review
Single-Use Telescopic Bougie: Case Series
Safety and Efficacy of Lung Recruitment Maneuvers in Pediatric Post-
   Operative Cardiac Patients
January 2020 Critical Care Case of the Month: A Code Post Lung 
   Needle Biopsy
October 2019 Critical Care Case of the Month: Running Naked in the
   Park
Severe Accidental Hypothermia in Phoenix? Active Rewarming Using 
   Thoracic Lavage

 

For complete critical care listings click here.

The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.

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Saturday
Nov212015

Ultrasound for Critical Care Physicians: 50 Ways to Line Your Liver

Seth Skiles ACNP

Theresa Heynekamp MD MPH

 

Division of Pulmonary, Critical care and Sleep Medicine,

University of New Mexico School of Medicine

Albuquerque, NM USA

 

A 54-year-old man with a past medical history significant for traumatic brain injury and aspiration pneumonia presented with hypoxic respiratory failure secondary to foreign body aspiration.

On presentation, the patient was found to be hypoxic and tachypneic, requiring endotracheal intubation and mechanical ventilation. Bronchoscopy was performed with removal of extensive food particles throughout both lungs. The patient subsequently developed sepsis secondary to aspiration pneumonia.  He became hypotensive, requiring central venous catheter placement for vasopressor therapy. A right subclavian central line was attempted under ultrasound guidance. A beside ultrasound was subsequently performed (Video 1).

Video 1. Sagittal view of the liver and heart at the level of the mid-abdomen and slightly right of mid-line.

 

What does the video obtained of a longitudinal view of the IVC at the level of the liver demonstrate? (Click on the correct answer for a discussion)

Cite as: Skiles S, Heynekamp T. Ultrasound for critical care physicians: 50 ways to line your liver. Southwest J Pulm Crit Care. 2015;11(5):235-7. doi: http://dx.doi.org/10.13175/swjpcc144-15 PDF

Monday
Nov022015

November 2015 Critical Care Case of the Month

Samir Sultan, DO

Banner University Medical Center Phoenix

Phoenix, AZ

 History of Present Illness

A 39-year-old Caucasian woman was admitted to the ICU with worsening dyspnea and increasing oxygen requirements. Her lips turned blue with minimal activity. She was admitted to another hospital 5 months earlier with pneumonia. At discharge she was placed on oxygen. At follow-up with her pulmonologist, she was diagnosed with sleep apnea.

Past Medical History, Family History, Social History

  • She has a history of an optic glioma at age 7 with resection followed by radiation therapy and development of panhypopituitarism.
  • Liver cirrhosis diagnosed in 2014 with presentation of hematemesis.
  • Type 2 diabetes mellitus
  • Denies tobacco, ethanol, or illicit drug use.
  • There is a family history of diabetes and liver cirrhosis

Physical Examination

  • Vital signs:110 / 86, HR 97, RR 16, 88% on 6 liter O2
  • General: obese female (BMI 35) in no apparent distress
  • Chest: Clear to auscultation bilaterally
  • Cardiovascular: regular rate without murmur or rub
  • The remainder of the physical exam is normal  

Radiography

      A chest x-ray was interpreted as normal.

Laboratory

  • CBC: hemoglobin 13.8 gm/dL, WBC 7 X 103 cells/microliter with a normal differential
  • Basic metabolic panel: Na+ 132 mEq/L, K+ 4 mEq/L, Cl- 100 mEq/L, HCO3- 22 mEq/L, glucose 150 mg/dL.
  • Arterial blood gases (ABGs): PaO2 35 mm Hg, PaCO2 37 mm Hg, pH 7.43

Which of the following is/are not possible cause(s) of hypoxemia in this patient? (Click on the correct answer to proceed to the second of six panels)

  1. Decreased diffusion (alveolar capillary block)
  2. Ventilation-perfusion mismatch
  3. Hypoventilation
  4. 1 and 3
  5. All of the above

Cite as: Sultan S. November 2015 critical care case of the month. Southwest J Pulm Crit Care. 2015;11(5):209-15. doi: http://dx.doi.org/10.13175/swjpcc137-15 PDF

Tuesday
Oct202015

Ultrasound for Critical Care Physicians: The Martian

Jawad Abukhalaf, MD

Michel Boivin, MD

 

Division of Pulmonary, Critical care and Sleep Medicine,

University of New Mexico School of Medicine

Albuquerque, NM USA

 

A 54 year old male with a past medical history significant for granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis) and chronic kidney disease presented with hemoptysis and chest pain.

On presentation, he was found to have a 10 cm right middle lobe cavitary lesion and was subsequently treated with high dose steroids, antibiotics and antifungals based on bronchoalveolar lavage results. On day 9 of his hospital stay the patient was found to have bilateral lower extremity deep venous thromboses that were treated with intravenous heparin. On day 11 of his stay, the patient started experiencing lower abdominal pain and hypotension. The patient was resuscitated with saline. Bedside ultrasonography was performed.

Figure 1. Transverse lower abdominal ultrasound in the pelvis.

What does the transverse view of the lower abdomen (just above the symphysis pubis) demonstrate? (Click on the correct answer for an explanation)

Cite as: Abukhalaf J, Boivin M. Ultrasound for critical care physicians: the martian. Southwest J Pulm Crit Care. 2015;11(4):186-8. doi: http://dx.doi.org/10.13175/swjpcc135-15 PDF 

Friday
Oct022015

October 2015 Critical Care Case of the Month: A Moldy But Gooey

Jennifer M. Hall, DO

Banner University Medical Center Phoenix

Phoenix, AZ

History of Present Illness

A 45-year-old man with a history of a kidney transplant in 2011 was admitted with subjective fevers, nausea, abdominal pain, chest pain and recurrent renal failure. Cardiac workup was negative for ischemia and intermittent hemodialysis was initiated. CT of chest and abdomen was significant for a new cavitary pulmonary lesion. Leading up to this admission, he had been on immunosuppressive agents including tacrolimus, mycophenolate and prednisone, and the day of presentation had been doing quite well, actually was bear hunting in the mountains near Flagstaff, Arizona.

Past Medical History

  • Donor kidney transplant in 1999, which failed in 2011, prompting a second kidney transplant
  • Failed pancreas transplant
  • Coronary artery disease, with percutaneous cardiac intervention in 2001
  • Diabetes mellitus type I
  • Chronic anemia
  • History of total parathyroidectomy
  • History of C5-C7 cervical fixation

Physical Examination

  • Vital signs stable
  • Appeared to be pale, no apparent distress
  • Cardiac exam unremarkable
  • Chest exam with fine crackles in left base / otherwise clear
  • Abdomen slightly tender in left lower quadrant, but without guarding, rebound or peritoneal signs; small dime-sized area of ecchymosis, where lovenox injections had been administered
  • No peripheral edema or clubbing

Laboratory Evaluation

  • WBC 17,900 cells/mcL with 96% segmented neutrophils, hemoglobin 8.9 g/dL(after transfused 2 units prior to transfer), PLT 232,000 cells/mcL,
  • INR 1.3
  • Blood urea nitrogen (BUN) 74 mg/dL, serum creatinine 2.32 mg/dL, electrolytes within normal limits, albumin 3.2 g/dL, aspartate aminotransferase (AST) 24 IU/L, alanine transaminase (ALT)81 IU/L.
  • NT-proBNP 6841 pg/ml (normal < 300 pg/ml)
  • Hemoglobin A1C 7.2%
  • Lactate 0.7 mmol/L

Imaging

A thoracic CT scan was performed (Figure 1).

Figure 1. Panels A-D: representative static views from the CT scan in lung windows. Note the cavitary lesion in the right lung (red arrow), the right pleural effusion (blue arrow) and the left lower lobe consolidation (yellow arrow) with a pleural effusion. Lower panel: video of the thoracic CT scan in lung windows.

Which diagnosis is least likely in this patient’s differential diagnosis for the cavitary pulmonary lesion? (Click on the correct answer to proceed to the second of five panels)

  1. Aspergillosis
  2. Coccidioidomycosis
  3. Invasive mucormycosis
  4. Metastatic malignancy
  5. Nocardiosis
  6. Pulmonary Infarct

Cite as: Hall JM. October 2015 critical care case of the month: a moldy but gooey. Southwest J Pulm Crit Care. 2015;11(4):136-43. doi: http://dx.doi.org/10.13175/swjpcc130-15 PDF

Thursday
Sep102015

Ultrasound for Critical Care Physicians: Shortness of Breath

Matthew JK Douglas, MD

David Verbunker, MD

Jarrod Mosier, MD 

Department of Emergency Medicine

Banner University Medical Center Tucson

University of Arizona

Tucson, AZ

 

Figure 1. Video of the right thoracic ultrasound (coronal).

An 85 year old woman with a history of congestive heart failure and diabetes presented to the emergency department with progressive shortness of breath. She had recently been discharged from another hospital where she had been admitted for several days for community acquired pneumonia. The patient was in respiratory distress on arrival with tachypnea, increased work of breathing, and hypoxia despite supplemental oxygen with a non-rebreather mask and she was subsequently intubated. ED point-of-care ultrasound was performed of the right hemithorax.

What does Figure 1 demonstrate? (Click on the correct answer for the second of two panels and an explanation)

  1. Intravascular volume depletion
  2. Normal lung aeration
  3. Numerous B-lines
  4. Pleural effusion and consolidation
  5. Pneumothorax

Cite as: Douglas MJK, Verbunker D, Mosier J. Ultrasound for critical care physicians: shortness of breath. Southwest J Pulm Crit Care. 2015;11(3):112-3. doi: http://dx.doi.org/10.13175/swjpcc116-15 PDF