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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Background: Paravertebral myositis is uncommon, and this case highlights a number of important therapeutic and diagnostic considerations. We discuss the role of appropriate antimicrobial therapy and the potential dilemma regarding the use of immunoglobulin in the septic patient. The key elements of treatment are early recognition, and the early initiation of appropriate antibiotics, typically a β-lactamase resistant anti-staphylococcal agent and clindamycin.

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Ventilation of lungs with parenchymal injury which can be caused by either disease or trauma has always been a diffi cult task for both respiratory therapists and physicians. There have been great many advances made in mechanical ventilators and ventilator modes over last decade. This has included the introduction of modes such as High Frequency Oscillator Ventilation (HFOV) [1] and Airway Pressure Release Ventilation (APRV).

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