Pulmonary/Critical Care

Fast Facts-Critical Care

November 22, 2006
Fast Facts-Critical Care

VA MICU Conference 11/22/06

56 y.o. male with PMH ETOH abuse and COPD presented with a LUL PNA and BCx positive for penicillin-resistant pneumococcus.

 

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock

Early broad spectrum antibiotics. Goal directed hemodynamic resuscitation with IV fluids pressors PRBCs (for Hct <30) inotropes To maintain: Central Venous Pressure 8-12 mm Hg Arterial Pressure: MAP >65 mm Hg but <90 mm Hg Central Venous Oxygen Saturation >70% Consider cosyntropin stimulation to evaluate for relative adrenal insufficiency. Consider Recombinant Activated Protein C

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Should We Screen All Smokers for Lung Cancer?

November 15, 2006

Commentary by Deborah Shapiro, M.D.  Attending Physician, Dept. Veterans Affairs

The International Early Lung Cancer Action Program Investigators. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-1771

Over the last few weeks there has been major press in the lay media about this lead article in the NEJM from 10/26/06.  This study was designed to diagnose lung cancer at an earlier stage and therefore to decrease mortality rates. The authors…

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