DON’T BITE OFF MORE THAN YOU CAN CHEW – A CASE OF POST-OBSTRUCTIVE PULMONARY
Bibliographic record
Abstract
A 78-year-old man presented to the accident and emergency department (A&E) having choked on a bacon sandwich at lunch. A paramedic crew had attempted the Heimlich manoeuvre but was unsuccessful. On admission, he was cyanosed and unresponsive with saturations of 85 % of 15 litres of oxygen. He was acidotic. Chest examination revealed left upper zone crepitations. Chest x-ray showed bilateral haziness more on the left upper lobe. He was treated with high flow oxygen and back blows were attempted. An emergency laryngoscopy showed a large piece of bacon obstructing his airway and this was removed with McGill’s forceps. He was transferred to the high dependency unit (HDU) for 24 hours and discharged home the next day with a diagnosis of post-obstructive pulmonary oedema (POPE) secondary to foreign body aspiration. BACKGROUND This case illustrates that the pathophysiology of pulmonary oedema is not always the result of a low cardiac output, fluid overload or both. The cause in this case was heralded by an obstructed airway, most frequently seen in anaesthetics as a consequence of laryngospasm(1,2). Fluid overload and low cardiac output do not feature in POPE, instead fluid leaks into the alveoli from the capillary beds supplying blood to the lungs. Diuretics and inotropes have not been proven to be helpful in the treatment of POPE, the management being supportive(3). CASE PRESENTATION A 78-year-old gentleman presented to A&E after choking on a piece of bacon whilst eating lunch at Morrisons. He started choking at 1400 hrs and an ambulance was called at 1410 hrs. The ambulance crew attempted the Heimlich manoeuvre but this was unsuccessful. On arrival to A&E at 1440 hrs, he had stridor and was struggling to breathe. He was cyanosed with saturations of 85 % on 15 litres of oxygen. His respiratory rate was 25 and a
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".