Lung collapse, recruitment and bronchoscopy

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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 Dissection

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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

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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.

More green urine…

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You are looking after a 23 year old male who has a subarachnoid haemorrhage and the nurse calls because the patient has started to pass unusual urine:

Rapidly progressive respiratory failure

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A 30 year old male presents with a 3 day history of fevers and increasing breathlessness. On presentation he is noted to be severely hypoxic with sats of 80% on room air. The following chest X-ray is obtained:

Metabolic mayhem post-subacrachnoid hemorrhage

Life in the Fast lane 150 thumb

An 87 year old female presented with a subarachnoid haemorrhage. GCS 8/15. A nasogastric tube was unable to be placed due to patient agitation. As a consequence, the patient was fasted for five days due to concern about swallowing. Can you figure out her acid-base disturbance?

A Nasty Sore Throat

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A 38 year old male with a background history of type 2 diabetes presents with fevers, rigors and pain on swallowing. There is no sign of impending airway compromise; however, marked trismus is noted. The following plain X-ray is obtained:

A Case of CO2 Narcosis

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A 67 year old gentleman with a BMI of 45 was waiting for his respiratory outpatient clinic appointment. While waiting, he fell asleep. A medical emergency was called because he could not be woken up. On arrival of the MET team the patient is found to have a blood pressure of 140/70, a heart rate of 100bpm and oxygen sats of 68% on room air. He is breathing spontaneously but requires airway support. His GCS is 3/15. Supplemental oxygen is applied and the following arterial blood gas is obtained.