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?
Category LITFL
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.
Roast duck and juniper beer
Consider a 73 year old female admitted with vomiting and subsequent chest pain. This is her admission chest X-ray.
Not just a PE
A classic respiratory case. This 25 year old female presented with worsening breathless. She has no previous medical problems.
Not just pneumonia
A 30 year-old male presented with 24 hours of worsening respiratory distress, following a 5-day prodrome of cough, fever, diarrhoea, lethargy and malaise.
Pott fracture
Archaic eponym: Effectively a fracture-dislocation of the ankle, involving a fracture of the fibula, disruption of the deltoid ligaments with an intact tibiofibular ligament