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  • If we are being sticklers-- to chest radiologists, "infiltrates" are a bad word. It's too nonspecific of a word. For whatever reason, density and opacity meet the threshold for "ok." Consolidation should be reserved for pneumonia. Atelectasis should just be called so when seen.

    It was beat into me in residency...

    Comment


    • Originally posted by Brains428 View Post
      If we are being sticklers-- to chest radiologists, "infiltrates" are a bad word. It's too nonspecific of a word. For whatever reason, density and opacity meet the threshold for "ok." Consolidation should be reserved for pneumonia. Atelectasis should just be called so when seen.

      It was beat into me in residency...
      I have been using the term “ground glass infiltrates in the periphery of the mid-lower lung zones” for covid cxr in the ED. I don’t use infiltrates to describe covid in my reports. Not sure why I choose to use it in my post.

      Lung zones kinda trashy term (there are lung lobes not zones) but it’s easy for referring docs and PAs to understand. At least one my chest attending many years ago yelled at me for using “zone”.

      Comment


      • Ah, yes. The lung zone argument. The peds radiologists were okay with it. The adult chest radiologists hated it. For any radiologist trainee who lurks and reads this- like many things in life- know your audience.

        We can save debates upon descriptors on various images for the radiology specific website that no one visits anymore.

        Comment


        • If it’s an AP how can you know unless obvious silhouette or etc ? I’d rather say lower lung zone than say lower lobe which may or may not be true. Not trashy at all, it’s literally correct. It’s disregarding basic anatomy and understanding X-ray to not use lung zone IMO unless you are sure. You don’t know where it is, so how can you say? It’s not our job to guess. I will even say in on PA and lateral if unsure like if patient body habitus very tough or just a subtle finding.

          My standard description is patchy alveolar/ground glass opacities with a mid to lower lung zone predominance. I will add peripheral too if I think it fits. I personally think you can use ground glass on CXR (which I’m sure some academic will lose their mind over). If I think it’s going to be ground glass on a CT I will call it as such. Obviously depends on exam and technique if you can actually tell.

          Comment


          • Panscan I think its the term "zone" that chest radiologists have issues with. I don't personally use it, but it doesn't keep me up at night if I see it. Same with infiltrate.

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            • I see the infiltrate criticism but I just don’t see logically the zone thing like what do they want instead? I can’t tell you it’s in the lower lobe if I’m not sure.

              As I’m sure everyone in this conversation understands, you don’t know where it is on 1 view unless it’s clearly abutting a fissure or silhouetting something

              Comment


              • Originally posted by zlandar View Post
                Seeing so much covid has really sharpened my ability to see subtle infiltrates on chest xrays. Usually you are left guessing whether an infiltrate was real or not. When the ED is packed with covid patients getitng a f/u CTA chest you know if you were right or wrong.
                CTA practice seems to have changed recently.

                early pandemic it seemed pointless and a waste of PPE.

                then we seemed to realize that covid seems hypercoagulable?

                now we're mostly holding off on CTA unless there is some specific concern for PE (hypoxia, chest pain, tachy, sob obviously don't cut it)

                Comment


                • https://www.dallasnews.com/news/watc...nation-status/

                  Came across my news feed. I feel incredibly lucky to take care of kids. It would be crazy to hold children responsible for decisions their parents made but I really feel for our adult colleagues. With our PICUs quite full, we constantly make decisions on who most needs the resources of the large academic PICU (happens every winter and now this summer). I cannot imagine how hard it would be to manage a full MICU and try to make those types of triage decisions without letting my frustration over vaccine politics unduly influence my choices.

                  Comment


                  • Originally posted by MPMD View Post

                    CTA practice seems to have changed recently.

                    early pandemic it seemed pointless and a waste of PPE.

                    then we seemed to realize that covid seems hypercoagulable?

                    now we're mostly holding off on CTA unless there is some specific concern for PE (hypoxia, chest pain, tachy, sob obviously don't cut it)
                    Shortness of breath, d dimer elevation, hypoxia, they are getting dye.

                    I have found a ton. Have had 2 icu downgrades with d dimer 4000 plus and got the PE diagnosis within a week of each other.

                    if during hospitalization d dimer rises and I hadn’t scanned yet, I consider.

                    it’s helpful for me to see if my diuretics I put most my covid patients on are targeting anything.



                    Comment


                    • Anyone doing plasma anymore?
                      im starting to think remdesivir needs to end.

                      currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

                      I’ll do anything I can to chill people out to prone.

                      my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

                      I notice sinus bradycardia super common in these patients. Also transaminitis.

                      anyone doing anything different?

                      I don’t do any of the scam invermectin, plaquenil, D zinc etc

                      ive probably done over 5000 rvu of covid so far ...

                      Comment


                      • Originally posted by Ekanive23 View Post
                        Anyone doing plasma anymore?
                        im starting to think remdesivir needs to end.

                        currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

                        I’ll do anything I can to chill people out to prone.

                        my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

                        I notice sinus bradycardia super common in these patients. Also transaminitis.

                        anyone doing anything different?

                        I don’t do any of the scam invermectin, plaquenil, D zinc etc

                        ive probably done over 5000 rvu of covid so far ...
                        We have stopped using remdesivir and plasma
                        otherwise pretty similar

                        Comment


                        • Originally posted by Ekanive23 View Post
                          Anyone doing plasma anymore?
                          im starting to think remdesivir needs to end.

                          currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

                          I’ll do anything I can to chill people out to prone.

                          my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

                          I notice sinus bradycardia super common in these patients. Also transaminitis.

                          anyone doing anything different?

                          I don’t do any of the scam invermectin, plaquenil, D zinc etc

                          ive probably done over 5000 rvu of covid so far ...
                          Thank you for this!

                          Why not remdisivir any more?

                          Also, where do monocolonals fit in? In your above scenario, patients have passed that point?

                          With delta, how often are you seeing young, truly healthy patients (ie, under 50 or under 40, not obese, not diabetic, etc)?

                          Comment


                          • Thoughts on South Florida physicians protesting unvaccinated patients?

                            Comment


                            • Originally posted by StateOfMyHead View Post
                              Thoughts on South Florida physicians protesting unvaccinated patients?
                              I'd like to hear more about that (so far I've not seen much about it in the media). I can certainly understand their motivations.

                              Pfizer got got full FDA approval. Moderna is expected to receive it by the end of September. So much for the "it's experimental!" excuse.

                              Comment


                              • Originally posted by artemis View Post

                                I'd like to hear more about that (so far I've not seen much about it in the media). I can certainly understand their motivations.

                                Pfizer got got full FDA approval. Moderna is expected to receive it by the end of September. So much for the "it's experimental!" excuse.
                                Except now the goalposts will move to “they rushed it through approval so it’s still NoT lEgItImAtE.”

                                Comment

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