Puffed Post-Tracheostomy
An ICU patient has become increasingly 'puffed' post-tracheostomy. Can you figure out why? What are your going to do about it?
Category Clinical Cases
LITFL Clinical Case Collection. Over 250 Q&A style clinical cases to assist Just in Time Learning and Life Long Learning. Cases are categorised by specialty and can be searched by keyword from the database table
Alarmingly high pressures
A mechanically ventilated patient has high peak inspiratory pressures. You need to silence that incessant the alarm... What are you going to do?
Bronchospastic BP Badness
A young man has been intubated for severe asthma. Now his blood pressure is heading for the floor. What are you going to do about it? Think you can save a life?
Man versus Machine
A patient develops hypoxia soon after intubation. Where lies the problem? Is it man or machine?
Is resistance futile?
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?
Extraordinary Cries
aka Pulmonary Puzzler 010 A 13 year-old boy with a history of allergic rhinitis is sent in to the emergency department by his family doctor. Three days previously he was exposed to smoke from a bushfire and has been having…
Rapid descent
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:
Collapse and recruit
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.
A Case of CO2 Narcosis
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.
Pulmonary panic
A 17 year old female with a background history of HIV presents with a 3 day history of fevers, chills and rigors. Her admission chest X-rays are shown below:
Ballooning Up
A 36 year-old immunosuppressed male was infected with swine-origin influenza virus requiring mechanical ventilation. Overnight the inspiratory pressures needed to maintain his tidal volume had progressively increased and his face had become markedly swollen.
Pneumonia gone bad
Consider a 56 year old male with no past medical history presenting with 10 days of fevers, chills, myalgia and cough followed by worsening breathlessness over the past 4 days.