Jon-Emile S. Kenny MD [@heart_lung] “… but prejudices, like odorous bodies, have a double existence, both solid and subtle – solid as the pyramids, subtle as the twentieth echo of an echo, or as the memory of hyacinths which once scented the darkness.” -Mary Ann Evans  Background As previously described, the SARS-CoV-2 main protease inhibitor [Mpro] [... read more] The post Nirmatrelvir-Ritonavir for ‘Standard Risk’ COVID-19 appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “When she smiles without her teeth in place she looks like a witch. But with them in her mouth she’s very pretty.” -Judy Blume  Basic Biology The SARS-CoV-2 genome encodes structural proteins [i.e., spike, envelope, membrane, nucleocapsid] and polyproteins [i.e., pp1a and pp1ab]. When the guts of SARS-CoV-2 spew into a [... read more] The post EPIC-HR Evaluates Nirmatrelvir-Ritonavir for COVID-19 appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “I find real life challenging enough.  If I get to the dry cleaners without having a huge fight, that’s challenging enough.” -Fran Lebowitz  Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome.  As considered, however, contrast should be made between a fluid bolus, [... read more] The post What Minimal Volume of Intravenous Fluid Challenges the Heart? appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “If you’re afraid of butter, use cream.” -Julia Child  Background Early observational studies and the RECOVERY collaborative group initially demonstrated the benefit of corticosteroid therapy in oxygen-requiring, COVID-19-patients; additional randomized studies as well as a meta-analysis of these reports corroborated this. Yet the dosing of corticosteroids across the above studies was [... read more] The post COVID STEROID 2 Trial Investigates Dexamethasone 6 mg or 12 mg in COVID-19 appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “It was after this realization that I began trying to find the ‘point’ of California, to locate some message in its history.” -Joan Didion  Background A few months ago, I found myself in one of my favourite places – the American Museum of Natural History in New York City.  Meandering through [... read more] The post Fact-Checking Buffalo Chest appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “… Sartre tells us that man makes himself this lack of being in order that there might be being.” -Simone de Beauvoir  Background Like many early, proposed therapies for COVID-19, inhaled corticosteroids [ICS] had suggestive, conflicting evidence.  For example, in a very large observational investigation – the OpenSAFELY platform – patients with both [... read more] The post PRINCIPLE Investigators Study Inhaled Budesonide for COVID-19 appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] About a decade ago, a handful of terrific reviews and investigations about phenylephrine – an alpha1 agonist – were published [1-3].  While this vasoactive medication might be thought only to ‘increase afterload,’ phenylephrine’s hemodynamic effects are knotty and noteworthy.  Therefore, this dedicated dispatch delineates the difficulties encountered when predicting the hemodynamics [... read more] The post ICU Physiology in 1000 Words: Phenylephrine Pushes & Stroke Volume appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] “In those years, truth was elusive – as was my own faith that I could recognize and contain it.” -Mary Oliver Previously, the very basic underpinnings of fluvoxamine as a pharmacological method to quell cytokine unruliness was outlined.  In brief, fluvoxamine is a sigma-1-receptor [S1R] agonist – an effect that opposes [... read more] The post The TOGETHER Trial Evaluates Fluvoxamine for COVID-19 appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] The left ventricular ejection fraction [LVEF] is a commonly-sought cardiac measure.  With the explosion of bedside ultrasound and automated methods to capture LVEF, the ejection fraction will grow in clinical prominence and affect decisions for the acutely-ill.  Asked the meaning of the LVEF, many clinicians might describe it as a ‘measure [... read more] The post ICU Physiology in 1000 Words: The Geometry of Ejection Fraction appeared first on PulmCCM ..read more

Jon-Emile S. Kenny MD [@heart_lung] The relative simplicity of extending one’s finger onto the tissue overlaying a major artery belies the complicated forces generating an arterial pulse.  Descriptions and physiological elucidations have been put forth across the decades, yet even today the machinations relating cardiac contraction to a waxing and waning arterial wall are a bit [... read more] The post ICU Physiology in 1000 Words: The Pulse appeared first on PulmCCM ..read more