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Critical Care

Last 50 Critical Care Postings

(Click on title to be directed to posting, most recent listed first, CME offerings in Bold)

July 2019 Critical Care Case of The Month: An 18-Year-Old with
   Presumed Sepsis and Progressive Multisystem Organ Failure 
An Observational Study Demonstrating the Efficacy of Interleukin-1 
   Antagonist (Anakinra) in Critically-ill Patients with Hemophagocytic
   Lymphohistiocytosis
Which Half Are You? Almost Half of Pediatric Oncologists and Intensivists
   Are Burnt Out……
Management of Refractory Hypoxemic Respiratory Failure Secondary to
   Diffuse Alveolar Hemorrhage with Venovenous Extracorporeal Membrane
   Oxygenation
Amniotic Fluid Embolism: A Case Study and Literature Review
April 2019 Critical Care Case of the Month: A Severe Drinking
   Problem
Ultrasound for Critical Care Physicians: An Unexpected Target Lesion
January 2019 Critical Care Case of the Month: A 32-Year-Old Woman
   with Cardiac Arrest
The Explained Variance and Discriminant Accuracy of APACHE IVa 
   Severity Scoring in Specific Subgroups of ICU Patients
Ultrasound for Critical Care Physicians: Characteristic Findings in a 
   Complicated Effusion
October 2018 Critical Care Case of the Month: A Pain in the Neck
Ultrasound for Critical Care Physicians: Who Stole My Patient’s Trachea?
August 2018 Critical Care Case of the Month
Ultrasound for Critical Care Physicians: Caught in the Act
July 2018 Critical Care Case of the Month
June 2018 Critical Care Case of the Month
Fatal Consequences of Synergistic Anticoagulation
May 2018 Critical Care Case of the Month
Airway Registry and Training Curriculum Improve Intubation Outcomes in 
   the Intensive Care Unit
April 2018 Critical Care Case of the Month
Increased Incidence of Eosinophilia in Severe H1N1 Pneumonia during 2015
   Influenza Season
March 2018 Critical Care Case of the Month
Ultrasound for Critical Care Physicians: Ghost in the Machine
February 2018 Critical Care Case of the Month
January 2018 Critical Care Case of the Month
December 2017 Critical Care Case of the Month
November 2017 Critical Care Case of the Month
A New Interventional Bronchoscopy Technique for the Treatment of
   Bronchopleural Fistula
ACE Inhibitor Related Angioedema: A Case Report and Brief Review
Tumor Lysis Syndrome from a Solitary Nonseminomatous Germ Cell Tumor
October 2017 Critical Care Case of the Month
September 2017 Critical Care Case of the Month
August 2017 Critical Care Case of the Month
Telemedicine Using Stationary Hard-Wire Audiovisual Equipment or Robotic 
   Systems in Critical Care: A Brief Review
Carotid Cavernous Fistula: A Case Study and Review
July 2017 Critical Care Case of the Month
High-Sensitivity Troponin I and the Risk of Flow Limiting Coronary Artery 
   Disease in Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)
June 2017 Critical Care Case of the Month
Clinical Performance of an Interactive Clinical Decision Support System for 
   Assessment of Plasma Lactate in Hospitalized Patients with Organ
   Dysfunction
May 2017 Critical Care Case of the Month
Management of Life Threatening Post-Partum Hemorrhage with HBOC-201 
   in a Jehovah’s Witness
Tracheal Stoma Necrosis: A Case Report
April 2017 Critical Care Case of the Month
March 2017 Critical Care Case of the Month
Ultrasound for Critical Care Physicians: Unchain My Heart
February 2017 Critical Care Case of the Month
January 2017 Critical Care Case of the Month
December 2016 Critical Care Case of the Month
Ultrasound for Critical Care Physicians: A Pericardial Effusion of Uncertain 
   Significance
Corticosteroids and Influenza A associated Acute Respiratory Distress 
   Syndrome

 

For complete critical care listings click here.

The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.

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Wednesday
Oct022013

October 2013 Critical Care Case of the Month: Slow to Respond

Michael P. Mohning, MD

 

Pulmonary Sciences and Critical Care Medicine

University of Colorado Hospital

Denver, CO

 

History of Present Illness

A 66-year-old woman presents with confusion and lower extremity edema. She was brought to the emergency department by her family after 2-3 days of increasing confusion.  She has fatigue and a dry non-productive cough but denies shortness of breath, chest pain, fevers or chills. She had a decrease in oral intake and constipation for several days.

PMH, SH, FH

Five months ago, she was admitted to a hospital for community acquired pneumonia and hyponatremia. She is a never smoker, and doesn’t use alcohol.

There is no significant family history.

Medications

  • Omega 3 fatty acids
  • Multivitamins

Physical Examination

Temperature 36.1° C, blood pressure 106/61 mm Hg, heart rate 72 beats/min, respiratory rate 15 breaths/min, oxygen saturation 90% on room air.

She was confused, and oriented to self only.  She had facial edema.  Cardiac exam was normal. Pulmonary findings include rales at the lung bases. Her abdomen was non-tender, with active bowel sounds. She had 1+  lower extremity edema, no rashes, and delayed relaxation of reflexes.

Laboratory

She was anemic with hematocrit of 32%, hemoglobin 11 g/dL and WBC 5,000. Serum sodium is low at 118 meq/L, anion gap was normal at 9 and potassium and calcium levels were normal. Albumin is low at 3.2 g/dL. Remaining liver function, blood glucose and creatinine are normal. EKG shows no T wave inversions or ST segment elevation.

Radiography

Chest x-ray is shown in figure 1.

 

Figure 1. Admission PA (Panel A) and lateral (Panel B) chest x-ray.

Which best describes the chest-x-ray?

  1. Bilateral interstitial infiltrates
  2. Enlarged cardiac silhouette
  3. Hyperexpanded lungs
  4. Poor inspiratory effort
  5. Pulmonary edema

Reference as: Mohning MP. October 2013 critical care case of the month: slow to respond. Southwest J Pulm Crit Care. 2013;7(4):214-20. doi: http://dx.doi.org/10.13175/swjpcc105-13 PDF

Friday
Sep062013

Ultrasound for Critical Care Physicians: Connecting Disparate Symptoms

An 18-year-old woman was recently diagnosed with non-ACTH-Mediated Cushing syndrome, now with a complaint of mild shortness of breath.

Her cardiac exam showed normal sinus rhythm at 84 beats per minute and blood pressure of 130/80 mmHg. Her mitral first heart sound was slightly accentuated, but the pulmonic sound was normal. Grade-I diastolic murmur was heard over the mitral area. Opening snap was absent. Lungs were clear and chest radiograph showed slight cardiomegaly. She had multiple freckles on his face and trunk and along the vermillion border of the lips.

An ultrasound of the heart was performed (Figure 1).

Figure 1. Four chamber view of the heart.

 

Which of the following is the likely diagnosis?

  1. Brugada syndrome
  2. Carney syndrome
  3. Gotway syndrome
  4. Jervell and Lange-Nielsen syndrome
  5. Peutz-Jeghers syndrome

Reference as: Gotway MB. Ultrasound for critical care physicians: connecting disparate symptoms. Southwest J Pulm Crit Care. 2013;7(3):176-8. doi: http://dx.doi.org/10.13175/swjpcc122-13 PDF

Monday
Sep022013

September 2013 Critical Care Case of the Month: Revenge of the Pharaohs

Robert A. Raschke, MD

Elijah Poulos, MD

Banner Good Samaritan Regional Medical Center

Phoenix, AZ

 

History of Present Illness

The patient was a 68 year-old man, admitted to our ICU through the emergency room (ER) in July 2013 with suspected urinary tract origin sepsis.

The patient was evaluated in ER by the ICU team. He was in his usual state of general good health until he visited his primary care physician for what he felt was a left inguinal hernia, and underwent a prostate examination, four days previously. The patient associated this prostate examination with the onset of fevers and chills that began the next morning. He was seen in an urgent care center where he was told his urinalysis was normal, and antibiotics were not prescribed. Over the intervening 3 days, he suffered recurrent fevers, had vomited three times, and had one diarrheal bowel movement. Earlier on the day of presentation, he had been mowing his lawn (in >100° F environment) and had become a little dizzy. His wife, a retired nurse, finally convinced him to report to the ER.

He denied dysuria, urinary frequency or urgency, headache, sore throat, cough, or abdominal pain.

PMH, SH, FH

He had a prior history of hypertension, gastroesophageal reflux, gout and hypercholesterolemia. He drank alcohol about twice a month and did not smoke.

There was no family history of illnesses.

Medications

  • Atorvastatin
  • Allopurinol
  • Hydrochlorothiazide
  • Lisinopril
  • Temazepam

Physical Exam

On ER triage, his temperature was 41.2° C, but vitals at the time of our initial examination were temp 38.2° C, HR 93 beats/min, BP 103/48 mm Hg, and respiratory rate 20 breaths/min. He was awake and alert, but made a few errors while relating his history – for instance, he initially answered yes when asked if he had a headache, then corrected himself and said no – he meant he had a fever. He was actively rigoring. HEENT exam was unrevealing. He had no lymphadenopathy. His lungs were clear. His abdomen was soft and nontender. He had a sliding left inguinal hernia that was not tender. None of his joints were acutely inflamed. His prostate was not enlarged or tender to palpation. He had no focal neurological deficits.

Laboratory

Pertinent laboratory values in the ER:

  • WBC: 7.7 x109/L
  • Hematocrit: 38.4%
  • Sodium: 131 me/L
  • Potassium: 3.1 me/L
  • BUN:28 g/dL
  • Creatinine: 1.3 mg/dL
  • Lactate: 2.1 mMol/L.

The rest of his admission labs and urinalysis were unremarkable.

Chest Radiography

His initial portable chest x-ray is shown in Figure 1.

Figure 1. Initial portable chest x-ray.

 

Which of the following is the likely cause of his fever?

  1. Prostatitis exacerbated by digital rectal exam
  2. Right middle lobe pneumonia
  3. Urinary tract infection
  4. All of the above
  5. None of the above

Reference as: Raschke RA, Poulos E. September 2013 critical care case of the month: revenge of the pharaohs. Southwest J Pulm Crit Care. 2013;7(3):142-50. doi: http://dx.doi.org/10.13175/swjpcc104-13 PDF

Friday
Aug232013

Ultrasound for Critical Care Physicians: Sickle Cell Crisis

A 32 year old man was admitted a week earlier with sickle cell pain crisis. He had developed increasing dyspnea, oxygen desaturation and bilateral pulmonary infiltrates.  He had a pulseless electric activity code blue and an ultrasound of the heart was obtained (Figure 1).

Figure 1. Subxiphoid view ultrasound of the heart.

What does the ultrasound show?

  1. Aortic dissection
  2. Aortic stenosis
  3. Enlarged left ventricle
  4. Enlarged right ventricle
  5. Pericardial effusion

Reference as: Raschke RA. Ultrasound for critical care physicians: sickle cell crisis. Southwest J Pulm Crit Care. 2013:7(2):110-1. doi: http://dx.doi.org/10.13175/swjpcc113-13 PDF

Friday
Aug022013

August 2013 Critical Care Case of the Month: My, That’s a Big One

Andrew Waas, M.D.

 

Pulmonary Sciences and Critical Care Medicine

University of Colorado Hospital

Denver, Co

  

History of Present Illness

A 75 year old male presented to the emergency department with complaints of three days of increasing nausea, generalized weakness, and dyspnea on exertion.  He had undergone a radical prostatectomy 13 days prior to presentation from which he was recovering well until the onset of these symptoms. There was no associated chest pain, cough, fevers, chills or weight loss.

 

PMH, SH, FH

He had a history of hypertension and prostate cancer for which he underwent a recent prostatectomy.

He was born in Colorado and had not traveled recently.  There was no history of tobacco use, he drank ethanol on rare occasions, and did not use any illicit drugs. 

There was no family history of illnesses of which he was aware.

 

Medications

  • Dutasteride 0.5 mg daily
  • Telmisartan 40 mg daily

 

Physical Exam

Blood pressure 142/85, heart rate 108, temperature 36.7 C, respiratory rate 25, saturating 95% on 2L oxygen. 

Generally, he was in no distress, but was slightly tachypneic.  Lungs were clear to auscultation bilaterally and he was tachycardic but regular.  Otherwise, his exam was normal. 

 

Laboratory

Laboratory evaluation revealed a mild leukocytosis at 13 x 106 cells/mcL with 72% neutrophils and 20% lymphocytes.  His basic metabolic panel (including creatinine) was normal; his liver function tests were likewise normal. 

 

Chest Radiography

His initial portable chest x-ray is shown in Figure 1.

Figure 1. Initial portable chest x-ray

 

Which of the following best describes the chest x-ray?

  1. Cardiomegaly
  2. Cavitating lung mass
  3. Multifocal infiltrates
  4. All of the above
  5. None of the above

Reference as: Waas A. August 2013 critical care case of the month: my, that's a big one. Southwest J Pulm Crit Care. 2013;7(2):66-74. doi: http://dx.doi.org/10.13175/swjpcc096-13 PDF