ICU Management & Practice, Volume 19 - Issue 2, 2019 A structural approach for diagnosing weaning failure A case from a specialised weaning centre Using a case of a former patient we describe the structured approach of analysis of the cause of weaning failure with corresponding specific therapies used in our Centre for Expertise. Previously, we suggested a structural approach for diagnosing the cause of weaning failure (Heunks and van der Hoeven 2010;...

IMAGES IN CLINICAL MEDICINE Emphysematous Cholecystitis Sondes Mhamdi and Kais Mhamdi N Engl J Med 2019; 381:e14DOI: 10.1056/NEJMicm1814551 An 80-year-old man with a history of hypertension presented to the emergency department with a 2-day history of abdominal pain in the right upper quadrant. The patient was febrile. On physical examination, he had abdominal tenderness in the right upper quadrant, and Murphy’s sign was positive. Laboratory studies reveal...

IMAGES IN CLINICAL MEDICINE Fish Bone Perforation Takafumi Taguchi and Hiroyuki Kitagawa N Engl J Med 2019; 381:762DOI: 10.1056/NEJMicm1900442 A 73-year-old man presented to the emergency department with the acute onset of severe lower abdominal pain. He recalled eating yellow-tail fish the day before the onset of the pain. His temperature was 38°C, blood pressure 122/69 mm Hg, and heart rate 77 beats per minute. On physical examination, he had tenderness ...

IMAGES IN CLINICAL MEDICINE Air in the Spleen Simon De Freitas, Evan G. Wong N Engl J Med 2019; 381:566DOI: 10.1056/NEJMicm1817266 A 56-year-old woman presented to the emergency department with a 1-month history of epigastric and left-upper-quadrant abdominal pain. Her medical history included polysubstance use disorder (including cocaine and heroin use) and hepatitis C virus infection, as well as rheumatoid arthritis, for which she had been taking naproxe...

JAMA Diagnostic Test Interpretation June 14, 2019 Adenosine Deaminase Diagnostic Testing in Pericardial Fluid Edward Chau, Minoo Sarkarati,Brad Spellberg JAMA. 2019;322(2):163-164. doi:10.1001/jama.2019.7535 Case A 65-year-old Vietnamese man with hypertension, type 2 diabetes mellitus, and chronic hepatitis B with cirrhosis presented with a 2-week history of shortness of breath at rest, orthopnea, and lower extremity edema. He ...

JAMA Diagnostic Test Interpretation June 14, 2019 Adenosine Deaminase Diagnostic Testing in Pericardial Fluid Edward Chau, Minoo Sarkarati,Brad Spellberg JAMA. 2019;322(2):163-164. doi:10.1001/jama.2019.7535 Case A 65-year-old Vietnamese man with hypertension, type 2 diabetes mellitus, and chronic hepatitis B with cirrhosis presented with a 2-week history of shortness of breath at rest, orthopnea, and lower extremity edema. He ...

IMAGES IN CLINICAL MEDICINE Thrombotic Thrombocytopenic Purpura Shruti Bhandari and Rohit Kumar N Engl J Med 2019; 380:e23DOI: 10.1056/NEJMicm1813768 A 35-year-old man presented to the emergency department with a 2-day history of abdominal pain, headache, and brown urine. On examination, his temperature was 37.5°C. He was alert and oriented to time, place, and self, and he had no purpura or petechiae. Laboratory evaluation revealed a hemoglobin level of 8....

IMAGES IN CLINICAL MEDICINE Pneumatosis Cystoides Intestinalis with Pneumoperitoneum Francesco Pata, and Salomone Di Saverio N Engl J Med 2019; 380:e17DOI: 10.1056/NEJMicm1808960 A 61-year-old woman presented to the emergency department with acute onset of diffuse abdominal pain and a 1-week history of diarrhea and vomiting. Her medical history included chronic obstructive pulmonary disease, which was being treated with an inhaled glucocorticoid and a long...

CLINICAL DECISIONS Early Administration of Antibiotics for Suspected Sepsis Michael Y. Mi, Michael Klompas, Laura Evans N Engl J Med 2019; 380:593-596DOI: 10.1056/NEJMclde1809210 Case Vigenette 病例 A Man with Hypoxemia and a Woman with Acute Kidney Injury 一名低氧血症男性患者及一名急性肾损伤女性患者 Michael Y. Mi, M.D. Mr. Shui is a 35-year-old man who is brought to the emergency department by ambulance after falling from the crest of a tall wave ...

CLINICAL DECISIONS Early Administration of Antibiotics for Suspected Sepsis Michael Y. Mi, Michael Klompas, Laura Evans N Engl J Med 2019; 380:593-596DOI: 10.1056/NEJMclde1809210 Case Vigenette 病例 A Man with Hypoxemia and a Woman with Acute Kidney Injury 一名低氧血症男性患者及一名急性肾损伤女性患者 Michael Y. Mi, M.D. Mr. Shui is a 35-year-old man who is brought to the emergency department by ambulance after falling from the crest of a tall wave ...