1/38. botulism with respiratory insufficiency requiring extra corporeal carbon dioxide removal.Despite a low incidence of botulism in the industrialized world some cases occasionally occur in germany after eating contaminated food. Because botulism is rarely seen, most physicians are unfamiliar with its early recognition and treatment. However, immediate intensive care treatment is important. We report the case of a previously healthy 54-year-old female who developed signs of botulism after eating vacuum packed smoked fish and developed severe respiratory insufficiency with difficult carbon dioxide elimination in the days following.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/38. Bronchial mucormycosis with progressive air trapping.A previously healthy 70-year-old woman developed fever, cough, and exertional dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the addition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstrated diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetrating ulcer with exposed bronchial cartilage of the bronchus intermedius and dynamic airway obstruction with complete closure during expiration. biopsy of the ulcer revealed rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphotericin b. Before surgery could be performed, pseudomonas aeruginosa pneumonia and septic shock developed, and the patient died.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/38. Eosinophilic pneumonia and respiratory failure associated with venlafaxine treatment.Drugs are well known causes of eosinophilic lung disease. In many patients, symptoms increase slowly, pulmonary infiltrates and eosinophilia progress over weeks, and resolve upon withdrawal of the offending agent. Rarely, the disease presents like acute eosinophilic pneumonia with acute onset of symptoms and rapidly progressing infiltrates which may be associated with respiratory failure. This report describe a case of venlafaxine-induced acute eosinophilic pneumonia causing respiratory insufficiency that rapidly resolved upon institution of corticosteroid treatment. This 5-hydroxytryptamine and noradrenaline reuptake inhibitor was previously not known to cause lung or peripheral blood eosinophilia. Considering the increasing use of this class of medication physicians have to be aware of this life-threatening and fully reversible complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/38. Debate: what constitutes 'terminality' and how does it relate to a living will?A moribund and debilitated patient arrives in an emergency department and is placed on life support systems. Subsequently it is determined that she has a 'living will' proscribing aggressive measures should her condition be judged 'terminal' by her physicians. But, as our round table of authorities reveal, the concept of 'terminal' means different things to different people. The patient's surrogates are unable to agree on whether she would desire continuation of mechanical ventilation if there was a real chance of improvement or if she would want to have her living will enforced as soon it's terms were revealed. The problem of the potential ambiguity of a living will is explored.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/38. Fulminant pneumonia due to aeromonas hydrophila in a man with chronic renal failure and liver cirrhosis.A 40-year-old man on hemodialysis was admitted due to dyspnea and chest pain and was diagnosed with pneumonia and pericarditis. ampicillin was administered, but thereafter severe septic shock developed. The fulminant type of pneumonia progressed rapidly, and he died only 48 hours after the onset of symptoms. The autopsy and sputa culture revealed pneumonia due to aeromonas hydrophila. The source of this infection remained unkown. Interestingly, there were two types of A. hydrophila found during such a short period. The physician should suspect this disease by questioning the patient's history. Early treatment with adequate antibiotics is the only means of saving such a patient's life.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/38. Anaphylactic shock from a latex allergy in a patient with spinal trauma.Allergy to latex is a condition that affects patients as well as health care workers. It is a spectrum of immunologic disorders that ranges from mild hypersensitivity to life-threatening anaphylaxis. Beginning in the early 1970s, the health care community has become more aware of this entity, leading to many improvements in the understanding, diagnosis and treatment of patients with latex allergy. Many hospitals have developed protocols and procedures for patients with latex sensitivity. However, some physicians remain unaware of the logistics of taking care of patients with this disorder. We present a case of a severe anaphylactic reaction to latex in a trauma patient with a spinal cord injury. The difficulty of treating the acutely injured patient with this disorder is illustrated. A list of equipment that may be included in a latex-free emergency kit is provided.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/38. The legal duty of physicians and hospitals to provide emergency care.Accessibility of hospital emergency services has been an issue of increasing concern and was recently brought into public focus in ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care on the existing standard of medical practice will be considered.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
8/38. Profiles in patient safety: sidedness error.This case describes a 45-year-old woman with significant respiratory distress secondary to a left-sided pleural effusion that mandated an urgent thoracentesis. An adverse event occurred when the physician performed the procedure on the incorrect side of the patient. Results of the incident investigation followed by a discussion of medical errors models, common errors types, human factors considerations, and conditions that contribute to error are presented. Pertinent case-specific and general concepts of a system approach to reduce this type of medical error are discussed, and educational recommendations are offered.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/38. Late-onset respiratory distress after inhalation of laundry detergent.Accidental poisoning with household cleaning products can pose significant risks to children. Exposure to granular laundry detergents accounts for a number of calls each year to poison control centers, though few of these exposures result in hospitalization. While caustic gastrointestinal injury resulting from ingestion of these highly alkaline cleaning agents is well-recognized, few reports address the potential damage to the respiratory tract that can occur following ingestion or inhalation of granular laundry detergent. We present a previously healthy 1-year-old who presented to the emergency department with Late-onset stridor and increased work of breathing following presumed inhalation of granular laundry detergent. parents, primary care providers, and emergency department physicians need to be aware of the potential toxicity of these widely used household products.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/38. The pulmonary physician in critical care * illustrative case 3: pulmonary vasculitis.The case history of a patient admitted to the ICU with severe hypoxic respiratory failure later diagnosed as Wegener's granulomatosis is presented. The diagnosis and management of patients with suspected pulmonary vasculitis is discussed.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
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