Thursday, August 25, 2016

Ventilators III

This unresponsive patient was intubated for airway protection.

Challenge: What is your goal with the ventilator?

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Monday, August 22, 2016

Ventilators II

A patient with severe COPD presents with an acute exacerbation. He is intubated for hypercapneic respiratory failure and has the waveform seen above. Over the next hour, he develops significant hemodynamic instability. Suddenly, he has a cardiac arrest, and you immediately start CPR and follow ACLS.

Challenge: What is your next intervention (with the ventilator)?

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Thursday, August 18, 2016

Ventilators I

By request, some ICU topics. This mode of ventilation is occasionally used in medical, surgical, or trauma patients with acute respiratory distress syndrome. The advantage is that it allows the patient to be awake or lightly sedated, spontaneously ventilating. Its high mean airway pressures aid alveolar recruitment.

Challenge: What kind of mode is this?

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Monday, August 15, 2016


This man presents with an erythemaous genital papule that evolved into a pustule and eroded into an ulcer. The ulcer is 1-2cm in diameter, painful, with an erythematous base. The borders of the ulcer are clearly demarcated and the base has a gray-yellow exudate. The patient also has inguinal lymphadenitis. Aspiration of the lesion is shown above.

Challenge: What is this?

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Monday, August 8, 2016

Studying for ICU Boards

I'm studying for my critical care boards this week so next case will be next Monday. Also, just as a heads up, I am thinking of winding down this blog; we're getting close to reaching a thousand cases total. Thanks for reading!


Thursday, August 4, 2016


You are a medical student rotating on ICU, and on your first day, you witness a test. An intubated patient is put onto 100% oxygen for 10 minutes. An ABG and electrolytes are checked and normal. His vital signs, including temperature, are normal. He is then taken off the ventilator and observed for ten minutes. A repeat ABG is sent.

Challenge: What test did you just witness?

Monday, August 1, 2016


An adult patient develops severe hypoxemia from a pneumonia and goes into cardiac arrest. He is successfully resuscitated with the machine shown above. The following day, it is noted that a sat probe on his right forefinger and a sat probe on his ear reads 75% whereas a sat probe on the toe reads 98%. He does have a right femoral arterial cannula and an ABG drawn there reads a PaO2 of 150mmHg. However, when you do a fresh ABG stick from the right radial artery, the PaO2 is 40mmHg.

Challenge: What machine is he on?

Image is in the public domain.

Thursday, July 28, 2016

Musculoskeletal II

This happened while blocking a basketball shot. There is loss of sensation in a "shoulder badge" distribution.

Challenge: What's going on here?

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Monday, July 25, 2016

Musculoskeletal I

This child's deformities involve the proximal bones more than the distal ones. He also has macrocephaly and midface hypoplasia.

Challenge: What autosomal dominant disorder is seen here?

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Monday, July 18, 2016


Uh oh, it's the glycogen metabolism pathway.

The classic infantile form of this disease presents in the first few months of life with cardiomyopathy and severe generalized muscular hypotonia. At the median presentation age of four months, infants will have cardiomegaly, respiratory distress, muscle weakness, feeding disorders, and failure to thrive. Standard metabolic labs will be normal, but serum creatine kinase will be elevated.

A late onset juvenile or adult form presents without cardiac problems. The age of presentation varies, but the presentation is primarily skeletal myopathy eventually leading to respiratory failure. Children might present with delayed gross motor development, and adults might present with progressive limb girdle weakness (starting with hip flexors). Creatine kinase will be elevated as well.

Challenge: What autosomal recessive disease is this?

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