An ICU patient has become increasingly ‘puffed’ post-tracheostomy. Can you figure out why? What are your going to do about it?
About Paul Young
A proud graduate of The Breakfast Club, Paul is an Intensivist in Wellington, New Zealand. According to his father, Paul studied medicine after performing a cost-effectiveness analysis of his own biomedical fragility – a champion runner as a youth, he now struggles with a zimmer frame. Although he started out in the ED, Paul feels physically ill whenever he steps foot there these days.
An Obstetric Bleeder
July 21, 2010 By Leave a Comment
A 32 year-old woman is referred to the ICU post caesarean section. She had an uneventful elective caesarian section 10 hours previously. She has been referred because in the last 2 hours she has developed vaginal bleeding and oozing from her epidural site.
A Cure for Hurt Feelings
July 15, 2010 By 1 Comment
In response to concern (baseless) that the recent uncovering of the Society for the Prevention of Surgery was in some way meant to discredit the invaluable work of our Anaesthetic colleagues, Professor Staghorn and the Board of UCEM have undertaken and exhaustive search of the literature
Is resistance futile?
July 8, 2010 By Leave a Comment
An elderly man with a nasty looking chest x-ray is treated with penicillin. Should the antibiotic be changed in light of his sputum MCS?
New Zealand All Whites: World’s No.1 soccer team
July 2, 2010 By 4 Comments
All Whites: undefeated in the World Cup since 1982.
Laboratory Tester #004
May 4, 2010 By Leave a Comment
Acute hepatitis with jaundice and coagulopathy without hepatic encephalopathy is referred to as severe acute hepatitis. Fulminant hepatic failure is defined as the appearance of hepatic encephalopathy in a patient with acute deterioration of liver function with no previous history of liver disease.
Lung collapse, recruitment and bronchoscopy
April 14, 2010 By Leave a Comment
A 19 year old male is admitted after a severe traumatic brain injury. Due to refractory intracranial hypertension he is intubated and receiving 20mg an hour of morphine, 20mg an hour of midazolam and 200mg an hour of propofol.
DeBakey’s Dissection
March 23, 2010 By 2 Comments
A previously well 50 year old presents with sharp severe chest pain after a long haul flight from North America. A chest X-ray and ECG are performed and reveal no abnormalities
The Paradoxical Alternative
March 15, 2010 By 1 Comment
Consider a 49 year female old smoker with two weeks of increasing shortness of breath. She is being treated for pneumonia on the ward for three days but getting worse. An ICU review is performed on the ward and the following ECG is obtained.
A metabolic acidosis with hypernatremia
March 10, 2010 By Leave a Comment
A 20 year old male presents with 3 days of lethargy and generalised malaise. He is confused and looks very unwell. Can sort out this metabolic muddle?
