Chest
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Significant shallow-water injuries can occur in scuba divers, even in swimming pools. Two asthmatic patients are presented who sustained cerebral air emboli during Scuba classes in a swimming pool. Such injuries may be more common in asthmatics. Asthma is a contraindication to Scuba diving.
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Case Reports
Independent ventilation and ECMO for severe unilateral pulmonary edema after SLT for primary pulmonary hypertension.
Single lung transplantation (SLT) is now accepted therapy for selected cases of severe pulmonary hypertension. A recognized complication is the postoperative development of reperfusion edema in the graft, a potentially fatal cause of respiratory failure. Because reperfusion edema may be a reversible process, temporizing support measures can be life-saving. ⋯ Extracorporeal membrane oxygenation (ECMO) was instituted. Independent lung ventilation was later begun and resulted in markedly improved oxygenation allowing withdrawal of ECMO. We conclude that reperfusion edema following SLT for pulmonary hypertension may be uniquely amenable to treatment with independent lung ventilation and ECMO if needed.
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Viral infections are known to be associated with severe exacerbations of asthma in children. In contrast, there is limited data that viral infections evoke acute episodes of asthma that require emergency care in adults. To determine the role of viral infections in exacerbations of asthma in adults, we examined 33 patients who presented to the emergency room with 35 exacerbations of asthma between September 1990 and March 1991 for the presence of a viral infection. ⋯ Likewise, in all 16 patients tested, acute and convalescent serologic studies did not show a significant rise in titer by complement fixation test. Thus, despite symptoms consistent with viral infection, viral pathogens could not be shown by current virologic techniques. This study suggests that viral infection may not be as prevalent a precipitate of asthma in adults requiring emergency room treatment as is generally thought.
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Bronchoscopy has been incorporated as a useful adjunct to increase the safety and effectiveness of percutaneous endoscopic tracheostomy (PET). Insertion of the bronchoscope, along with the intraluminal dilators of the PET set, into the airway potentially leads to hypoventilation and hypercarbia during the procedure. ⋯ In a third patient, the rise in PaCO2 was accompanied by a marked rise in intracranial pressure (ICP), and a corresponding fall in cerebral perfusion pressure. While transient hypercarbia seems well tolerated by most patients, this phenomenon and its effect on cerebral blood flow should be strongly considered before performing PET on the critically ill patient with evidence of elevated ICP.
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To characterize the physiologic response to, and safety of, intravenacaval membrane oxygenation and carbon dioxide removal. ⋯ Intravenacaval membrane oxygen and carbon dioxide removal can provide partial respiratory support during severe respiratory failure and permit reductions in the level of mechanical ventilator support, with an acceptable safety profile.