Critical Care and Shock

February 2010

Successful recruitment in severe unilateral pneumonia using airway pressure release ventilation and lateral decubitus position

A 25 year-old Caucasian male with no past medical history of note presented with tetraplegia after hitting his head following a dive into a shallow pool. An MRI of the cervical spine showed bilateral facet dislocation of C4/C5 with spinal cord injury and edema from C4 to C6. A posterior facet joint reduction, instrumentation and fusion, anterior C4/C5 discectomy and fusion was performed forty-eight hours later and he was transferred to the surgical intensive care unit (SICU) for postoperative ventilation.

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Acute transverse myelitis in systemic lupus erythematosus: report of a case

Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause multiple organ damage. It is more common in females with a ratio of 9:1 with respect to males. (1)
Neuropsychiatric manifestations in patients with SLE are common, and when these manifestations are developed, the course of the disease and the prognosis are significantly worse. (2)

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Repeated acute respiratory failure: the strongyloidiasis hyperinfection syndrome

A 63 year-old gentleman with a history of mitral valve repair and recent travel to the Philippines presented to our hospital with complaints of dry cough for three days. His clinical exam was remarkable for diffuse rhonchi. Initial chest radiograph was non-revealing. The patient clinical condition deteriorated in the emergency department (ED) with rapidly progressive respiratory insufficiency and interval development of radiographic infiltrates (Figure 1). The patient was then admitted to the intensive care unit (ICU) and broad-spectrum antibiotics started.

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Increased serum cystatin C is a predictive factor for renal outcome in non-cardiac critically ill patients

Cystatin C is a 122-amino-acid, 13 kDa protein that is a member of the family of competitive inhibitors of lysosomal cysteine proteinases. (1) Serum cystatin C is a useful tool employed in cardiac disease patients to measure kidney function, (2,3) and it may be a risk factor for cardiac events, including heart failure, coronary artery disease, and diastolic dysfunction, with or without chronic heart disease. (4-11) The estimated glomerular filtration rate (eGFR) of serum creatinine is also an established tool employed in measuring kidney function in cardiac disease patients. (12)

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Traumatic pneumomediastinum

A previously-healthy thirty-year old man presented to the Emergency Department at Hawke’s Bay Hospital with central chest pain, following blunt chest trauma whilst SCUBA diving. He was at a depth of approximately five metres, during his ascent, when he was dumped onto a rock by a wave, hitting the left side of his chest. Several hours later, he developed central chest tightness and mild dyspnoea. He had no dysphagia or abdominal pain. Examination findings showed normal vital signs, reduced air entry over left chest wall, and a “crunchy” systolic murmur.

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An unusual cause of dyspnea

A 41 year-old woman case with nonproductive cough, dyspnea, weight loss and fever is described. Laboratories were remarkable for hypoxemia, leukocytosis, anemia and elevated hepatic enzymes. Chest X-ray demonstrated bilateral interstitial opacities. She was hospitalized with diagnosis of suspected pneumonia. Patient’s condition progressed to multiple organ failure and unfortunately, death. The diagnostic of gastric adenocarcinoma with lymphangitic spread was established at autopsy.

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