Induced hypothermia (IH) has been used for over 60 years (1) as an adjuvant therapy in a group of critically ill patients. Described by Fay in the 1940s, (2) IH has been used in operating rooms since the early 1950s for patients undergoing cardiac surgery and neurosurgery. The use of IH after cardiac arrest was first reported in 1957 by Benson et al. (3) The beneficial effects of hypothermia in animal tests during periods of ischemia result in a wide range of biological effects and it is not a simple mechanism of action. When IH is used in any clinical

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Diaphragmatic rupture occurs in 0.8-5% of patients with major blunt thoraco-abdominal trauma and up to 70% of diaphragmatic tears are missed initially. Elevation of a single hemi diaphragm can be attributed to adjacent pleural, pulmonary or subphrenic disease, or it can occur secondary to a phrenic nerve palsy. (1) Rarely, it is related to an intrinsic weakness of the diaphragm or eventration. Because diaphragmatic rupture is often associated with thoracic or abdominal injuries that require surgical treatment, the diagnosis is usually made intraoperatively in many cases.

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In the Intensive Care Unit (ICU), patients are vulnerable to develop psychomotor disturbances with increase in both motor and psychological activities, often accompanied by loss of action control and disorganization of thought. Various terms have been used including agitation, anxiety and delirium. (1) Predisposing factors such as alcohol and substance abuse, male gender, advancing age, dementia and sensory impairment can further aggravate the symptoms.

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A 25 year-old Caucasian male with no past medical history of note presented with tetraplegia after hitting his head following a dive into a shallow pool. An MRI of the cervical spine showed bilateral facet dislocation of C4/C5 with spinal cord injury and edema from C4 to C6. A posterior facet joint reduction, instrumentation and fusion, anterior C4/C5 discectomy and fusion was performed forty-eight hours later and he was transferred to the surgical intensive care unit (SICU) for postoperative ventilation.

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Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause multiple organ damage. It is more common in females with a ratio of 9:1 with respect to males. (1)
Neuropsychiatric manifestations in patients with SLE are common, and when these manifestations are developed, the course of the disease and the prognosis are significantly worse. (2)

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A 63 year-old gentleman with a history of mitral valve repair and recent travel to the Philippines presented to our hospital with complaints of dry cough for three days. His clinical exam was remarkable for diffuse rhonchi. Initial chest radiograph was non-revealing. The patient clinical condition deteriorated in the emergency department (ED) with rapidly progressive respiratory insufficiency and interval development of radiographic infiltrates (Figure 1). The patient was then admitted to the intensive care unit (ICU) and broad-spectrum antibiotics started.

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Fasting has been the standard of many medical procedures such as upper endoscopic procedure, surgery, bronchoscopy and abdominal ultrasound imaging. Generally, the fasting recommendations follow The Canadian Anesthetist’s Society (CAS) and American Society of Anesthesiologists (ASA) guidelines. In that recommendation, patients only received clear liquid which contains simple carbohydrate or water two to six hours prior to surgery. After three hours of meal body has to provide nutritions for itself by gluconeogenesis.

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