Resp Care
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The bedside chest x-ray (CXR) is an indispensible diagnostic tool for monitoring seriously ill patients in the intensive care unit. The CXR often reveals abnormalities that may not be detected clinically. ⋯ The interpretation of the bedside CXRs is often challenging, and requires extensive radiologic experience to avoid misinterpretation of the wide spectrum of pleural and pulmonary disease. The clinical information is of substantial value for the interpretation of the frequently nonspecific findings.
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Hypersensitivity pneumonitis is an immunologic reaction to an inhaled antigen, with a wide spectrum of clinical presentations. The most common manifestations are fever, cough, and dyspnea. We describe a case of hypersensitivity pneumonitis with marked alveolar lymphocytosis; the patient presented with respiratory failure and shock requiring mechanical ventilation and vasopressive agents. We hypothesized that immune mediators implicated in the pathogenesis of hypersensitivity pneumonitis were responsible for the transient shock observed in this patient.
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While group C beta hemolytic streptococcal infections are uncommon in humans, group C beta hemolytic streptococcal pneumonia is exceedingly rare. To the best of our knowledge, only 2 cases of necrotizing pneumonia caused by group C beta hemolytic streptococcus have been reported in the past. Thus, we are reporting a rare case of necrotizing group C beta hemolytic streptococcal pneumonia in a young healthy adult with no risk factors.
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Case Reports
Continuous noninvasive ventilation delivered by a novel total face mask: a case series report.
Noninvasive ventilation (NIV) has been widely used to decrease the complications associated with tracheal intubation in mechanically ventilated patients. However, nasal ulcerations may occur when conventional masks are used for continuous ventilation. ⋯ The total face mask was very well tolerated by all the patients, and permitted safe and efficient continuous NIV for several days until the acute respiratory failure episode resolved. None of the patients required endotracheal intubation during the acute episode.
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Inhaled nitric oxide (INO) has been shown to preferentially lower resistance in the pulmonary vasculature. The relative selectiveness of INO in accomplishing this effect makes it an attractive drug to administer as salvage therapy in patients with acute right ventricular failure secondary to pulmonary embolism. We describe 4 cases in which INO was used as a temporizing agent to decrease right ventricular after-load following massive near-fatal pulmonary embolism. All 4 patients survived to hospital discharge.