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When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse, and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of COPD that incorporates the necessary interprofessional collaboration among physicians, nurses, and respiratory therapists caring for these patients.
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Acute pulmonary embolism (PE) is a common disease encountered by pulmonologists, cardiologists, and critical care physicians throughout the world. For patients with high risk (defined by systemic hypotension) and intermediate high-risk (defined by the absence of systemic hypotension but the presence of numerous other concerning clinical and imaging features) acute PE, intensive care is often necessary. Initial management strategies should focus on optimization of right ventricular (RV) function while decisions about advanced interventions are being considered. ⋯ Norepinephrine is a reasonable first choice for hemodynamic support with vasopressin as an adjunct. Intravenous loop diuretics may be useful if there is evidence of RV dysfunction or volume overload. Fluids should only be given if there is concern for hypovolemia and absence of RV dilatation. Supplemental oxygen administration should be considered even without hypoxemia. Positive pressure ventilation should be avoided if possible. VA-ECMO cannulation should be implemented early if ongoing deterioration occurs despite these interventions.
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In this article, the authors provide guidance for applicants to any subspecialty in the medical specialties matching program, with a particular focus on those seeking a match into a pulmonary or critical care medicine training program, or both. The preparation, application, interview, ranking, and match steps are used to discuss available literature that informs this process. ⋯ Finally, key points about generating a rank order list are summarized. This resource will prove useful to any candidate pursuing medical subspecialty training in the current era.