Aerobic organisms are the main cause of aspiration pneumonia and not anaerobes due to the inhalation of oropharyngeal microbes, therefore we no longer Tx with clindamycin - we give Ceftriaxone plus Azithromycin
in regards to managing increased pco2 levels, most of the questions i'm getting on UWorld prefer increasing respiratory rate as a opposed to tidal volume to limit barotrauma. thoughts?
It depends on the situation. Do you have a particular example? For example if it is an ARDS patient, then yes you would want to have low TV. But as a general rule of thumb, from a physiological standpoint, the most effective way to blow off Co2 is via TV not RR due to deadspace.
@@DoctorHighYieldMD Hi! I just did a question like that in UWORLD. Their explanation for choosing Respiratory Rate over Tidal Volume was that excessive manipulation of Tidal volume could cause barotrauma. According to this, While Tidal Volume manipulation is the most efficient, adjusting respiratory rate was the most safe for the patient. Thank you for the awesome videos!
Meli Be yes if they were initially hyperventilating and now they have pco2 of 35 and above that's alarming you want to intubate. But u have to look at the vignette carefully. If someone with asthma comes in and was in no respiratory distress u don't intubate because what if they were truly breathing fine. You want to intubate if a patient is having an asthma attack, respiratory distress, lips pursed, hypoxic, and then Abg shows normal pco2 that is not normal, they should be hyperventilating, therefore it means they are getting weak so u want to intubate before they stop breathing all together
Hi highyieldguy, around 13:30 you're talking about lactate, but the screen went blank. Just wasn't sure if it was intentional. Thank you for the videos though!
so if you have an exacerbation do you start on azithromycin and do you change to zosyn if you have pneumonia? when do you preferer invasive ventilation instead of non invasive in COPD patient? do you prefer bpap rather than cpap right? Thank you so much !!!
You add LABA to inhaled steroid in moderate persistent Asthma when the patient is having symptoms daily or walking up at night due to Asthma more than once per week.
Update regarding Aspiration Pneumonia treatment:
Anaerobic coverage no longer recommended UNLESS lung abscess or empyema is suspected.
Aerobic organisms are the main cause of aspiration pneumonia and not anaerobes due to the inhalation of oropharyngeal microbes, therefore we no longer Tx with clindamycin - we give Ceftriaxone plus Azithromycin
In the most recent Kaplan QA, the correct answer was Clinda
Can I ask when this was the most recent guideline? I remember this to be the case but cannot remember when this was implemented
in regards to managing increased pco2 levels, most of the questions i'm getting on UWorld prefer increasing respiratory rate as a opposed to tidal volume to limit barotrauma. thoughts?
It depends on the situation. Do you have a particular example? For example if it is an ARDS patient, then yes you would want to have low TV. But as a general rule of thumb, from a physiological standpoint, the most effective way to blow off Co2 is via TV not RR due to deadspace.
@@DoctorHighYieldMD Hi! I just did a question like that in UWORLD. Their explanation for choosing Respiratory Rate over Tidal Volume was that excessive manipulation of Tidal volume could cause barotrauma. According to this, While Tidal Volume manipulation is the most efficient, adjusting respiratory rate was the most safe for the patient. Thank you for the awesome videos!
Thank you for this great video 😊
Thank you so much for your awesome videos. Minute 3:28, what C02 percentage should prompt us to intubate pt? 35% and above?
Meli Be yes if they were initially hyperventilating and now they have pco2 of 35 and above that's alarming you want to intubate. But u have to look at the vignette carefully. If someone with asthma comes in and was in no respiratory distress u don't intubate because what if they were truly breathing fine. You want to intubate if a patient is having an asthma attack, respiratory distress, lips pursed, hypoxic, and then Abg shows normal pco2 that is not normal, they should be hyperventilating, therefore it means they are getting weak so u want to intubate before they stop breathing all together
Thank you so much for this a wonderful work! ❤
Do you finish the notes of these videos?
dude ur awesome
Hi highyieldguy, around 13:30 you're talking about lactate, but the screen went blank. Just wasn't sure if it was intentional. Thank you for the videos though!
hello Dr. Vuu, just got your high yield notes 2022 version, do you have ob gyn and surgery videos too? to go along with the notes
thank youu
COPD mcc is not pseudomonas it’s Hflu
so if you have an exacerbation do you start on azithromycin and do you change to zosyn if you have pneumonia? when do you preferer invasive ventilation instead of non invasive in COPD patient? do you prefer bpap rather than cpap right?
Thank you so much !!!
We use BPAP for COPD with exacerbation unless the PH < 7.20, confusion or excessive secretions
amazing
What about LABA on asthma algorithm?
You add LABA to inhaled steroid in moderate persistent Asthma when the patient is having symptoms daily or walking up at night due to Asthma more than once per week.
my hand hurts lol ty