DOCSLIB.ORG

Mantke, Peitz, Surgical Ultrasound -- Index

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

419 Index A esophageal 218 Anorchidism 376 gallbladder 165 Aorta 364–366 A-mode imaging 97 gastric 220 abdominal aneurysm (AAA) AAA (abdominal aortic aneurysm) metastasis 142 20–21, 364, 366 20–21, 364, 366 pancreatic 149, 225 dissection 364, 366 Abdominal wall Adenofibroma, breast 263 perforation 366 abscess 300–301 Adenoma pseudoaneurysm 364 diagnostic evaluation 297 adrenal 214 Aortic rupture 20 hematoma 73, 300, 305 colorectal 231, 232 Aplasia, muscular 272 rectus sheath 297–300 duodenal papilla 229, 231 Appendicitis 1–4 hernia 300, 302–304 gallbladder 165 consequences for surgical indications for sonography 297 hepatic 54, 58, 141 treatment 2 seroma 298, 300, 305 multiple 141 sonographic criteria 1 trauma 297–300 parathyroid 213 Archiving 418 Abortion, tubal 30 renal 241 Arteriosclerosis 346, 348 Abscess thyroid 202–203 carotid artery 335, 337, 338 abdominal wall 300–301 Adenomyomatosis 8, 164, 165 plaque 337, 338, 345, 367, 370 causes 301 Adrenal glands 214–216 Arteriovenous (AV) malformation amebic 138 adenoma 214 139, 293, 326–329 breast 264 carcinoma 214 Artery chest wall 173, 178 cyst 214 carotid 334–339 diverticular 120, 123 hematoma 214 aneurysm 338 drainage 85–88, 93 hemorrhage 214 arteriosclerosis 335 hepatic 6, 138, 398 hyperplasia 214 plaque characteristics inflammatory bowel disease limpoma/myelipoma 214 337, 338, 345 116, 119 metastases 214 bifurcation 334, 337 intramural 5 sonographic criteria 214 bulb 339 lung 183, 186, 190 tuberculosis 214 dissection 338, 339, 346 pancreatic 11 Advanced dynamic flow (ADF) sonographic assessment pararenal 244 410 336, 338 pericecal 1, 2 Aliasing 307, 363 stenosis 334, 335–340, 345 postoperative 74, 300–301 Alimentary tract duplications classification 337 prostatic 246 375–376 stages 339 pyogenic 138, 398 Alpha-fetoprotein (AFP) 143 tumor 340, 345 renal 244 Amebiasis 398 celiac trunk 366–367 soft tissue 291 Amebic abscess 138 femoral sonographic criteria 89 Amplitude modulation 415 aneurysm 326 splenic 154, 155, 158 Analgesia 80 stenosis 330, 332 tubo-ovarian 27 Aneurysm 326–329 fibular 325 typical localizations 85 abdominal aortic (AAA) 20–21, gastroduodenal 145 Absorption 96 364, 366 hepatic 125 Acetylsalicylic acid (ASA) 80 carotid 338 dilatation 130 Achalasia 232 fusiform 327 iliac 324 Achilles tendon hemodialysis shunt complica- mesenteric 366–367 peritendonitis 274, 276 tion 252 inferior 366 rupture 273 mesenteric artery 367 superior 366, 367 Acromioclavicular joint 276–279 popliteal 326, 329 peripheral see Peripheral arteries arthritis 277 saccular 327 popliteal 324–325, 329 separation 277, 279 Angiomyolipoma 293 aneurysm 326 Acute renal failure 243 hepatic 142, 241 entrapment 331 Adenocarcinoma 60 Ankle 290 stenosis 330, 332 biliary tree 228 Ankle brachial index (ABI) 330 renal 368–370 Mantke, Peitz, Surgical Ultrasound (ISBN 9783131318716), 2007 Georg Thieme Verlag KG 420 Index Artery, subclavian 339, 340 B Breast 257–270 stenosis 339, 340, 345 anatomy 259 tibial B-mode imaging 97–98, 336 benign tumors 263 anterior 325 Bakers cysts 287, 292 fibroadenoma 262–263 posterior 325 Barretts esophagus 218 biopsy 268, 269 vertebral 339, 340, 346 Beam width artifact 104 carcinoma 257, 266–268 Arthritis 291 Beckwith–Wiedemann syn- metastases 142 acromioclavicular joint 277 drome 383 cyst 260–261 cubital 282 Benign prostatic hyperplasia juvenile 260, 261 rheumatoid 291 (BPH) 246 diagnostic evaluation 257–258 septic 291 Biceps tendon equipment 258 sternoclavicular joint 280, 282 dislocation 277 focal findings 260 Arthrosonography tear 277, 279 indications for sonography 257 acromioclavicular joint 276–279 tendonitis 277 interventional techniques 268 ankle 290 Bile duct mastitis 264–265 elbow 282–283 atresia 169 needle aspiration 269 hand 283 common 159 Brescia–Cimino hemodialysis hip 284–286 congenital anomalies 169 shunt 252 humeroscapular joint 276–279 cyst 169 Bruises 271, 298 knee 286–289 dilatation 147 Budd–Chiari syndrome sternoclavicular joint 280–282 hypoplasia 169 133–134 sternum 280–282 obstruction 166–168 Bulls eye sign 142 Artifacts 102–107 causes 167 Bursitis 274, 276 beam width 104 cholecystitis 6 knee 286, 287, 289 comet-tail 105 stones 162, 167, 232 olecranon 282, 283 edge shadowing 103 tumors 166–168, 228 subacromial 277, 279 electronic noise 104 hamartoma 142 flow 107 Biliary system 158–169 mirror image 105 cholangitis 163 C posterior enhancement 103 diagnostic evaluation 158–159 posterior shadowing 102 indications for sonography 158 Calcification reverberation 104 laparoscopic intraoperative adrenal 214 side-lobe 106 sonography 50–51 arterial wall 331 transit time 106 tumors 228 goiter 193 Ascites 8 see also Bile duct; Cholecystitis; parenchymal 147 appendix and 1 Gallbladder rotator cuff 277, 292 gastric cancer 220 Biloma 73 splenic 154, 155 pancreatitis 10 drainage 89, 93 thyroid nodules 199 portal hypertension 132 sonographic criteria 89 Calculi see Stones Asepsis 80 Biopsy Cannulation, central venous 75 Aspiration aspiration biopsy 82–83 Carcinoid, ectopic pancreatic biopsies 82–83 breast 268, 269 tissue 223 breast 268, 269 solid lesions 83 Carcinoma complication rates 84 Bladder see Urinary bladder adrenal 214 pathological fluid collections 82 Bleeding see Hemorrhage bile duct 166–168 technique 79–80 Bone tumors 292–295 bladder 245 see also Drainage Bowel breast 257, 266–268 Atelectasis 183, 187, 190 loops of 302 cholangiocarcinoma 58 Atheroma 305 obstruction see Intussusception; colorectal 231, 232 Atresia, bile duct 169 Mechanical bowel obstruction duodenal papilla 229, 231 Augmentation test 313 (MBO) esophageal 48, 218 Autoimmune disease trauma 44 metastasis 50, 218 hyperthyroidism 195 see also Colorectal cancer; gallbladder 8, 160, 161, 166 hypothyroidism 197–198 Gastrointestinal tract gastric 48, 220 thyroiditis 197–198 Bowel wall metastasis 50 Automatic image optimization 417 edema 374 hepatocellular (HCC) 52, 58, Automatic measurements 417–418 hematoma 25–27 143–145 Mantke, Peitz, Surgical Ultrasound (ISBN 9783131318716), 2007 Georg Thieme Verlag KG Index 421 contrast-enhanced sonography Cirrhosis 130–131 Cruveilhier–Baumgarten 391, 392, 401–402 hepatocellular carcinoma risk syndrome 132 pancreatic 48, 60, 149–152, 225 and 143 Cryosurgery consequences for surgical Cockade 109 complications 64–65 treatment 152 Colitis, ulcerative 116 hepatic metastases 64–65 metastasis 50, 142 Color flow Doppler imaging primary liver tumors 64–65 sonographic criteria 150 (CFDI) 99, 307 Cryptorchidism 376–377 parathyroid 213 high-resolution 409–410 Cyst renal cell 241 parallel signal processing adrenal gland 214 staging laparoscopy 48 409–410 Bakers 287, 292 thyroid 207–208 wideband Doppler bile duct 169 Carcinomatosis techniques 410 breast 260–261 peritoneal 8, 113 indications for 314, 324 juvenile 260, 261 pleural 218 intra-abdominal arteries 363–370 choledochal 169 Cardiac tamponade 69 peripheral arterial occlusive disease dermoid 379 Caroli disease 162, 169 (PAOD) 333–334 drainage 88, 93 Catheter, suprapubic 75–76 renal arteries 368 epidermoid 379 Celiac trunk 366–367 supra-aortic vessels 334–346 goiter and 193 Central venous cannulation 75 techniques 363 hepatic 53, 136 Charcots triad 163 Colorectal cancer 231 dysontogenetic 136 Chest metastases 52, 58, 66, 142, 145 polycystic liver disease 136 indications for sonography 173 Comet-tail artifact 105 hydatid 84, 137, 138 pleural effusion 178–183 Compartment syndrome 272 ovarian 29 pulmonary consolidation Compounding 408–409 torsion 29 183–190 Compression testing 310, 312, 313 pancreatic see also Lung Congenital anomalies indications for resection 152 Chest wall bile duct 169 postnecrotic 59 abscess 178 muscle 272 retention 59 cancer 178 Continuous wave (CW) Doppler popliteal 287 sonographic findings 176 imaging 98, 307 renal 239 hematoma 178 Contrast agents 389, 390, 414–416 atypical 239 masses 173–178 detection of 414–416 polycystic kidney disease 240 consequences for surgical destructive techniques 415 splenic 155, 158 treatment 178 real-time techniques 415–416 thyroid gland 204–205 Cholangiocarcinoma 58, 167 Contrast harmonic imaging 308 complicated 204 Cholangiolithiasis 162 Contrast-enhanced sonogra- hemorrhagic 204 Cholangitis 163 phy 389–404 serous/colloid 204 acute 163 infarction 403–404 Cystadenocarcinoma chronic 163 liver lesions 391–402 metastases 142 Cholecystitis fatty liver disease 396–397 pancreatic 152, 225 acute 5–8, 70, 165 focal nodular hyperplasia mucinous 225 acalculous (stress-related) 70 (FNH) 393–396 Cystadenoma 60 consequences for surgical hemangioma 392–393 biliary 142 treatment 6, 70 hepatocellular carcinoma pancreatic 152, 153 intensive care unit setting 70 401–402 Cystic neoplasia 225 sonographic criteria 5–6 metastases 399–400 Cystitis 245 chronic 163–164, 165 pyogenic abscess 398 emphysematous 6, 164 practical considerations 390 pyogenic abscess and 398 see also Ultrasonic contrast D Cholecystolithiasis 162 imaging Choledochal cyst 169 Contusion 1.
Recommended publications
  • Update on Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

    Update on Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis

    J Bras Pneumol. 2015;41(5):454-466 http://dx.doi.org/10.1590/S1806-37132015000000152 REVIEW ARTICLE Update on diagnosis and treatment of idiopathic pulmonary fibrosis José Baddini-Martinez1, Bruno Guedes Baldi2, Cláudia Henrique da Costa3, Sérgio Jezler4, Mariana Silva Lima5, Rogério Rufino3,6 1. Divisão de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil. 2. Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, ABSTRACT Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of 3. Disciplina de Pneumologia e Tisiologia, unknown etiology, which is associated with a progressive decrease in pulmonary Faculdade de Ciências Médicas, function and with high mortality rates. Interest in and knowledge of this disorder have Universidade do Estado do Rio de grown substantially in recent years. In this review article, we broadly discuss distinct Janeiro, Rio de Janeiro, Brasil. aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We 4. Ambulatório de Pneumologia, Hospital list the current diagnostic criteria and describe the therapeutic approaches currently Ana Nery, Salvador, Brasil. available, symptomatic treatments, the action of new drugs that are effective in slowing 5. Ambulatório de Doenças Pulmonares Intersticiais, Hospital do Servidor the decline in pulmonary function, and indications for lung transplantation. Público Estadual de São Paulo, São Keywords: Idiopathic pulmonary fibrosis/diagnosis; Idiopathic pulmonary fibrosis/therapy; Paulo, Brasil. Idiopathic pulmonary fibrosis/rehabilitation. 6. Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
  • Toxicological Profile for Jp-5, Jp-8, and Jet a Fuels

    Toxicological Profile for Jp-5, Jp-8, and Jet a Fuels

    TOXICOLOGICAL PROFILE FOR JP-5, JP-8, AND JET A FUELS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry March 2017 JP-5, JP-8, AND JET A FUELS ii DISCLAIMER Use of trade names is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services. JP-5, JP-8, AND JET A FUELS iii UPDATE STATEMENT A Toxicological Profile for JP-5, JP-8, and Jet A Fuels, Draft for Public Comment was released in February 2016. This edition supersedes any previously released draft or final profile. Toxicological profiles are revised and republished as necessary. For information regarding the update status of previously released profiles, contact ATSDR at: Agency for Toxic Substances and Disease Registry Division of Toxicology and Human Health Sciences Environmental Toxicology Branch 1600 Clifton Road NE Mailstop F-57 Atlanta, Georgia 30329-4027 JP-5, JP-8, AND JET A FUELS iv This page is intentionally blank. JP-5, JP-8, AND JET A FUELS v FOREWORD This toxicological profile is prepared in accordance with guidelines* developed by the Agency for Toxic Substances and Disease Registry (ATSDR) and the Environmental Protection Agency (EPA). The original guidelines were published in the Federal Register on April 17, 1987. Each profile will be revised and republished as necessary. The ATSDR toxicological profile succinctly characterizes the toxicologic and adverse health effects information for these toxic substances described therein. Each peer-reviewed profile identifies and reviews the key literature that describes a substance's toxicologic properties.
  • Clinical Excellence Series Volume VI an Evidence-Based Approach to Infectious Disease

    Clinical Excellence Series Volume VI an Evidence-Based Approach to Infectious Disease

    Clinical Excellence Series n Volume VI An Evidence-Based Approach To Infectious Disease Inside The Young Febrile Child: Evidence-Based Diagnostic And Therapeutic Strategies Pharyngitis In The ED: Diagnostic Challenges And Management Dilemmas HIV-Related Illnesses: The Challenge Of Emergency Department Management Antibiotics In The ED: How To Avoid The Common Mistake Of Treating Not Wisely, But Too Well Brought to you exclusively by the publisher of: An Evidence-Based Approach To Infectious Disease CEO: Robert Williford President & Publisher: Stephanie Ivy Associate Editor & CME Director: Jennifer Pai • Associate Editor: Dorothy Whisenhunt Director of Member Services: Liz Alvarez • Marketing & Customer Service Coordinator: Robin Williford Direct all questions to EB Medicine: 1-800-249-5770 • Fax: 1-770-500-1316 • Non-U.S. subscribers, call: 1-678-366-7933 EB Medicine • 5550 Triangle Pkwy Ste 150 • Norcross, GA 30092 E-mail: [email protected] • Web Site: www.ebmedicine.net The Emergency Medicine Practice Clinical Excellence Series, Volume Volume VI: An Evidence-Based Approach To Infectious Disease is published by EB Practice, LLC, d.b.a. EB Medicine, 5550 Triangle Pkwy Ste 150, Norcross, GA 30092. Opinions expressed are not necessarily those of this publication. Mention of products or services does not constitute endorsement. This publication is intended as a general guide and is intended to supplement, rather than substitute, professional judgment. It covers a highly technical and complex subject and should not be used for making specific medical decisions. The materials contained herein are not intended to establish policy, procedure, or standard of care. Emergency Medicine Practice, The Emergency Medicine Practice Clinical Excellence Series, and An Evidence-Based Approach To Infectious Disease are trademarks of EB Practice, LLC, d.b.a.
  • Kyomuhangi-CHS-Masters.Pdf

    Kyomuhangi-CHS-Masters.Pdf

    MAKERERE UNIVERSITY COLLEGE OF HEALTH SCIENCES DEPARTMENT OF RADIOLOGY ACCURACY OF CHEST ULTRASOUND IN DIAGNOSING PNEUMONIA IN PEDIATRIC PATIENTS AT MULAGO NATIONAL REFERRAL HOSPITAL, KAMPALA, UGANDA. PRINCIPAL INVESTIGATOR: DR KYOMUHANGI AGNES, MBChB, MUK SUPERVISORS: 1. DR BUGEZA SAM MBChB(MUK), MMED (Rad). 2. DR EREM GEOFFREY MBChB(MUST), MMED(Rad) 3. DR MWOROZI EDISON ARWANIRE MBChB(MUK), MMED (SENIOR CONSULTANT, Pead). A DISSERTATION SUBMITTED TO SCHOOL OF GRADUATE STUDIES IN PARTIAL FULLFILLMENT OF THE REQUIREMENT FOR AWARD OF THE DEGREE OF MASTERSAggie OF MEDICINE IN RADIOLOGY AT MAKERERE UNIVERSITY. [Date] AUGUST 2019 i DECLARATION I Kyomuhangi Agnes, hereby declare that the work presented in this dissertation has not been presented for any other degree in this university. Signed…………………………………. …………………………………. DR. KYOMUHANGI AGNES Date This dissertation has been submitted for examination with approval of the following supervisors; Signed…………………………………. …………………………………. DR. BUGEZA SAMUEL Date MBChB, MMed Rad Specialist Radiologist / lecturer, College of Health Sciences, Makerere University. Signed……………………………….... ………………………………….. DR. EREM GEOFFREY Date MBChB, MMed Rad Specialist Radiologist / lecturer, College of Health Sciences, Makerere University. Signed…………………………………. ……………………………………. DR. MWOROZI EDISON ARWANIRE Date MBChB, MMed Pead Consultant Pediatrician Mulago National Referral Hospital / Senior lecturer, College of Health Sciences, Makerere University. ii DEDICATION To my family, for being a constant source of inspiration, I am eternally grateful for their love, unwavering encouragement and all round support during the course of my masters programme. iii ACKNOWLEDGEMENTS The development and completion of this course/work was first of all made possible, by the Almighty God who has been faithful providing me with grace, mercy and strength. The funding to do this study was made possible by Uganda Cancer Institute (UCI-AfDB) scholarship which sponsored me throughout my masters programme and this study.
  • Common Pediatric Pulmonary Issues

    Common Pediatric Pulmonary Issues

    Common Pediatric Pulmonary Issues Chris Woleben MD, FAAP Associate Dean, Student Affairs VCU School of Medicine Assistant Professor, Emergency Medicine and Pediatrics Objectives • Learn common causes of upper and lower airway disease in the pediatric population • Learn basic management skills for common pediatric pulmonary problems Upper Airway Disease • Extrathoracic structures • Pharynx, larynx, trachea • Stridor • Externally audible sound produced by turbulent flow through narrowed airway • Signifies partial airway obstruction • May be acute or chronic Remember Physics? Poiseuille’s Law Acute Stridor • Febrile • Laryngotracheitis (croup) • Retropharyngeal abscess • Epiglottitis • Bacterial tracheitis • Afebrile • Foreign body • Caustic or thermal airway injury • Angioedema Croup - Epidemiology • Usually 6 to 36 months old • Males > Females (3:2) • Fall / Winter predilection • Common causes: • Parainfluenza • RSV • Adenovirus • Influenza Croup - Pathophysiology • Begins with URI symptoms and fever • Infection spreads from nasopharynx to larynx and trachea • Subglottic mucosal swelling and secretions lead to narrowed airway • Development of barky, “seal-like” cough with inspiratory stridor • Symptoms worse at night Croup - Management • Keep child as calm as possible, usually sitting in parent’s lap • Humidified saline via nebulizer • Steroids (Dexamethasone 0.6 mg/kg) • Oral and IM route both acceptable • Racemic Epinephrine • <10kg: 0.25 mg via nebulizer • >10kg: 0.5 mg via nebulizer Croup – Management • Must observe for 4 hours after
  • Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease

    Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease

    Nursing Care in Pediatric Respiratory Disease Nursing Care in Pediatric Respiratory Disease Edited by Concettina (Tina) Tolomeo, DNP, APRN, FNP-BC, AE-C Nurse Practitioner Director, Program Development Yale University School of Medicine Department of Pediatrics Section of Respiratory Medicine New Haven, CT A John Wiley & Sons, Inc., Publication This edition first published 2012 © 2012 by John Wiley & Sons, Inc. Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office: John Wiley & Sons Inc., The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 2121 State Avenue, Ames, Iowa 50014-8300, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1768-2/2012. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners.
  • Acute Respiratory Illness in Immunocompetent Patients

    Acute Respiratory Illness in Immunocompetent Patients

    Revised 2018 American College of Radiology ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients Variant 1: Acute respiratory illness in immunocompetent patients with negative physical examination, normal vital signs, and no other risk factors. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography chest Usually Appropriate ☢ CT chest with IV contrast Usually Not Appropriate ☢☢☢ CT chest without and with IV contrast Usually Not Appropriate ☢☢☢ CT chest without IV contrast Usually Not Appropriate ☢☢☢ MRI chest without and with IV contrast Usually Not Appropriate O MRI chest without IV contrast Usually Not Appropriate O US chest Usually Not Appropriate O Variant 2: Acute respiratory illnesses in immunocompetent patients with positive physical examination, abnormal vital signs, organic brain disease, or other risk factors. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography chest Usually Appropriate ☢ US chest May Be Appropriate O CT chest with IV contrast Usually Not Appropriate ☢☢☢ CT chest without and with IV contrast Usually Not Appropriate ☢☢☢ CT chest without IV contrast Usually Not Appropriate ☢☢☢ MRI chest without and with IV contrast Usually Not Appropriate O MRI chest without IV contrast Usually Not Appropriate O Variant 3: Acute respiratory illness in immunocompetent patients with positive physical examination, abnormal vital signs, organic brain disease, or other risk factors and negative or equivocal initial chest radiograph.
  • Chronic Cough- Whoop It

    Chronic Cough- Whoop It

    3/3/2016 Chronic Cough- Whoop it Cassaundra Hefner PULMONARY ANATOMY DNP, FNP-BC FryeCare Lung Center Upper Airway Nasopharynx Oropharynx Laryngopharynx Lower Larynx Trachea Bronchi Bronchopulmonary segments Terminal bronchioles Acinus (alveolar regions) Upper and Lower Airway are lined with cilia which propel mucus and trapped bacteria toward the oropharynx Cough COUGH ACTION Protective reflex that keeps throat clear allowing for mucocilliary clearance of airway secretion Intrathoracic process of air from a vigorous cough through nearly closed vocal cords can approach 300mmHG, the velocities tear off mucus from the airway walls. The velocity can be up to 500mph 4 Cough/Sputum Defense mechanism to prevent aspiration- cough center stimulated- cough begins with deep inspiration to 50 % vital capacity- maximum expiratory flow increases coil - decreasing airway resistance- glottis opens wide and takes in large amount of air - glottis then rapidly closes - abdominal and intercostal muscles contract- increases intrapleural pressure - the glottis reopens- explosive release of air the tracheobronchial tree narrows rips the mucous off the walls = sputum 1 3/3/2016 Chronic Cough Defined (AACP, 2016) Effects of cough that prompts visit Talierco & Umur, 2014 Acute Sub-acute Chronic Fatigue 57% Cough Cough 3-8 Unexplained chronic less than weeks cough(UCC) Insomnia 45% 3 weeks Excessive perspiration 42% Cough lasting greater Incontinence 39% than 8 weeks in 15 yo or older MSK pain 45% Cough lasting greater Inguinal herniation than 4 weeks in Dysrhythmias those under the Headaches age of 15 Quality of life questionnaires are recommended for adolescents and children (CQLQ) Work loss Data Institute (NCG) (2016) Cough Referral to Pulmonology 80%-90% chronic cough Most common symptom for PCP visits in the U.S.
  • Retropharyngeal Abscess: Diagnosis and Treatment Update

    Retropharyngeal Abscess: Diagnosis and Treatment Update

    Infectious Disorders – Drug Targets, 2012, 12, 291-296 291 Retropharyngeal Abscess: Diagnosis and Treatment Update 1 2,3 Brian K. Reilly * and James S. Reilly 1Children’s National Medical Center, Washington, DC; USA; 2Chair, Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA; 3Professor of Otolaryngology and Pediatrics, Thomas Jefferson Univer- sity, Philadelphia, PA, USA Abstract: Retropharyngeal abscess is a deep neck space infection that may present in various subtle ways permitting po- tentially lethal complications to occur before appropriate diagnosis is made and expedient management undertaken. This article reviews in detail the pertinent anatomy, diagnostic pearls, and clinical recommendations to optimally manage these common infections in children. Keywords: Abscess, imaging, infection, neck, pediatric, retropharyngeal. OVERVIEW whether purulence is obtained intra-operatively [3]. Classic findings for abscess include large fluid with central A retropharyngeal abscess (RPA) is a deep neck space hypodensity, complete ring enhancement, and scalloping infection defined by its anatomical location within the deep Fig. (1). cervical tissue planes. RPA is located behind the pharyngeal mucosa and is contained anteriorly by the buccopharyngeal fascia (around the constrictor muscles) and laterally by the carotid sheath/parapharyngeal space. Superiorly, it may ex- tend to the skull base, and inferiorly, it can travel to the me- diastinum. This “potential” retropharyngeal space, which expands with infection, is occupied by a lymph-node basin [1] that serves as the common, final drainage pathway of the nasal cavity, paranasal sinuses, nasopharynx, oropharynx, hypopharynx, and larynx. Inadequately treated and virulent infections of these regions can cause suppuration of these nodes. Thus, retropharyngeal lymphadenitis with edema can progress to a cellulitis, which, if untreated, evolves to early abscess or phlegmon and then to abscess.
  • Chest Pain and Cardiac Dysrhythmias

    Chest Pain and Cardiac Dysrhythmias

    Chest Pain and Cardiac Dysrhythmias Questions 1. A 59-year-old man presents to the emergency department (ED) com- plaining of new onset chest pain that radiates to his left arm. He has a his- tory of hypertension, hypercholesterolemia, and a 20-pack-year smoking history. His electrocardiogram (ECG) is remarkable for T-wave inversions in the lateral leads. Which of the following is the most appropriate next step in management? a. Give the patient two nitroglycerin tablets sublingually and observe if his chest pain resolves. b. Place the patient on a cardiac monitor, administer oxygen, and give aspirin. c. Call the cardiac catheterization laboratory for immediate percutaneous inter- vention (PCI). d. Order a chest x-ray; administer aspirin, clopidogrel, and heparin. e. Start a β-blocker immediately. 2. A 36-year-old woman presents to the ED with sudden onset of left- sided chest pain and mild shortness of breath that began the night before. She was able to fall asleep without difficulty but woke up in the morning with persistent pain that is worsened upon taking a deep breath. She walked up the stairs at home and became very short of breath, which made her come to the ED. Two weeks ago, she took a 7-hour flight from Europe and since then has left-sided calf pain and swelling. What is the most com- mon ECG finding for this patient’s presentation? a. S1Q3T3 pattern b. Atrial fibrillation c. Right-axis deviation d. Right-atrial enlargement e. Tachycardia or nonspecific ST-T–wave changes 1 2 Emergency Medicine 3.
  • Don't Overlook Unexpected, but Risky, Diagnoses

    Don't Overlook Unexpected, but Risky, Diagnoses

    ® NOVEMBER 2020 VOLUME 15, NUMBER 2 THE JOURNAL OF URGENT CARE MEDICINE ® www.jucm.com The Official Publication of the UCA and CUCM CLINICAL cme ALSO IN THIS ISSUE 19 Original Research Probably Strep Informed Decisions Are Safer ‘ ’ Is Decisions in Patients with Sinusitis cme 29 Case Report Potentially Dangerous— When a Disease ‘of Childhood’ Threatens the Life of an Adult Patient 35 Clinical Don’t Overlook Unexpected, Better to Risk Patient Outrage Than Antibiotic Resistance When Treating but Risky, Diagnoses Otitis Media cme Health Law and Compliance The COVID-19 Vaccine Could Save Lives—and Your Business. But What If Employees Refuse to Get It? Ad_FullPage_Sized.indd 1 10/21/20 3:13 PM URGENT PERSPECTIVES Finding Urgent Care (and the Value of Recognizing a Specialty) n GUY MELROSE, MB, ChB arrived in New Zealand 11 years ago, a doctor without direc- Ition and certainly with no inkling of urgent care. I was one of those doctors who had always hoped to find their ultimate career path whilst at university. Alas, whilst I was able to remove some options (here’s looking at you Ob/Gyn),no single spe- cialty sufficiently inspired me to follow that rabbit hole through to its conclusion. So, my medical career began with an eclectic mix of jobs and travel, mainly focused around the emergency department. Maintaining this level of generalism seemed sensible, until such time as a specialty found me. As a young person, the ED was an exciting and flexible option. Yet in the back of my mind, I always assumed the career that would suit my broad interest in medicine whilst also addressing my growing need for a work-life balance would be general practice (or family practice, as it’s known in the U.S.).
  • Consolidation in Primary Pulmonary Tuberculosis by D

    Consolidation in Primary Pulmonary Tuberculosis by D

    Thorax: first published as 10.1136/thx.8.3.223 on 1 September 1953. Downloaded from Tlzo'ax (1953), 8, 223. CONSOLIDATION IN PRIMARY PULMONARY TUBERCULOSIS BY D. ADLER AND W. F. RICHARDS From High Wood Hospital, Brentwood, Essex (RECEIVED FOR PUBLICATION FEBRUARY 3, 1953) The occurrence of large radiological opacities in although atelectasis and consolidation may coexist, the lung parenchyma in cases ofprimary tuberculosis giving rise to a condition of collapse-consolidation. has been recognized since Eliasberg and Neuland NON-TruBERCULOUS PNEUMONIA.-Eliasberg and (1920) described a dense shadow, occurring usually Neuland (1920) doubted that the consolidation they in the right upper lobe, in young children with a described was a true tuberculous process. Engel primary infection. They stated that the onset was (1921) noticed the absence of tubercles in the not acute, the course was benign, and that tubercle consolidated area at necropsy and suggested the bacilli were not recoverable from the sputum. In term " para-tuberculosis," as in his opinion it was a second paper (1921) they differentiated the not a true tuberculous process. Winkler, quoted condition from caseous pneumonia, but made no by Reichle (1933), thought that tuberculosis lowered mention of atelectasis. They suggested that the the resistance of the neighbouring lung tissue to term " epituberculosis " be applied to the condition. other organisms. Pinner (1945) came to the Since the publication of these papers there has conclusion on clinical observation that bronchial been considerable controversy over the condition. occlusion did not produce atelectasis but a benign copyright. The following theories as to its pathology and physiological consolidation of the lung distal to it.