PE-classification massive, submassive, non massive

This was a tough session today with some difficult cases and questions. PE classification based on clinical shock, uss evidence rv dysfunction or tn leak indicating damage or dysfunction. Check out Dunn or UTD on this topic

HIV and fistula

Very low CD counts = Cell mediated immunity severely affected = viral infection, fungal infection, then TB and microbes. See the document on UTD regarding immune deficient patients such as HIV or chemotherapy patients. Also review Harrisons for a good review of the subject. Pertinent as a disease modifier on the floor and in exams.

Pneumomediastinum

Risk factors – esp alcoholic patients / boerhaves
present with chest pain and sepsis
cxr findings can be subtle – cardiac borders outlined sharply, continuous diaphragm sign etc – check radiopedia or Rabi et al.
polymicrobial – needs broad spectrum management of sepsis – NGT / enteric tubes for feeding