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Clinical Features of Acute Epiglottitis in Adults in the Emergency Department
대한응급의학회지 제 27 권 제 1 호 � 원저� Volume 27, Number 1, February, 2016 Eye, Ear, Nose & Oral Clinical Features of Acute Epiglottitis in Adults in the Emergency Department Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do1, Korea Kyoung Min You, M.D., Woon Yong Kwon, M.D., Gil Joon Suh, M.D., Kyung Su Kim, M.D., Jae Seong Kim, M.D.1, Min Ji Park, M.D. Purpose: Acute epiglottitis is a potentially fatal condition Key Words: Epiglottitis, Emergency medical services, Fever, that can result in airway obstruction. The aim of this study is Intratracheal Intubation to examine the clinical features of adult patients who visited the emergency department (ED) with acute epiglottitis. Methods: This retrospective observational study was con- Article Summary ducted at a single tertiary hospital ED from November 2005 What is already known in the previous study to October 2015. We searched our electronic medical While the incidence of acute epiglottitis in children has records (EMR) system for a diagnosis of “acute epiglottitis” shown a marked decrease as a result of vaccination for and selected those patients who visited the ED. Haemophilus influenzae type b, the incidence of acute Results: A total of 28 patients were included. There was no epiglottitis in adults has increased. However, in Korea, few pediatric case with acute epiglottitis during the study period. studies concerning adult patients with acute epiglottitis The mean age of the patients was 58.0±14.8 years. The who present to the emergency department (ED) have been peak incidences were in the sixth (n=7, 25.0%) and eighth reported. -
Report of Two Cases Presenting with Acute Abdominal Symptoms
Journal of Accident and Tension pneumothorax: report of two cases presenting J Accid Emerg Med: first published as 10.1136/emj.11.1.43 on 1 March 1994. Downloaded from Emergency Medicine 1993 with acute abdominal symptoms 10, 43-44 G.W. HOLLINS,1 T. BEATTIE,1 1. HARPER2 & K. LITTLE2 Departments of Accident and Emergency 1 Aberdeen Royal Infirmary, Foresterhill, Aberdeen and 2Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh INTRODUCTION diagnoses were peptic ulcer disease or acute pancreatitis. Work-up appropriate to these diag- Tension pneumothorax constitutes a medical noses was commenced. An erect chest radiograph emergency and rapid diagnosis should be possible revealed a large pneumothorax with mediastinal on the basis of history and clinical examination. shift to the left. Following drainage using a large Following treatment with the delivery of high con- bore needle there was immediate resolution of his centration oxygen and the insertion of a large bore symptoms and all abdominal signs. An intercostal needle into the pleural space of the affected side, chest drain was formally sited and full expansion of the diagnosis can be confirmed radiologically and his right lung was achieved after 36 h. He was dis- an intercostal chest drain formally sited.1'2 We report charged home after 3 days. two cases where diagnosis was not made on the basis of history and examination alone. Both cases Case 2 presented with symptoms and signs suggestive of an acute intra-abdominal pathology and the diag- A 37-year-old male computer operator presented nosis was only made on radiological grounds. with a 1-week history of general malaise associated with mild neck and back pain. -
Acute Gastroenteritis
Article gastrointestinal disorders Acute Gastroenteritis Deise Granado-Villar, MD, Educational Gap MPH,* Beatriz Cunill-De Sautu, MD,† Andrea In managing acute diarrhea in children, clinicians need to be aware that management Granados, MDx based on “bowel rest” is outdated, and instead reinstitution of an appropriate diet has been associated with decreased stool volume and duration of diarrhea. In general, drug therapy is not indicated in managing diarrhea in children, although zinc supplementation Author Disclosure and probiotic use show promise. Drs Granado-Villar, Cunill-De Sautu, and Objectives After reading this article, readers should be able to: Granados have disclosed no financial 1. Recognize the electrolyte changes associated with isotonic dehydration. relationships relevant 2. Effectively manage a child who has isotonic dehydration. to this article. This 3. Understand the importance of early feedings on the nutritional status of a child who commentary does has gastroenteritis. contain a discussion of 4. Fully understand that antidiarrheal agents are not indicated nor recommended in the an unapproved/ treatment of acute gastroenteritis in children. investigative use of 5. Recognize the role of vomiting in the clinical presentation of acute gastroenteritis. a commercial product/ device. Introduction Acute gastroenteritis is an extremely common illness among infants and children world- wide. According to the Centers for Disease Control and Prevention (CDC), acute diarrhea among children in the United States accounts for more than 1.5 million outpatient visits, 200,000 hospitalizations, and approximately 300 deaths per year. In developing countries, diarrhea is a common cause of mortality among children younger than age 5 years, with an estimated 2 million deaths each year. -
Laryngitis from Reflux: Prevention for the Performing Singer
Laryngitis from Reflux: Prevention for the Performing Singer David G. Hanson, MD, FACS Jack J. Jiang, MD, PhD Laryngitis in General Laryngitis is the bane of performers and other professionals who depend on their voice for their art and livelihood. Almost every person has experienced acute laryngitis, usually associated with a viral upper- respiratory infection. Whenever there is inflammation of the vocal fold epithelium, there is an effect on voice quality and strength. Therefore, it is important to understand the factors that can cause laryngitis, especially the preventable causes of laryngitis. Laryngitis is a generic term for inflammation or irritation of the laryngeal tissues. The inflammation can be caused by any kind of injury, including infection, smoking, contact with caustic or acidic substance, allergic reaction, or direct trauma. Inflammatory response of the tissues includes leakage of fluid from blood vessels with edema or swelling, congregation of white blood cells, which release mediators of inflammation, and engorgement of the blood vessels. Most commonly laryngitis occurs from viral infection of the laryngeal epithelial lining associated with a typical cold. The viral infection is almost always quickly conquered by the body's immune system and lasts at most a few days. This kind of acute laryngitis rarely causes any long-term problem unless the vocal folds are damaged by overuse during the illness. Examination of the larynx will show whether the vocal folds are inflamed and allows some prediction of the degree of risk for damage. Other infections of the larynx are fortunately not common but include infections with bacteria and other organisms. -
Bacterial Tracheitis and the Child with Inspiratory Stridor
Bacterial Tracheitis and the Child With Inspiratory Stridor Thomas Jevon, MD, and Robert L. Blake, Jr, MD Columbia, Missouri Traditionally the presence of inspiratory stridor The child was admitted to the hospital with a and upper respiratory tract disease in a child has presumptive diagnosis of croup and was treated led the primary care physician to consider croup, with mist, hydration, and racemic epinephrine. epiglottitis, and foreign body aspiration in the Initially he improved slightly, but approximately differential diagnosis. The following case demon eight hours after admission he was in marked res strates the importance of considering another piratory distress and had a fever of 39.4° C. At this condition, bacterial tracheitis, in the child with time he had a brief seizure. After this episode his upper airway distress. arterial blood gases on room air were P02 3 8 mmHg and PC02 45 mm Hg, and pH 7.38. Direct laryngos copy was performed, revealing copious purulent Case Report secretions below the chords. This material was A 30-month-old boy with a history of atopic removed by suction, and an endotracheal tube was dermatitis and recurrent otitis media, currently re placed. He was treated with oxygen, frequent suc ceiving trimethoprim-sulfamethoxazole, presented tioning, and intravenous nafcillin and chloramphen to the emergency room late at night with a one-day icol. Culture of the purulent tracheal secretions history of low-grade fever and cough and a three- subsequently grew alpha and gamma streptococci hour history of inspiratory stridor. He was in mod and Hemophilus influenzae resistant to ampicillin. erate to severe respiratory distress with a respira Blood cultures were negative. -
Table of Contents
viii Contents Chapter 1. Taking the Certification Examination . 1 General Suggestions for Preparing for the Exam About the Certification Exams Chapter 2. Developmental and Behavioral Sciences . 11 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Paula Chiplis, PhD, RN, CPNP Psychosocial, Cognitive, and Ethical-Moral Development Behavior Modification Physical Development: Normal Growth Expectations and Developmental Milestones Family Concepts and Issues Family-Centered Care Cultural and Spiritual Diversity Chapter 3. Communication . 23 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Culturally Sensitive Communication Components of Therapeutic Communication Communication Barriers Modes of Communication Patient Confidentiality Written Communication in Nursing Practice Professional Communication Advocacy Chapter 4. The Nursing Process . 33 Clara J. Richardson, MSN, RN–BC Nursing Assessment Nursing Diagnosis and Treatment Chapter 5. Basic and Applied Sciences . 49 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Paula Chiplis, PhD, RN, CPNP Trauma and Diseases Processes Common Genetic Disorders Common Childhood Diseases Traction Pharmacology Nutrition Chemistry Clinical Signs Associated With Isotonic Dehydration in Infants ix Chapter 6. Educational Principles and Strategies . 69 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Patient Education Chapter 7. Life Situations and Adaptive and Maladaptive Responses . 75 Mary Jo Gilmer, PhD, MBA, RN-BC, FAAN, and Karen Corlett, MSN, RN-BC, CPNP-AC/PC, PNP-BC Palliative Care End-of-Life Care Response to Crisis Chapter 8. Sensory Disorders . 87 Clara J. Richardson, MSN, RN–BC Developmental Characteristics of the Pediatric Sensory System Hearing Disorders Vision Disorders Conjunctivitis Otitis Media and Otitis Externa Retinoblastoma Trauma to the Eye Chapter 9. -
Risk of Acute Epiglottitis in Patients with Preexisting Diabetes Mellitus: a Population- Based Case–Control Study
RESEARCH ARTICLE Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population- based case±control study Yao-Te Tsai1,2, Ethan I. Huang1,2, Geng-He Chang1,2, Ming-Shao Tsai1,2, Cheng- Ming Hsu1,2, Yao-Hsu Yang3,4,5, Meng-Hung Lin6, Chia-Yen Liu6, Hsueh-Yu Li7* 1 Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan, 3 Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, 4 Institute of Occupational Medicine and a1111111111 Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, 5 School of a1111111111 Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, 6 Health a1111111111 Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan, 7 Department of a1111111111 Otolaryngology±Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan a1111111111 * [email protected] Abstract OPEN ACCESS Citation: Tsai Y-T, Huang EI, Chang G-H, Tsai M-S, Hsu C-M, Yang Y-H, et al. (2018) Risk of acute Objective epiglottitis in patients with preexisting diabetes Studies have revealed that 3.5%±26.6% of patients with epiglottitis have comorbid diabetes mellitus: A population-based case±control study. PLoS ONE 13(6): e0199036. https://doi.org/ mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains 10.1371/journal.pone.0199036 unclear. In this study, our aim was to explore the relationship between preexisting DM and Editor: Yu Ru Kou, National Yang-Ming University, acute epiglottitis in different age and sex groups by using population-based data in Taiwan. -
Problems in Family Practice
problems in Family Practice Coughing in Childhood Hyman Sh ran d , M D Cambridge, M assachusetts Coughing in childhood is a common complaint involving a wide spectrum of underlying causes which require a thorough and rational approach by the physician. Most children who cough have relatively simple self-limiting viral infections, but some may have serious disease. A dry environment, allergic factors, cystic fibrosis, and other major illnesses must always be excluded. A simple clinical approach, and the sensible use of appropriate investigations, is most likely to succeed in finding the cause, which can allow precise management. The cough reflex as part of the defense mechanism of the respiratory tract is initiated by mucosal changes, secretions or foreign material in the pharynx, larynx, tracheobronchial Table 1. Persistent Cough — Causes in Childhood* tree, pleura, or ear. Acting as the “watchdog of the lungs,” the “good” cough prevents harmful agents from Common Uncommon Rare entering the respiratory tract; it also helps bring up irritant material from Environmental Overheating with low humidity the airway. The “bad” cough, on the Allergens other hand, serves no useful purpose Pollution Tobacco smoke and, if persistent, causes fatigue, keeps Upper Respiratory Tract the child (and parents) awake, inter Recurrent viral URI Pertussis Laryngeal stridor feres with feeding, and induces vomit Rhinitis, Pharyngitis Echo 12 Vocal cord palsy Allergic rhinitis Nasal polyp Vascular ring ing. It is best suppressed. Coughs and Prolonged use of nose drops Wax in ear colds constitute almost three quarters Sinusitis of all illness in young children. The Lower Respiratory Tract Asthma Cystic fibrosis Rt. -
Medical Terminology Abbreviations Medical Terminology Abbreviations
34 MEDICAL TERMINOLOGY ABBREVIATIONS MEDICAL TERMINOLOGY ABBREVIATIONS The following list contains some of the most common abbreviations found in medical records. Please note that in medical terminology, the capitalization of letters bears significance as to the meaning of certain terms, and is often used to distinguish terms with similar acronyms. @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial blood gas a.c.—before meals ac & cl—acetest and clinitest ACLS—advanced cardiac life support AD—right ear ADL—activities of daily living ad lib—as desired adm—admission afeb—afebrile, no fever AFB—acid-fast bacillus AKA—above the knee alb—albumin alt dieb—alternate days (every other day) am—morning AMA—against medical advice amal—amalgam amb—ambulate, walk AMI—acute myocardial infarction amt—amount ANS—automatic nervous system ant—anterior AOx3—alert and oriented to person, time, and place Ap—apical AP—apical pulse approx—approximately aq—aqueous ARDS—acute respiratory distress syndrome AS—left ear ASA—aspirin asap (ASAP)—as soon as possible as tol—as tolerated ATD—admission, transfer, discharge AU—both ears Ax—axillary BE—barium enema bid—twice a day bil, bilateral—both sides BK—below knee BKA—below the knee amputation bl—blood bl wk—blood work BLS—basic life support BM—bowel movement BOW—bag of waters B/P—blood pressure bpm—beats per minute BR—bed rest MEDICAL TERMINOLOGY ABBREVIATIONS 35 BRP—bathroom privileges BS—breath sounds BSI—body substance isolation BSO—bilateral salpingo-oophorectomy BUN—blood, urea, nitrogen -
Chest Pain and Non-Respiratory Symptoms in Acute Asthma
Postgrad Med J 2000;76:413–414 413 Chest pain and non-respiratory symptoms in Postgrad Med J: first published as 10.1136/pmj.76.897.413 on 1 July 2000. Downloaded from acute asthma W M Edmondstone Abstract textbooks. Occasionally the combination of The frequency and characteristics of chest dyspnoea and chest pain results in diagnostic pain and non-respiratory symptoms were confusion. This study was prompted by the investigated in patients admitted with observation that a number of patients admitted acute asthma. One hundred patients with with asthmatic chest pain had been suspected a mean admission peak flow rate of 38% of having cardiac ischaemia, pleurisy, pericardi- normal or predicted were interviewed tis, or pulmonary embolism. It had also been using a questionnaire. Chest pain oc- observed that many patients admitted with curred in 76% and was characteristically a asthma complained of a range of non- dull ache or sharp, stabbing pain in the respiratory symptoms, something which has sternal/parasternal or subcostal areas, been noted previously in children1 and in adult worsened by coughing, deep inspiration, asthmatics in outpatients.2 The aim of this or movement and improved by sitting study was to examine the frequency and char- upright. It was rated at or greater than acteristics of chest pain and other symptoms in 5/10 in severity by 67% of the patients. A patients admitted with acute asthma. wide variety of upper respiratory and sys- temic symptoms were described both Patients and methods before and during the attack. One hundred patients (66 females, mean (SD) Non-respiratory symptoms occur com- age 45.0 (19.7) years) admitted with acute monly in the prodrome before asthma asthma were studied. -
Asthma Exacerbation Management
CLINICAL PATHWAY ASTHMA EXACERBATION MANAGEMENT TABLE OF CONTENTS Figure 1. Algorithm for Asthma Exacerbation Management – Outpatient Clinic Figure 2. Algorithm for Asthma Management – Emergency Department Figure 3. Algorithm for Asthma Management – Inpatient Figure 4. Progression through the Bronchodilator Weaning Protocol Table 1. Pediatric Asthma Severity (PAS) Score Table 2. Bronchodilator Weaning Protocol Target Population Clinical Management Clinical Assessment Treatment Clinical Care Guidelines for Treatment of Asthma Exacerbations Children’s Hospital Colorado High Risk Asthma Program Table 3. Dosage of Daily Controller Medication for Asthma Control Table 4. Dosage of Medications for Asthma Exacerbations Table 5. Dexamethasone Dosing Guide for Asthma Figure 5. Algorithm for Dexamethasone Dosing – Inpatient Asthma Patient | Caregiver Education Materials Appendix A. Asthma Management – Outpatient Appendix B. Asthma Stepwise Approach (aka STEPs) Appendix C. Asthma Education Handout References Clinical Improvement Team Page 1 of 24 CLINICAL PATHWAY FIGURE 1. ALGORITHM FOR ASTHMA EXACERBATION MANAGEMENT – OUTPATIENT CLINIC Triage RN/MA: • Check HR, RR, temp, pulse ox. Triage level as appropriate • Notify attending physician if patient in severe distress (RR greater than 35, oxygen saturation less than 90%, speaks in single words/trouble breathing at rest) Primary RN: • Give oxygen to keep pulse oximetry greater than 90% Treatment Inclusion Criteria 1. Give nebulized or MDI3 albuterol up to 3 doses. Albuterol dosing is 0.15 to 0.3mg/kg per 2007 • 2 years or older NHLBI guidelines. • Treated for asthma or asthma • Less than 20 kg: 2.5 mg neb x 3 or 2 to 4 puffs MDI albuterol x 3 exacerbation • 20 kg or greater: 5 mg neb x 3 or 4 to 8 puffs MDI albuterol x 3 • First time wheeze with history consistent Note: For moderate (dyspnea interferes with activities)/severe (dyspnea at rest) exacerbations you with asthma can add atrovent to nebulized albuterol at 0.5mg/neb x 3. -
Guidelines for Prevention of Healthcare Associated Lower
State of Kuwait Ministry of Health Infection Control Directorate Guidelines for Prevention of Healt Care Associated LRTI Aug. 2006 1 I- Introduction Respiratory tract infections are extremely common health-care associated infections. Lower respiratory tract infection incorporates a spectrum of disease from acute bronchitis to pneumonia. Several factors (age, underlying disease, environment) influence mortality, morbidity and also microbial aetiology especially with the most frequently identified antibiotic resistance of respiratory pathogens. Of the lower respiratory tract infections, pneumonia remains the most common infection seen among hospitalized patients. It is defined as a lower respiratory tract infection occurring > 48 hrs of admission to a hospital or nursing home in a patient who was not incubating the infection on admission. It is the second most common health-care associated infection worldwide after urinary tract infection accounting for 13-18% of all health-care associated infections. Health-care associated pneumonia tends to be more serious because defense mechanisms against infection are often impaired , and the kind of infecting organisms are more dangerous than those generally encountered in the community. It is commonly caused by pathogens that need aggressive diagnostic approach with prompt recognition and urgent treatment to reduce morbidity and mortality; often the strains causing health-care associated pneumonia are multiple. It is complicate up to 1% of all hospitalizations. Critically ill patients who require mechanical ventilation are especially vulnerable to develop ventilator associated pneumonia (VAP). Because of its tremendous risk in the last two decades, most of the research on hospital associated pneumonia has been focused on VAP. As treatment, prognosis and outcome of VAP may differ significantly from other forms of hospital acquired pneumonia, it will be discussed extensively.