- Email: [email protected]
Perspectives on the Management of Acute Respiratory Illness
Preface P e r s p e c t i v e s on t h e M a n a g e m e n t of Acute Respiratory Illness
Mithu Molla, MD, MBA, FACP Editors
Nicholas Kenyon, MD, MAS
Hospitalists and Pulmonary and Critical Care physicians must share numerous patient care responsibilities in the emergency room, medicine wards, and the intensive care units to optimize patient triaging and flow and to provide care for a wide range of acute illnesses. Understandably, patient care discussions often focus on hospital logistics, and they can often usurp substantive discussions about the management of critically ill patients with and without pulmonary disease. In this issue of Hospital Medicine Clinics, we take a step back and offer such a thoughtful and comprehensive discussion from the perspective of the Hospitalist and Pulmonary and Critical Care physician. At UC Davis School of Medicine, the Chair of Medicine, Dr Timothy E. Albertson, has understood the building interrelationship between hospitalists and intensivists for many years. To address this, he has housed the Section of Hospital Medicine within the Division of Pulmonary, Critical Care, and Sleep Medicine for the past 15 years. This vision has allowed us to streamline patient care processes, share ideas about the transitions of care within hospital, and establish care teams to manage certain chronic lung diseases. This issue is one product of this successful relationship. The care of the rapidly deteriorating patient with acute or chronic lung disease is among the most difficult and anxiety-provoking in the hospital. Complex questions arise that require technical expertise and forethought, but must be coupled with quick decision making and action. For example, should you perform an ultrasound-guided thoracentesis in this progressively dyspneic patient with a chronic lung effusion? Do I place this patient with pneumonia and renal failure on noninvasive ventilation or not? Can this patient with an acute asthma flare and an elevated lactate level be admitted to a hospital ward? In this issue of Hospital Medicine Clinics, we address these and other patient management questions and provide insight with parallel perspectives. We have teamed authors from Hospital Medicine with content experts in pulmonary and critical care Hosp Med Clin 6 (2017) A9–A10 http://dx.doi.org/10.1016/j.ehmc.2017.08.001 2211-5943/17/ª 2017 Published by Elsevier Inc.
A10
Preface
medicine to illuminate areas of concern or conflict when faced with the acutely ill patient with respiratory disease. The spectrum of problems that can arise with such patients is immense, and our author teams have spent considerable time outlining the questions and scenarios most relevant to the hospitalist. We are impressed and proud of the team efforts that have resulted in these coauthored articles. Their contributions will serve as an excellent reference on such timely topics for hospitalist training in echocardiography, in the use of noninvasive ventilatory adjuncts on the wards, and in treatment of flares of interstitial lung disease, among others. Enjoy! Mithu Molla, MD, MBA, FACP Section of Hospitalist Medicine Department of Internal Medicine UC Davis Health System University of California, Davis 4150 V Street, Suite 3400 Sacramento, CA 95816, USA Nicholas Kenyon, MD, MAS Division of Pulmonary, Critical Care and Sleep Medicine Department of Internal Medicine UC Davis School of Medicine University of California, Davis 4150 V Street, Suite 3400 Sacramento, CA 95816, USA E-mail addresses: [email protected] (M. Molla) [email protected] (N. Kenyon)
Mithu Molla, MD, MBA, FACP Editors
Nicholas Kenyon, MD, MAS
Hospitalists and Pulmonary and Critical Care physicians must share numerous patient care responsibilities in the emergency room, medicine wards, and the intensive care units to optimize patient triaging and flow and to provide care for a wide range of acute illnesses. Understandably, patient care discussions often focus on hospital logistics, and they can often usurp substantive discussions about the management of critically ill patients with and without pulmonary disease. In this issue of Hospital Medicine Clinics, we take a step back and offer such a thoughtful and comprehensive discussion from the perspective of the Hospitalist and Pulmonary and Critical Care physician. At UC Davis School of Medicine, the Chair of Medicine, Dr Timothy E. Albertson, has understood the building interrelationship between hospitalists and intensivists for many years. To address this, he has housed the Section of Hospital Medicine within the Division of Pulmonary, Critical Care, and Sleep Medicine for the past 15 years. This vision has allowed us to streamline patient care processes, share ideas about the transitions of care within hospital, and establish care teams to manage certain chronic lung diseases. This issue is one product of this successful relationship. The care of the rapidly deteriorating patient with acute or chronic lung disease is among the most difficult and anxiety-provoking in the hospital. Complex questions arise that require technical expertise and forethought, but must be coupled with quick decision making and action. For example, should you perform an ultrasound-guided thoracentesis in this progressively dyspneic patient with a chronic lung effusion? Do I place this patient with pneumonia and renal failure on noninvasive ventilation or not? Can this patient with an acute asthma flare and an elevated lactate level be admitted to a hospital ward? In this issue of Hospital Medicine Clinics, we address these and other patient management questions and provide insight with parallel perspectives. We have teamed authors from Hospital Medicine with content experts in pulmonary and critical care Hosp Med Clin 6 (2017) A9–A10 http://dx.doi.org/10.1016/j.ehmc.2017.08.001 2211-5943/17/ª 2017 Published by Elsevier Inc.
A10
Preface
medicine to illuminate areas of concern or conflict when faced with the acutely ill patient with respiratory disease. The spectrum of problems that can arise with such patients is immense, and our author teams have spent considerable time outlining the questions and scenarios most relevant to the hospitalist. We are impressed and proud of the team efforts that have resulted in these coauthored articles. Their contributions will serve as an excellent reference on such timely topics for hospitalist training in echocardiography, in the use of noninvasive ventilatory adjuncts on the wards, and in treatment of flares of interstitial lung disease, among others. Enjoy! Mithu Molla, MD, MBA, FACP Section of Hospitalist Medicine Department of Internal Medicine UC Davis Health System University of California, Davis 4150 V Street, Suite 3400 Sacramento, CA 95816, USA Nicholas Kenyon, MD, MAS Division of Pulmonary, Critical Care and Sleep Medicine Department of Internal Medicine UC Davis School of Medicine University of California, Davis 4150 V Street, Suite 3400 Sacramento, CA 95816, USA E-mail addresses: [email protected] (M. Molla) [email protected] (N. Kenyon)