Pneumothorax in Intubated Patients With COVID-19: A Case Series.

Pneumothorax is a rare complication among mechanically ventilated patients since low tidal volumes are used nowadays instead of traditional high tidal volumes, but the incidence is slightly higher in patients with high positive end-expiratory pressure (PEEP). Herein we describe a case series of nine patients who were on mechanical ventilation due to acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19) and developed pneumothorax in due course. A retrospective analysis was done on COVID-19 intubated patients from March 2020 to June 2020 in a community hospital in Central New Jersey, which was one of the early hit states in the United States at the beginning of the pandemic.

Lesson of the month 1: To stop a fit, but swinging low.

This is a case of an elderly woman who presented to our emergency room with an episode of a witnessed fall. The past medical history of the patient was significant for post-stroke epilepsy for which she was on oxcarbazepine. Initial blood work showed a white cell count of 4.

Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl.

Purpose: To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia.

Materials And Methods: This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention.

Meningitis and Challenges in Treatment.

Neurosurgical interventions are rarely associated with meningitis with a very low incidence rate ranging from 1.1% to 2.5%.

Trends of Cannabis Use Disorder in the Inpatient: 2002 to 2011.

Objectives: The nationwide prevalence of cannabis use/abuse has more than doubled from 2002 to 2011. Whether the outpatient trend is reflected in the inpatient setting is unknown. We examined the prevalence and incidence of cannabis abuse/dependence as determined by discharge coding in a 10-year (2002-2011) National Inpatient Sample, as well as various trends among demographics, comorbidities, and hospitalization outcomes.

Implementation of an Intensive Care Unit Delirium Protocol: An Interdisciplinary Quality Improvement Project.

Background: Delirium is a commonly observed problem for adult patients in the intensive care unit (ICU) that is associated with increased mortality, increased hospital length of stay, and long-term disability of ICU survivors. This makes prevention and prompt treatment of delirium imperative goals for critical-care providers. Bedside critical-care nurses are uniquely poised to champion efforts to prevent, detect, and treat delirium but oftentimes are not aware of the most recent evidence-based guidelines or the potential long-term implications for the ICU survivor.

Postoperative changes in sleep-disordered breathing and sleep architecture in patients with obstructive sleep apnea.

Background: Anesthetics, analgesics, and surgery may profoundly affect sleep architecture and aggravate sleep-related breathing disturbances. The authors hypothesized that patients with preoperative polysomnographic evidence of obstructive sleep apnea (OSA) would experience greater changes in these parameters than patients without OSA.

Methods: After obtaining approvals from the Institutional Review Boards, consented patients underwent portable polysomnography preoperatively and on postoperative nights (N) 1, 3, 5, and 7 at home or in hospital.

Systematic review of the quality and generalizability of studies on the effects of opioids on driving and cognitive/psychomotor performance.

Introduction: The effect of opioids on driving performance has been much debated. Driving is a complex task requiring integration of psychomotor, cognitive, motor and decision-making skills, visual-spatial abilities, divided attention, and behavioral and emotional control. The objective of this systematic review was to assess the quality of studies and to revisit the concept that patients on stable opioids are safe to drive as it applies to everyday practice.

Chronic noncancer pain: characteristics of patients prescribed opioids by community physicians and referred to a tertiary pain clinic.

Objective: To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic.

Design: Cross-sectional, descriptive study.

Setting: A tertiary care, hospital-based pain clinic in Toronto, Ont.

Referring patients with chronic noncancer pain to pain clinics: survey of Ontario family physicians.

Objective: To examine the factors associated with FPs' referrals of patients with chronic noncancer pain to a tertiary care pain clinic.

Design: A questionnaire-based survey; data were analyzed using univariate methods.

Setting: A tertiary care pain clinic in Toronto, Ont.

Cardiovascular manifestations of acute pancreatitis.

Acute pancreatitis (AP) is an acute inflammatory process of the pancreas that is associated with variable involvement of pancreatic/peripancreatic tissue and one or more organ systems in varying degrees. Among the multiple organ system dysfunctions in severe AP, cardiovascular and/or pulmonary manifestations are frequent. The cardiovascular system may be affected alone or with other organ systems in all stages of AP.

Self limited disorder in a young female with fever, abdominal pain and lymphadenopathy: a case report.

Kikuchi-Fujimoto Disease is a rare, benign cause of lymphadenopathy that is often associated with fever, night sweats, and weight loss. The clinical and laboratory manifestation of Kikuchi-Fujimoto Disease are similar to those of lymphoma, tuberculosis, sarcoidosis, systemic lupus erythematosus, and it is often mistaken for these disorders. Definitive diagnosis is accomplished by lymph node biopsy.

Acute pancreatitis in pregnancy.

Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10,000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts and multiple organ dysfunction syndromes. Pregnancy related hematological and biochemical alterations influence the interpretation of diagnostic tests and assessment of severity of AP.

Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study.

Purpose: Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications.

Methods: Hospital ethics approval was obtained for the conduct of this study.

Effects of intravenous sodium amobarbital vs lidocaine on pain and sensory abnormalities in patients with spinal cord injury.

Objective: To compare the responses of patients with spinal cord injury (SCI) in regards to pain and sensory abnormalities to single blinded intravenous (i.v.) infusions of normal saline, sodium amobarbital, and lidocaine.