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The biggest, most pervasive misconception in internal medicine is that left heart failure causes pulm HTN and RHF via back pressure ... #pulmonary #cardiotwitter IMCrit Andrés von Wernitz Teleki #meded #MedTwitter #CriticalCare #hospitalist #HeartFailure Eduardo R Argaiz Journal of Brown Hospital Medicine Orlando R. Pérez-Nieto PRT

Incredible how high and fast PCO2 rises in OHS with HFpEF! #respiratory #COPD #chronicrespiratoryfailure #pulmonary #Anesthesiology #cardiotwitter #Cardiology #EmergencyMedicine #meded #MedTwitter #CriticalCare #hypercapnic #OHS #HFpEF #co2retention #respiratorytherapist PRT

Hemoptysis DO NOT 1) Risk Stratify via expirated blood estimation 2) Attemp to localize active bleeding via bronchoscopy 3) Intubate preemptively 4) Stop AC in PE #Pulmonary #Criticalcare #Emergencymedicine #InterventionalRadiology #anesthesiology #Meded #medtwitter #medicine

Subpulmonic Effusion #RockofGibraltar sign Effusion appears mod on CT scan but small on upright U/S & x-ray, often read as elevated hemi diaphragm, decub key #hospitalist #emergencymedicine #chestradiology #MedTwitter #pulmonary #internalmedicine #criticalcare #meded #radiology

DYSPNEA despite normal ventilation, pH and gas exchange ... Consider: 1) Neuromechanical Dissociation 2) Increased Cardiovascular Pressure 3) Panic / Anxiety #MedTwitter #hospitalist #pulmonary #criticalcare #emergencymedicine #Anesthesiology #CardioTwitter #dyspnea #meded PRT

When acute illness passes, but pressors persist: Change your target from MAP to SBP Next decrease your SBP goal focusing on MS, UO (if applicable) and lactate generation #pulmonary #Anesthesiology #EmergencyMedicine #cardiotwitter #meded #MedTwitter #CriticalCare #hospitalist PRT

#Obtundation Despite normal vital signs: R/o rapidly reversible causes (e.g. ⬇️BG or narcs) to prevent intubation, then look for hypoventilation (solid intubation indication) #criticalcare #emergencymedicine #anesthesia #meded #medtwitter #pulmonary

Group 2 PH: Most common and Most misunderstood NOT caused by back pressure Biventricular Heart Failure Reflex #pulmonary #Anesthesiology #EmergencyMedicine #meded #MedTwitter #CriticalCare #cardiotwitter #internalmedicine #hospitalist #cardiology #PulmonaryHypertension PRTIYL

Indeed! CTEPH common mistakes: 1) Not an accumulation of PEs over time 2) Progressive PH and RHF occur without new perfusion defects 3) Transient, new O2 requirement common post operatevily #MedTwitter #MedEd #pulmonary #criticalcare #hospitalist #cteph #CardioTwitter PRTIYL

Finally we start talking about the variability in the biventricular heart failure reflex and its implications on phenotype... ascites vs pulm edema. I rember coming up with the term when discussing HF with my dad, he said " the #biventricularheartfailurereflex ... I like that."

What keeps blood flowing forward through the lungs in LHF? What maintains the PV waterfall? How does LHF➡️RHF Biventricular Heart Failure Reflex #pulmonary #meded #MedTwitter #CriticalCare #cardiotwitter #internalmedicine #hospitalist #cardiology #PulmonaryHypertension PRTIYL

Two great cases of TXA toxicity presented UCSD Pulmonary, Critical Care, Sleep, & Physiology today ... TXA ... never a game changer... occasionally a killer or permanent disabler = never use ?! #pulmonary #CriticalCare #IP #interventionalpulmonary #anesthesiolgy #MedTwitter #MedEd #EmergencyMedicine #hemoptysis #ctsurg

Life Threatening Hemoptysis is Rx by obliteration or excision of the culprit abn art vessel. TXA stabilizes clot. Convenient Russell Miller, especially post Bx, but NOT a game changer for Massive Hemoptysis. UCSD Pulmonary, Critical Care, Sleep, & Physiology presented 2 cases of massive hemoptysis Rx with inhaled TXA

Inhaled TXA can be carried to the CNS via spinal arteries arising from bronchial or intercostal arteries with devastating consequences... #pulmonary #CriticalCare #IP #interventionalpulmonary #anesthesiolgy #MedTwitter #MedEd #EmergencyMedicine #hemoptysis #ctsurg #radiology

Finally rocking the number one slot...

Approach to O2 rx: Spo2 screens for pao2 < 60 Please feel free to print and place on the fridge or mirror ala rocky III #Anesthesiology #EmergencyMedicine #meded #MedTwitter #CriticalCare #hospitalist #internalmedicine #pulmonaryApproach

What is the biggest Missconception #Heartfailure ? How does LHF➡️ PH➡️ RHF? It's NOT back pressure! Check out the Biventricular Heart Failure Reflex... #pulmonary #meded #MedTwitter #CriticalCare #cardiotwitter #internalmedicine #hospitalist #cardiology #PulmonaryHypertension

Hypoxia vs. Hypoxemia... note.. its always been sao2 vs pao2 ... who wants to die on the spo2 hill ?! IMO East Coast IM gets it and West Coast IM is to blame for the confusion ... #pulmonary #criticalcare #anesthesiology #emergencymedicine #hospitalist #internalmedicine PRTIYL

Why the TRUE target of O2 Rx is a PaO2 >60 not an SpO2% 1)SpO2 estimates SaO2, often poorly 2)SaO2 is a product of PaO2 & pH, yet pH is tightly regulated NOT in relation to O2 3)The respiratory center protects a PaO2 of 60 NOT an SpO2% #pulmonary #criticalcare #meded #medtwitter

Isolated LHF doesn't exist When LH pressure is high Back pressure ➡️ pulm interstitial edema, effusions, alveolar edema RHF is NOT caused by back pressure PH and RHF occur via Neurohormonal Reflex #CardioTwitter #MedTwitter #pulmonary #HeartFailure youtu.be/Uk2YfL7Xjg4?si…