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AHA/ACC 2026 pulmonary embolism category & Risk Stratification


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I completed Definition, Etiology, and Outcomes!

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Is SIRS included again in the updated sepsis classification?


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Noor Ali Shah
Noor Ali Shah
Feb 23

Yes 👍

Patient with a chest tube

Hello everyone,

I would like to share this ventlator graphic with you

What is going on?

What is the best mode for this case?

Do you think SBT is possible?


97 Views
Noor Ali Shah
Noor Ali Shah
Jan 26

Thanks for sharing this ventilation graph. The is PRVC mode. It is noted that patient on mandatory RR 12/ min with 430 ml VTi and I: E ratio 1:2.0 but patient is tachycapnoec, RR 30/ min, it is reversed 1.9: 1 ratio, compromised expiration time, and dynamic compliance 15.9*

I believe that patient in volume trapping?

I will recommend to put him either ASV or AMV mode ( Adapted Support ventilation) according to ventilation options available. Either put him on spontaneous mode before proceeding SBT.

Either it is double triggering ?

Hopefully I will get a passing score.😀


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Inspiratory hold maneuver

The above inspiratory hold screenshot may indicate all of the following except:

  • 0%Pulmonary edema

  • 0%Pneumothorax

  • 0%Abdominal compartment syndrome

  • 0%Bronchospasm


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So the plateau pressure is high indicating low compliance that you see in all listed conditions except bronchospasm

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Hyperdynamic LV in septic shock patient

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Management of Sepsis-induced Cardiomyopathy

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Septic Shock

83 yo woman with morbid obesity, sleep apnea, DM, HTN, asthma, CAD who had presented at outlying facility for an elective cystoscopy with plans for laser lithotripsy and ureteral stent placement. During the procedure she became hypotensive and bradycardic. She was given atropine and epinephrine. Postprocedure she was initially extubated. Chest x-ray postprocedure showed right upper lobe and possible left lower lobe infiltrates concerning for aspiration. Troponins are positive consistent with non-STEMI demand ischemia. She has a severe metabolic acidosis with a lactate of almost 7. Her EKG showed sinus tach with a RBBB and no ischemic changes. She required to be intubated for severe respiratory distress. She was still hypotensive requiring norepinephrine and vasopressin despite 3 liters of LR. Her IVC was 1.4 cm. LiDCO was placed and the following hemodynamic parameters were obtained:

SVV was indicating fluid responsiveness and Pleth Variability Index was 18%:

SBP variation was also around 20%.

Patient was…

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Great case, indicating that fluid resuscitation should be individualized according functional hemodynamic (SVV, PPV,PVI) and not all patients will require the same amount of recommended IV fluid of 30 ml/kg; some will require less and others will require more. In this patient we don’t know the weight, ideally the IBW once the patient is morbid obese.

The patient despite having get 3 L of RL continued having evidence of hypovolemia (small IVC size) and high SVV, PPV, PVI indicating that the patient is fluid responsive; will be good to know the IVC distensibility index which is another sonography parameter of fluid responsiveness in a ventilated patient.


Also, should be highlighted the role of vasopressors in this patient once the SVR is low and high CO, and widen PP (86 mmHg) which is a pattern of vasoplegia, probably due to septic shock.

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