Diaphragm pacing improves respiratory mechanics in acute cervical spinal cord injury.

Background: Cervical spinal cord injury (CSCI) is devastating with ventilator-associated pneumonia being a main driver of morbidity and mortality. Laparoscopic diaphragm pacing implantation (DPS) has been used for earlier liberation from mechanical ventilation. We hypothesized that DPS would improve respiratory mechanics and facilitate liberation.

Hydropneumothorax Due to Esophageal Rupture.

Background: A brief review of the historical aspects of esophageal rupture is presented along with a case and current recommendations for diagnostic evaluation and treatment.

Case Report: A 97-year-old woman complained of acute dyspnea without prior vomiting. Chest x-ray study showed a large right pneumothorax with associated effusion.

Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature.

Background: Adult respiratory distress syndrome is often refractory to treatment and develops after entering the health care system. This suggests an opportunity to prevent this syndrome before it develops. The objective of this study was to demonstrate that early application of airway pressure release ventilation in high-risk trauma patients reduces hospital mortality as compared with similarly injured patients on conventional ventilation.

Stroke registry: hemorrhagic vs ischemic strokes.

Background: Epidemiologic studies of stroke in the 1970s and 1980s have reported the percentage of ischemic stroke as 73% to 86%, with hemorrhagic stroke as only 8% to 18%; the remainder was undetermined (due to not performing computed tomographic [CT] scanning or an autopsy). In our clinical work, it appeared anecdotally to the authors that we were seeing more hemorrhagic strokes than these previously quoted figures.

Methods: We conducted a retrospective review for 1 year of all patients discharged from the hospital, a regional stroke center, with a diagnosis of stroke; we compared ischemic to hemorrhagic stroke types.

Hyper-use of the ED.

Objectives: This study aims to describe the population that averages one or more emergency department (ED) visits per month and compare them to the general ED population to determine if there are associated characteristics.

Methods: A retrospective cohort study conducted in a teaching hospital between January 1, 2001, and December 31, 2004, identified all patients with more than 35 visits. This hyper-user (HU) cohort (n = 49) was compared to a randomly selected group of non-HU patients (n = 50) on the following measures: age, sex, insurance coverage, primary medical doctor (PMD), dwelling location, chief complaint, comorbidities, and disposition.

Severe non-anion gap metabolic acidosis induced by topiramate: a case report.

Background: A non-anion gap acidosis can be induced by topiramate, causing symptomatic dyspnea and confusion.

Objectives: Discuss the pathophysiology of the hyperchloremic metabolic acidosis caused by topiramate, the typical clinical presentation, and the recommended treatment.

Case Report: This case presents a young woman with a clinically significant non-anion gap metabolic acidosis believed to be caused by topiramate.

Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction.

Context: Despite 2 decades of evidence demonstrating benefits from prompt coronary reperfusion, registries continue to show that many patients with ST-segment elevation myocardial infarction (STEMI) are treated too slowly or not at all.

Objective: To establish a statewide system for reperfusion, as exists for trauma care, to overcome systematic barriers.

Design And Setting: A quality improvement study that examined the change in speed and rate of coronary reperfusion after system implementation in 5 regions in North Carolina involving 65 hospitals and associated emergency medical systems (10 percutaneous coronary intervention [PCI] hospitals and 55 non-PCI hospitals).