Prehospital intubations had a significantly higher success rate when performed by helicopter physicians. We promote a low threshold for HEMS deployment in cases of a potentially compromised airway.

Severe respiratory failure is an uncommon manifestation of psittacosis. We describe a patient with psittacosis who developed severe respiratory failure and required artificial ventilation. We also review 11 cases reported in the English-language literature over the past 30 years. A history of exposure to birds was reported in 10 of 12 cases and remains the most significant risk factor. Severe hypoxemia or renal impairment was associated with a poor prognosis. Eight patients died of psittacosis or related complications of the infection. Diagnostic aspects, clinical manifesta­ tions, and management options are discussed.

SummaryThe ejicacy of acupuncture and transcutaneous stimulation analgesia, supplemented by small doses of fentanyl (mean I .2 pg/kg, SD 1.7) was compared with moderate-dose fentanyl anaesthesia (mean 22.9 pg/kg, SD 2.8) in 29 patients who underwent surgery for retroperitoneal lymph node dissection. The present study describes the anaesthetic techniques and comparison of haemodynamics, demand for analgesics after surgery, recovery and blood gases, restoration of urinary and bowel functions, convalescence in terms of self-reliance and the postoperative course in respect of fatigue and morbidity. A more rapid return of consciousness, an absence of hypercapnia and a smaller decrease in p H were observed in patients who received acupuncture and transcutaneous stimulation ( p < 0.05). No clinically relevant disadvantages attributable to the method were demonstrated.

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Background Alemtuzumab is a T cell depleting antibody agent used as induction immunosuppressant therapy in solid organ transplant recipients. In addition, it is being increasingly used to treat severe or glucocorticoid-resistant graft rejection. Despite the effectiveness of the treatment, severe adverse events have been reported related to alemtuzumab administration. We present a similar event illustrating the severity of this adverse drug reaction (ADR) and we highlight the structure causality assessment provides in approaching such a case. Case presentation We report a case of life-threatening respiratory failure after alemtuzumab administration in a 17 year old paediatric kidney transplant recipient. He developed near fatal severe respiratory and circulatory failure based on acute respiratory distress syndrome (ARDS) with diffuse alveolar oedema and haemoptysis hours after his second alemtuzumab administration. As it was questionable whether alemtuzumab could be regarded as the origin of his reaction and in order to assess the causality of this reaction as well as to structure clinical reasoning, we applied a widely used ADR probability scale to systematically review our case. Discussion and conclusions Our case shows a severe ADR after alemtuzumab administration. It illustrates the importance of proper causality assessment, the structure it provides and the benefit of a clinical pharmacology consultation when a severe reaction is suspected to be an ADR. By taking our case as an example, we demonstrate the added value of structured causality assessment to clinical reasoning and in generating differential diagnoses.