Chest
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We propose an algorithmic approach to the interpretation of diffuse lung disease on high-resolution CT. Following an initial review of pertinent lung anatomy, the following steps are included. Step 1: a preliminary review of available chest radiographs, including the "scanogram" obtained at the time of the CT examination. ⋯ Step 4: determination of one of three predominant categories - primarily reticular disease, nodular disease, or diseases associated with diffuse alteration in lung density. Based on this determination, one of the three following Steps are followed: Step 5: evaluation of cases primarily involving diffuse lung reticulation; Step 6: evaluation of cases primarily resulting in diffuse lung nodules; and Step 7: evaluation of cases with diffuse alterations in lung density including those with diffusely diminished lung density vs those with heterogenous or diffusely increased lung density, respectively. It is anticipated that this algorithmic approach will substantially enhance initial interpretations of a wide range of pulmonary disease.
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Arterial catheterization is frequently performed in ICUs to facilitate hemodynamic monitoring and frequent blood sampling. Overall, arterial catheterization has high success and low complication rates, but in patients who are critically ill, the incidence of failure is higher because of hypotension, peripheral edema, and obesity. Ultrasound guidance significantly increases the likelihood of successful cannulation and decreases complications compared with traditional landmark-based techniques. Multiple ultrasound techniques for radial and femoral arterial catheter insertion have been described; this paper presents an approach for incorporating these tools into bedside practice, including illustrative figures and narrated video presentations to demonstrate the techniques described.
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Mobile health (mHealth) technologies are modernizing medicine by affording greater patient engagement, monitoring, outreach, and health-care delivery. The cardiopulmonary fields have led the integration of mHealth into clinical practice and research. mHealth technologies in these areas include smartphone applications, wearable devices, and handheld devices, among others, and provide real-time monitoring of numerous important physiological measurements and other key parameters. Use of mHealth-compatible devices has increased in recent years, and age and socioeconomic gaps of ownership are narrowing. ⋯ However, there is little regulation on the mHealth platforms available for commercial use and even fewer guidelines on implementing evidence-based practices into mHealth technologies. Online security is another challenge and necessitates development in data collection infrastructure to manage the extraordinary volume of patient data. Continued research on long-term implications of mHealth technology and the integration of effective interventions into clinical practice is required.
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The use of e-cigarettes to deliver aerosolized nicotine has gained popularity in recent years. Numerous reports have cited the development of acute pulmonary disease linked to vaping nicotine as well as marijuana-based products. As cultural attitudes evolve and policies shift toward the legalization of marijuana, its use has become more prevalent. ⋯ This case series highlights common clinical findings as well as the varied radiographic and histopathologic features of acute respiratory failure associated with vaping predominantly marijuana-based products. As more cases of vaping-associated pulmonary injury unfold, data will be available to further characterize this emerging disease entity. Improved understanding of disease pathogenesis and its clinical course will help clinicians determine optimal management and follow-up strategies for this patient population.