Compared to internal jugular and femoral central venous catheters (CVCs), I prefer placing subclavian CVCs because they don’t tether patients’ necks, they’re easy to access, they’re easy to dress, and they’re in a part of the body that doesn’t “bend.” Subclavian vein cannulation is similar to epidural catheter placement in…
Patients with liver cirrhosis often have low platelets (splenic sequestration) and elevated INRs due to decreased synthesis of factor VII, among other clotting factors; however, remember that they also have reduced synthesis of anticoagulant proteins like proteins C/S and antithrombin. The quantitative/qualitative platelet defects are offset to some degree by…
Enoxaparin (Lovenox) is a low molecular weight heparin (LMWH) routinely administered subcutaneously (SC) for prophylaxis or treatment of deep vein thrombosis, acute pulmonary embolism, and even medically-managed STEMIs (+/- percutaneous coronary interventions).
To maximize gas exchange, well-ventilated alveoli (V) should be associated with good pulmonary capillary blood perfusion (Q). This is the idea behind V/Q matching. Gravitational forces create heterogeneity perfusing dependent portions of the lung better – the lung base in the upright position, and the posterior lung in the supine…
In order for the heart muscle to actually contract, the physiological process of excitation-contraction coupling must occur via an action potential propagated through the myocardium. Normally, these muscle cells have a resting transmembrane potential (TMP) around -90 mV (more negative intracellularly than extracellularly). This gradient is created and changed by…
Tigecycline (Tygacil) is an intravenous glycylcycline antibiotic used to treat a variety of skin/soft tissue infections, complicated intra-abdominal infections, and community-acquired pneumonia (NOT hospital/ventilator-acquired pneumonia).
Endotracheal tubes (ETTs) and tracheostomy tubes have pilot balloons which are inflated to expand a pilot cuff situated within the trachea below the vocal cords. This is termed a “secure airway.”
Subcutaneous emphysema occurs when air gets trapped within the subcutaneous regions of the face, neck, chest wall, abdomen, and even down to the thighs/legs. The characteristic physical exam finding of crepitus (“snap-crackle-pop”) is caused by air traversing tissue planes during palpation.
With all the discussion surrounding antibody production after receiving a COVID-19 vaccine, let’s talk about the structure of an antibody.
In severe COVID-19 pneumonia with refractory hypoxemia, patients are often proned (put on their abdomen), deeply sedated, and paralyzed to improve synchrony with the ventilator. The goal with proning is to create a more homogenous alveolar recruitment thereby decreasing shunting (parts of the lung where there is pulmonary blood flow…