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Negative pressure pulmonary edema (NPPE) following the use of the laryngeal mask airway (LMA) is an uncommon and under-reported event. We present a case of a 58-year-old male, who developed NPPE following LMA use. After biting vigorously on his LMA, the patient developed stridor upon emergence, with concurrent appearance of blood-tinged, frothy sputum and pulmonary edema. He subsequently required three days of mechanical ventilation. After discontinuation of mechanical ventilation the patient continued to require additional pulmonary support using continuous positive airway pressure, with a full facemask, to correct the persistent hypoxemia. His roentgenographic findings demonstrated an accelerated improvement with judicious administration of intravenous furosemide. [ABSTRACT FROM AUTHOR]

The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers. It involves topics from economics to existentialism, and surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Here, we present a comprehensive overview of issues in the care of patients at the end-of-life stage that may cause physicians and other healthcare providers, medical, ethical, social, and philosophical concerns in the intensive care unit. [ABSTRACT FROM AUTHOR]

The authors present an image of a middle-aged male after coronary artery bypass grafting who received intravenous methylene blue for refractory hypotension that resulted in dermal tattooing/staining of the venous vasculature of his left shoulder and left upper chest. [ABSTRACT FROM AUTHOR]

A letter to the editor on acute myocardial infarction is presented.

Here we posit for discussion the example of a reversible metabolic encephalopthy in a very elderly male that was missed clinically. A metabolic encephalopathy in extrememly elderly patients may be confused with delerium or inattention. A reversible cause of cognative dysfunction in the aged may be missed by practitioners because the aged may be assumed to have some level of impaired cognition; this may lead to a "social dismissal" of mental status changes. We highlight the need for engaged physicians in the care of the aged and vigilance against a professional bias toward the elderly patient that is dismissive. [ABSTRACT FROM AUTHOR]

The article describes a case of extremely high and poisonous carboxyhemoglobin (COhb) level in a 41-year-old patient on extracorporeal membrane oxygenation (ECMO). The patient presented with shortness of breath and hypoxemia, requiring mechanical ventilation. The patient was given inhaled nitric oxide (iNO) as an adjunct treatment.