Pulmonary Medicine Rotation
The Breathtaking Guide to Pulmonary Medicine: A 4-Week Deep Dive
Intro 🩺
Welcome to your Pulmonary Medicine rotation!
This guide is designed to transform how you think about respiratory medicine. Rather than following the traditional organ-system approach, let’s explore pulmonary medicine through the lens of clinical reasoning, pathophysiology, and evidence-based practice.
Each week builds upon the previous, creating a scaffolded learning experience that will fundamentally change how you approach respiratory disease.
Self-Paced Curriculum 📕
WEEK ONE
Day 1-3 : Understanding Respiratory Mechanics 👉
: 📽️ 🫁 Classic Respiratory Physiology Series (UC San Diego) taught by Dr West himself (approximately 12h of YouTube videos)
Day 4: Understanding Nasal O2 Delivery & the O2 🪜 👉
: https://www.emdocs.net/covid-19-oxygen-escalation-therapy-and-noninvasive-ventilation/
🪜 Simply put, in conversational speak, the O2 Device Delivery ladder is…
Clear Nasal cannula (up to 6LPM) ➡️ Green nasal cannula (up to 10-12 LPM) ➡️ Non-rebreather mask (NRB, up to 15LPM) ➡️ HHFNC (think Vapotherm, Optiflow = heated humidified high flow nasal cannula, up to 60 LPM) ➡️ CPAP ➡️ Bilevel (“BIPAP”) ➡️ NIV ➡️ Invasive Mechanical Ventilation ➡️ VVECMO or ECCO2
📟 Check out Dr. Mark’s OnePager below
🧮 Learn the equation for calculation of FiO2 based on liters per minute and vice-versa below
It pt is on room air, they are breathing fraction of inspired oxygen of 21%.
If pt is on 4LPM of supplemental O2, they are breathing FiO2 of 37% using above formula.
Day 5: Taking the Pulmonary History 👉
😮💨 Dyspnea assessment
- Onset, duration, progression, symptom timing (rest or activity), triggers, foods, allergies
- Baseline functional status (activities limited?); Exercise tolerance?
- MMRC dyspnea scale (0-4); METs
- CAT and ACT scores
- Hospital exacerbations?
- Diurnal variations? Rule of 2s?
- Orthopnea, Platypnea, Orthodeoxia?
😷 Cough assessment
- Duration? (Acute <3wks, Subacute 3-8 wks, Chronic >8 wks)
- Timing - morning? post-exertional? Cold-triggered? Constant? Nighttime? Paroxysms?
- Voice change? Hoarse? Vomiting?
- Productive? Hemoptysis? Dry? Casts?
- Positional variations? Triggers?
🩻 Chest symptoms assessment
- Duration? (Acute <3wks, Subacute 3-8 wks, Chronic >8 wks)
- Timing - morning? post-exertional? Cold-triggered? Constant? Nighttime? Paroxysms?
Day 6: Taking the ILD History 👉
😮💨 Interstitial Lung Disease (ILD) assessment
- B symptoms Fever? Weight loss? Fatigue?
- Family history Pulmonary fibrosis or ILD?
- Connective tissue Raynaud’s? Joint pain? Synovitis? Morning stiffness? Carpal tunnel? Skin rashes? Photosensitive? Dry eyes? Dry mouth? Muscle weakness? Myalgia? Dysphagia? Reflux? Digital Clubbing?
- Medication / drug hx Nitrofurantoin, amiodarone, methotrexate, bleomycin, PDL1/PD1 inhibitors…?
- Farm Type, agricultural, dairy, cattle?
- Occupational Inhalants Gases, vapors, paints, fumes, woods, drywall/construction (gypsum dust)…?
- Hobbies Woodworking?
- Military Deployments? Duties? Firepits?
- Silicosis Sandblasting? Coal Mining? Construction?
- Metal work (aluminum, beryllium, tungsten, cadmium, cobalt…) Cutting, grinding, welding, fitting?
- Asbestos Removal /fitting car brakes, pipe-fitting, insulation, roofing, shipyards/shipbuilding…
- One approach to ILD
😮💨 Hypersensitivity pneumonitis (HP) assessment
- B symptoms Fever? Weight loss? Fatigue?
- Pets/animals Birds?
- Home/work Visible mold? Water damage? Humidifiers? Ozone machines? Hot tubs/sauna? HVAC maintenance? Down feathers?
- Seasonal variation relation to humidity
- Symptom-free period when not working or on vacation
- 👉 One approach to HP 👈
- 👉 HPLung.com 👈 Great bookmark for Mediations that can cause HP
WEEK TWO
To be update…
