Legacy Salmon Creek Medical Center

Climate change, fueled by greenhouse gas (GHG) emissions, is a major threat to human health and demands immediate and decisive action. The effects of climate change directly harm the health of patients cared for by pulmonary, sleep, and critical care health professionals while putting healthcare delivery at risk. Ironically, the healthcare sector itself contributes to GHG emissions. In 2024, an American Thoracic Society workshop convened an international work group of adult and pediatric pulmonologists, intensivists, nurses, researchers, educators, healthcare administrators, and healthcare advocates to identify strategies to decrease pulmonary, sleep, critical care, and research laboratory-related emissions; improve quality; and support sustainability. The workshop prioritized strategies with the highest probability of reducing healthcare sector emissions significantly and urgently while considering the short- and long-term impacts of mitigation strategies on safe healthcare delivery and unintended adverse effects on vulnerable populations. Interventions were identified on micro (individual provider), meso (healthcare organization), and macro (regulatory/government/policy) levels. As trusted voices, health professionals and their professional societies are uniquely positioned to advocate for systemic change, ensuring that healthcare not only adapts to the challenges of climate change but also actively contributes to solutions that promote a healthier, more sustainable future for all.

ABSTRACTInfliximab is a biologic agent used to treat moderate-to-severe ulcerative colitis by inhibiting the TNF cytokine signaling. Off-target effects of TNF inhibitors include immune suppression and disruption of the tissue repair response. Previous case reports have linked infliximab to several patterns of acute pulmonary toxicity; however, the potential for severe infliximab-induced pneumonitis on long-term respiratory impairment remains largely uncharacterized.

In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.

Introduction Intravascular lymphoma (IVL) is an uncommon and often fatal disease characterized by intraluminal proliferation of lymphomatous cells within blood vessels. Because of a heterogeneous clinical presentation and lack of sensitive diagnostic protocols, diagnosis of IVL is most often made at autopsy. However, with early diagnosis and appropriate chemotherapy, the prognosis is greatly improved and complete remission is possible. In order to broaden the possible presentations of IVL, we present a patient with an atypical manifestation of biopsy-proven intravascular large B-cell lymphoma who suffered dissections of both intracranial and extracranial arteries in addition to progressive intracranial hemorrhages. Case Report. A 47-year-old woman presented with unilateral paresthesias. She developed progressive multifocal infarcts and hemorrhage with dissections of both intracranial and extracranial arteries, resulting in coma. Brain biopsy revealed IVL. She received aggressive chemotherapy and remains in complete remission with good neurologic recovery. Conclusion IVL is known to exert its pathology on small arteries and capillaries, but is not known to cause dissections of large vessels. The diagnosis should be considered in cases with unexplained arterial dissections and progressive strokes. Early diagnosis with appropriate laboratory screening and tissue confirmation by biopsy can lead to greatly improved outcomes.

Not all births are happy occasions. As an obstetrician, I have helped many families as they experienced stillbirths and untimely deliveries over the last thirty years. During the last ten years I have witnessed a disturbing phenomenon: preterm babies dying needlessly because they are being denied life-sustaining interventions. I remember the families who were simply told their 23-week newborns would die because “all of them do”. I remember the families who were told “we do not recommend intensive care for babies born at 24 weeks because when they survive their outcomes are bleak”. I remember the 25-week babies who died because their parents chose palliative care after being told that their child could be disabled and destroy their family. I have been constrained to “follow the party line” even though I know that some babies do survive at 23 weeks, that when babies survive at 24 weeks their outcomes are often good, and I know that preterm babies do not destroy families. These babies, their families, their physicians and nurses and the integrity of health care facilities are victims of flawed guidelines that give an unbalanced message to parents. In this article I will describe how these guidelines were developed and how an absent dialogue has led to moral distress and adverse patient outcomes. This article is protected by copyright. All rights reserved.

For any medical procedure, informed consent consists of four basic elements: (1) voluntariness, (2) competence, (3) informed, and (4) comprehended (capacity). For neuroanesthesia, satisfaction of the elements may be more difficult due to both the underlying pathology and the difficult choices facing patients undergoing neurosurgery. As a result of the unique nature of neurosurgical cases, anesthesiologists need to allow more time and need to take more care in obtaining consent for the anesthetics used in those cases.

Gastric diverticuli are rare entities that may present with a variety of vague abdominal symptoms. Diagnosis requires endoscopic and radiologic evaluation preceded by clinical suspicion. This is the first report describing the laparascopic excision of a gastric diverticulum. A description of this procedure and suggestions for the workup of gastric diverticuli are presented.