Propofol is a sedative agent gaining popularity for Emergency Department Procedural Sedation (EDPS). However, some institutions across the country continue to restrict the use of propofol secondary to safety concerns. The purpose of our study was to evaluate the complication rate of EDPS with propofol. We conducted a prospective, observational, multi-center study of EDPS patients aged > or = 18...

Mechanical ventilation is the standard life-support technique for patients with severe acute respiratory failure. However, some patients develop persistent and refractory hypoxemia because their lungs are so severely damaged that they are unable to respond to the application of high inspired oxygen concentration and high levels of positive end-expiratory pressure. In this article, we review cur...

Evidence Summary A Cochrane meta-analysis of six RCTs (n = 489) found that corticosteroids given as early adjunctive anti–pneumocystis pneumonia therapy in patients with HIV infection decrease mortality at one month (risk ratio [RR] = 0.56; 95% confidence interval [CI], 0.32 to 0.98) and at three to four months (RR = 0.68; 95% CI, 0.5 to 0.94).1 Of the 489 patients, 463 had confirmed pneumocyst...

A 75-year old man was referred to hospital for symptomatic hypoxemia. He did not complain of dyspnea while supine, but while sitting or standing, he experienced dyspnea with severe hypoxemia. He did not have any pulmonary diseases that could cause dyspnea. Transesophageal echocardiography revealed an atrial septal aneurysm with a small atrial septal defect (ASD) and a mild left-to-right shunt t...

Platelet survival time (autologous labeling with 51chromium) was measured in 63 patients in order to evaluate the role of platelets in the thromboembolic complications of patients with hypoxemia and pulmonary hypertension. Thirty-eight of these patients had chronic obstructive airways disease; 13, primary pulmonary hypertension; seven, recurrent pulmonary embolism; four, the Eisenmenger syndrom...

To explore mechanisms of hypoxemia after acute pulmonary embolism, we measured regional pulmonary blood flow and alveolar ventilation before and after embolization with 780-micrometers beads in five anesthetized, mechanically ventilated pigs. Regional ventilation and perfusion were determined in approximately 2.0-cm3 lung volumes by using 1-micrometers-diameter aerosolized and 15-micrometers-di...

Mild to moderately severe hypoxemia was documented in 19 of 21 mostly asymptomatic firemen who were exposed to dense smoke containing polyvinylchloride and other pulmonary irritants. The hypoxemia was transient, with nearly complete reversibility within 24 hours. Subsequent tests for pulmonary function one month later demonstrated that this transient hypoxemia was not related to previous underl...

PURPOSE To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position. CLINICAL FEATURES A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthes...

Fat embolism syndrome (FES) is a life-threatening condition in which multiorgan dysfunction manifests 48-72 hours after long bone or pelvis fractures. Right ventricular (RV) failure, especially in the setting of pulmonary hypertension, is a frequent feature of FES. We report our experience treating 2 young, previously healthy trauma patients who developed severe hypoxemia in the setting of FES....