Critical Diagnostic Thinking in Respiratory Care

CONTRIBUTORS:
Loutfi S. Aboussouan, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine
WayneState University School of Medicine
Detroit, Michigan

Sandra G. Adams, MD
Division of Pulmonary Diseases/Critical Care Medicine
Department of Medicine
The University of Texas Health Science Center
San Antonio, Texas

Alejandro C. Arroliga, MD, FCCP
Head, Section of Critical Care
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Richard D. Branson, BA, RRT
Associate Professor of Surgery
University of Cincinnati
Cincinnati, Ohio
University Hospital
Cincinnati, Ohio

Howard Christie, PA-C, RRT
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Edgar Delgado, BS, RRT
Education/Quality Improvement/Research Coordination
Department of Respiratory Care
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Michael DeVita, MD
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Raed A. Dweik, MD
Department of Pulmonary and Critical CareMedicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Gary Falk, MD
Center for Swallowing and Esophageal Disorders
Department of Gastroenterology
The Cleveland Clinic Foundation
Cleveland, Ohio

Robert Gerber, MD
Department of Pulmonary and Critical Care Medicine
Cleveland Clinic Foundation
Cleveland, Ohio

Alison Morris Gimbel, MD
Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Lawrence Goldstein, MD
Eastern Ohio Pulmonary Consultations
Boardman, Ohio

John E. Heffner, MD
Professor of Medicine
Vice Chair, Department of Medicine
Medical University of South Carolina
Charleston, South Carolina

Ed Hoisington, RRT
Supervisor
Section of RespiratoryTherapy
Department of Pulmonary and Critical Care Medicine
TheCleveland Clinic Foundation
Cleveland, Ohio

Tareq Jamil, MD
Fellow
Division of Pulmonary and Critical Care Medicine
Wayne State University School of Medicine
Detroit, Michigan

Mani S. Kavuru, MD
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Lucy Kester, MBA, RRT, FAARC
Education Coordinator
Section of Respiratory Therapy
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Paul A. Lange, MD, FCCP.
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Case Western Reserve University
Cleveland, Ohio
Director of Lung Transplantation Services, University Hospitals of Cleveland
Cleveland, Ohio

Wayne Lawson, MS, RRT
Assistant Professor
Department ofRespiratory Care
University of Texas Health Science Center at San Antonio
San Antonio, Texas

Brian M. Legere, MD
Staff Physician
Coastal Pulmonary Medicine, PA
Wilmington, North Carolina

Neil MacIntyre, MD
Professor of Medicine
Duke University Medical Center
Durham, North Carolina

Atul C. Mehta, MD
Professor of Medicine
Vice-chairman, Department of Pulmonary and Critical Care Medicine
Head, Section of Bronchology
The Cleveland Clinic Foundation
Cleveland, Ohio

Doug Orens, RRT, MBA
Manager
Section of Respiratory Care
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Sanjay A. Patel, MD
Fellow
Division of Pulmonary, Allergy and Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Jay I. Peters, MD
Division of Pulmonary Diseases/Critical Care Medicine
Department of Medicine
The University of Texas Health Science Center
San Antonio, Texas

Albert L. Rafanan, MD
Senior Fellow
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Sunder Sandur, MD
Attending Physician
Department ofPulmonary and Critical Care Medicine
Saint Mary's Hospital
Waterbury, Connecticut

Bipin Sarodia, MD
Senior Clinical Fellow
Department of Pulmonary and Critical Care Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio

Frank Sciurba, MD
Division of Pulmonary, Allergy and Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

David Shelledy, PhD, RRT
Chairman, Department of RespiratoryCare
The University of Texas Health Science Center at San Antonio
San Antonio, Texas

Laurence A. Smolley, MD
ClinicalAssistant Professor of Internal Medicine
The Cleveland Clinic Foundation
Cleveland, Ohio
Chairman
Pulmonary Department
Cleveland Clinic Florida
Fort Lauderdale, Florida

Patrick J. Strollo, Jr., MD
Director, Pulmonary Sleep Evaluation Laboratory
Associate Professor of Medicine
Division of Pulmonary, Allergy, and Critical Care Medicine
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Irawan Susanto, MD, FACP
Associate Clinical Professor
Director, Pulmonary Consultation and Procedures
Pulmonary and Critical Care Medicine
UCLA School of Medicine
Los Angeles, California

Lynn Tanoue, MD
Associate Professor of Medicine
Yale University School of Medicine
New Haven, Connecticut

Fran Whalen, MD
Montefiore University Hospital
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania

Section I: Background An Introduction to Critical Diagnostic Thinking Section II: Common Presentations in the Outpatient Setting Chronic Cough Recurrent Episodes of Purulent Phlegm Progressive External Dyspnea Progressive External Dyspnea in a 65 Year Old Man {tentative} Fatigue Associated With Daytime Sleepiness Solitary Pulmonary Nodule Hemoptysis Digital Clubbing Bilateral Pleural Effusions Unilateral Right-Sided Pleural Effusions Platypnea Chronic Hypercapnea Community Acquired Pneumonia Pleuritic Chest Pain Non-Pleuritic Chest Pain Upper Lobe Infiltrate Wheezing Stridor Cavitary Pulmonary Infiltrate Bilateral Hilar Adenopathy Section III: Common Problems in the Non-ICU Adult Inpatient Fever and a Pulmonary Infiltrate Hypoxia Hypercapnic Respiratory Failure Atlectasis Preoperative Evaluation The Difficult-to-Wean Patient The Weak Patient Ventilatory Dys-synchrony Hypotension with Mechanical Ventilation Immediate Reintubation Subcutaneous Emphysema Bubbling Chest Tube Refractory Hypoxemia High Peak Airway Pressures Ventilator-Associated Pneumonia