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A healthy 62-year-old man presented with acute abdominal pain, nausea and vomiting due to a small bowel obstruction. An incarcerated inguinal hernia was found and he was operated on. In the recovery room, he became increasingly dyspnoeic (45 respirations/min) and hypoxaemic (oxygen saturation 84%), with neither pain nor fever. Chest X-ray (normal initially) and CT demonstrated diffuse bilateral alveolar infiltrates (figures 1 and 2). In the intensive care unit, he required incessant continuous positive airway pressure (CPAP) …
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