**Source:** https://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome#/media/File:ARDSSevere.png

The Cheese - Corticosteroid Use in Sepsis, ARDS, & CAP

October 4, 2024

A 78-year-old female presents with dyspnea, and her chest x-ray demonstrates signs concerning for community-acquired pneumonia (CAP). Despite your best interventions, her oxygenation and work of breathing are worsening, so you call Respiratory Therapy to initiate high-flow nasal cannula. Meanwhile, you’re left thinking, “Would steroids help turn her around? But what are the guidelines - are steroids best used for CAP or sepsis or both? What kind of CAP? When and how much?”

Taylor Wahrenbrock, MD; Kathryn McGregor, MD; and Eric Leser, MD

**Source:** http://www.svuhradiology.ie/case-study/mediastinal-widening-cxr/

The Cheese - A Predictive Clinical Tool for Aortic Dissection

September 20, 2024

Picture the following encounter: A 52-year-old male presents with chest pain. He seems comfortable and is slightly hypertensive to 156/83, but the rest of his vital signs are normal. He admits to using cocaine prior to the onset of chest pain. He denies any radiation of pain or other associated symptoms. When you are going through your differential, you consider aortic dissection, and you wonder if there are any tools to help you decide if this patient should get a CT angiography (CTA) study to further evaluate for aortic dissection.

Taylor Wahrenbrock, MD and Kathryn McGregor, MD

**Figure 1.** Point-of-care echocardiogram demonstrating the D-sign and a trace pericardial effusion.

Consider The Probe: ILD Sign

September 13, 2024

The Case:

The patient is a 64-year-old female with an unknown past medical history who presented to the ED with altered mental status. Her BP was 100/80 mmHg, HR 101 BPM, RR 21 bpm, SPO2 63% on room air, and T 36.8ºC (98.3ºF). The patient was placed on a non-rebreather mask at 15L, and her oxygen saturation improved to 97%. She was given sedatives for acute agitation and delirium. On exam, the patient was tachypneic and had bilateral crackles and decreased breath sounds throughout all lung fields. Her cardiac exam was notable for a regular rhythm without murmur. The remainder of the physical exam was unremarkable.

Michael Hohl, MD

the County Consult