Problems in Family Practice
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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. -
Identifying COPD by Crackle Characteristics
BMJ Open Resp Res: first published as 10.1136/bmjresp-2020-000852 on 5 March 2021. Downloaded from Respiratory epidemiology Inspiratory crackles—early and late— revisited: identifying COPD by crackle characteristics Hasse Melbye ,1 Juan Carlos Aviles Solis,1 Cristina Jácome,2 Hans Pasterkamp3 To cite: Melbye H, Aviles ABSTRACT Key messages Solis JC, Jácome C, et al. Background The significance of pulmonary crackles, Inspiratory crackles— by their timing during inspiration, was described by Nath early and late—revisited: and Capel in 1974, with early crackles associated with What is the key question? identifying COPD by bronchial obstruction and late crackles with restrictive ► In the diagnosis of chronic obstructive pulmonary crackle characteristics. defects. Crackles are also described as ‘fine’ or disease (COPD), is it more useful to focus on the tim- BMJ Open Resp Res ‘coarse’. We aimed to evaluate the usefulness of crackle ing of crackles than on the crackle type? 2021;8:e000852. doi:10.1136/ bmjresp-2020-000852 characteristics in the diagnosis of chronic obstructive What is the bottom line? pulmonary disease (COPD). ► Pulmonary crackles are divided into two types, ‘fine’ Methods In a population-based study, lung sounds Received 2 December 2020 and ‘coarse’ and coarse inspiratory crackles are re- Revised 2 February 2021 were recorded at six auscultation sites and classified in garded to be typical of COPD. In bronchial obstruc- Accepted 5 February 2021 participants aged 40 years or older. Inspiratory crackles tion crackles tend to appear early in inspiration, and were classified as ‘early’ or ‘late and into the types’ this characteristic of the crackle might be easier for ‘coarse’ and ‘fine’ by two observers. -
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. -
Hemoptysis in Children
R E V I E W A R T I C L E Hemoptysis in Children G S GAUDE From Department of Pulmonary Medicine, JN Medical College, Belgaum, Karnataka, India. Correspondence to: Dr G S Gaude, Professor and Head, Department of Pulmonary Medicine, J N Medical College, Belgaum 590 010, Karnataka, India. [email protected] Received: November, 11, 2008; Initial review: May, 8, 2009; Accepted: July 27, 2009. Context: Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatrician depends largely on the special interests of the center to which the child is referred. Diagnosis and management of hemoptysis in this age group requires knowledge and skill in the causes and management of this infrequently occurring potentially life-threatening condition. Evidence acquisition: We reviewed the causes and treatment options for hemoptysis in the pediatric patient using Medline and Pubmed. Results: A focused physical examination can lead to the diagnosis of hemoptysis in most of the cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with close monitoring. Massive hemoptysis may require additional therapeutic options such as therapeutic bronchoscopy, angiography with embolization, and surgical intervention such as resection or revascularization. Conclusions: Hemoptysis in the pediatric patient requires prompt and thorough evaluation and treatment. -
Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients
Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients 1 Hajime Kataoka, MD ABSTRACT 2 Osamu Matsuno, MD PURPOSE The presence of age-related pulmonary crackles (rales) might interfere 1Division of Internal Medicine, with a physician’s clinical management of patients with suspected heart failure. Nishida Hospital, Oita, Japan We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart 2Division of Respiratory Disease, Oita University Hospital, Oita, Japan Association heart failure staging criteria), stratifi ed by decade, because little is known about these issues in such patients at high risk for congestive heart failure who have no structural heart disease or acute heart failure symptoms. METHODS After exclusion of comorbid pulmonary and other critical diseases, 274 participants, in whom the heart was structurally (based on Doppler echocar- diography) and functionally (B-type natriuretic peptide <80 pg/mL) normal and the lung (X-ray evaluation) was normal, were eligible for the analysis. RESULTS There was a signifi cant difference in the prevalence of crackles among patients in the low (45-64 years; n = 97; 11%; 95% CI, 5%-18%), medium (65-79 years; n = 121; 34%; 95% CI, 27%-40%), and high (80-95 years; n = 56; 70%; 95% CI, 58%-82%) age-groups (P <.001). The risk for audible crackles increased approximately threefold every 10 years after 45 years of age. During a mean fol- low-up of 11 ± 2.3 months (n = 255), the short-term (≤3 months) reproducibility of crackles was 87%. The occurrence of cardiopulmonary disease during follow-up included cardiovascular disease in 5 patients and pulmonary disease in 6. -
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. -
Assessing and Managing Lung Disease and Sleep Disordered Breathing in Children with Cerebral Palsy Paediatric Respiratory Review
Paediatric Respiratory Reviews 10 (2009) 18–24 Contents lists available at ScienceDirect Paediatric Respiratory Reviews CME Article Assessing and managing lung disease and sleep disordered breathing in children with cerebral palsy Dominic A. Fitzgerald 1,3,*, Jennifer Follett 2, Peter P. Van Asperen 1,3 1 Department of Respiratory Medicine, University of Sydney, Sydney, New South Wales, Australia 2 Department of Physiotherapy, The Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia 3 The Children’s Hospital at Westmead Clinical School, Discipline of Paediatrics & Child Health, University of Sydney, Sydney, New South Wales, Australia EDUCATIONAL AIMS To appreciate the insidious evolution of suppurative lung disease in children with cerebral palsy (CP). To be familiar with the management of excessive oral secretions in children with CP. To understand the range of sleep problems that are more commonly seen in children with CP. To gain an understanding of the use of non-invasive respiratory support for the management of airway clearance and sleep disordered breathing in children with CP. ARTICLE INFO SUMMARY Keywords: The major morbidity and mortality associated with cerebral palsy (CP) relates to respiratory compromise. Cerebral palsy This manifests through repeated pulmonary aspiration, airway colonization with pathogenic bacteria, Pulmonary aspiration the evolution of bronchiectasis and sleep disordered breathing. An accurate assessment involving a Suppurative lung disease multidisciplinary approach and relatively simple interventions for these conditions can lead to Physiotherapy significant improvements in the quality of life of children with CP as well as their parents and carers. This Airway clearance techniques Obstructive sleep apnoea review highlights the more common problems and potential therapies with regard to suppurative lung Sleep disordered breathing disease and sleep disordered breathing in children with CP. -
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. -
Chest Pain in a Patient with Cystic Fibrosis
Copyright ©ERS Journals Ltd 1998 Eur Respir J 1998; 12: 245–247 European Respiratory Journal DOI: 10.1183/09031936.98.12010245 ISSN 0903 - 1936 Printed in UK - all rights reserved CASE FOR DIAGNOSIS Chest pain in a patient with cystic fibrosis D.P. Dunagan*, S.L. Aquino+, M.S. Schechter**, B.K. Rubin**, J.W. Georgitis** Case history A 38 yr old female with a history of cystic fibrosis (CF) presented to an outside emergency department with dysp- noea and right-sided chest pain of approximately 12 h duration. Her history was significant for recurrent pneu- mothoraces and a recent respiratory exacerbation of CF requiring prolonged antibiotic therapy for Pseudomonas aeruginosa. She described the pain as relatively acute in onset, sharp, increased with deep inspiration, without out- ward radiation, and progressive in intensity. There was no history of travel, worsening cough, fever, chills or increase in her chronic expectoration of blood-streaked sputum. An outside chest radiograph was interpreted as demonstrating a "rounded" right lower lobe pneumonia and she was transferred to our institution for further evaluation. Fig. 2. – Computed tomography scan of the chest. Open arrow: multi- On examination, she was thin, afebrile and in minimal ple cysts; closed white arrow: 3.8×5 cm round mass, respiratory distress. There were decreased breath sounds throughout all lung fields, symmetric chest wall excursion with inspiration and bilateral basilar crackles. Subjective right lateral chest discomfort was reported with deep ins- piratory manoeuvres. The remaining physical examination was normal except for clubbing of the upper extremities. Laboratory data revealed an elevated white blood cell count of 19.2×109 cells·L-1 with a normal differential. -
Subset of Alphabetical Index to Diseases and Nature of Injury for Use with Perinatal Conditions (P00-P96)
Subset of alphabetical index to diseases and nature of injury for use with perinatal conditions (P00-P96) SUBSET OF ALPHABETICAL INDEX TO DISEASES AND NATURE OF INJURY FOR USE WITH PERINATAL CONDITIONS (P00-P96) Conditions arising in the perinatal period Conditions arising—continued - abnormal, abnormality—continued Note - Conditions arising in the perinatal - - fetus, fetal period, even though death or morbidity - - - causing disproportion occurs later, should, as far as possible, be - - - - affecting fetus or newborn P03.1 coded to chapter XVI, which takes - - forces of labor precedence over chapters containing codes - - - affecting fetus or newborn P03.6 for diseases by their anatomical site. - - labor NEC - - - affecting fetus or newborn P03.6 These exclude: - - membranes (fetal) Congenital malformations, deformations - - - affecting fetus or newborn P02.9 and chromosomal abnormalities - - - specified type NEC, affecting fetus or (Q00-Q99) newborn P02.8 Endocrine, nutritional and metabolic - - organs or tissues of maternal pelvis diseases (E00-E99) - - - in pregnancy or childbirth Injury, poisoning and certain other - - - - affecting fetus or newborn P03.8 consequences of external causes (S00-T99) - - - - causing obstructed labor Neoplasms (C00-D48) - - - - - affecting fetus or newborn P03.1 Tetanus neonatorum (A33) - - parturition - - - affecting fetus or newborn P03.9 - ablatio, ablation - - presentation (fetus) (see also Presentation, - - placentae (see also Abruptio placentae) fetal, abnormal) - - - affecting fetus or newborn -
Defective Regulation of Immune Responses in Croup Due to Parainfluenza Virus
716 WELLIVER ET AL. Science 221: 1067-1070 20. Mawhinney TP, Feather MS, Martinez JR, Barbero GJ 1979 The chronically 17. Quissell DO 1980 Secretory response of dispersed rat submandibular cells: I. reserpinized rat as an animal model for cystic fibrosis: acute effect of Potassium release. Am J Physiol 238:C90-C98 isoproterenol and pilocarpine upon pulmonary lavage fluid. Pediatr Res 18. Lowry OH, Rosebrough NF, Farrar AL, Randall RJ 195 1 Protein measurement 13:760-763 with the Folin phenol reagent. J Biol Chem 193:265-268 21. Frizzell RA, Fields M, Schultz SG 1979 Sodium-coupled chloride transport by 19. Perlmutter J, Martinez JR 1978 The chornically reserpinized rat as a possible epithelial tissues. Am J Physiol 236:FI-F8 model for cystic fibrosis: VII. Alterations in the secretory response to secretin 22. Welsh M 1983 Inhibition of chloride secretion by furosemide in canine tracheal and to cholecystokinin from the pancreas in vivo. Pediatr Res 12: 188- 194 epithelium. J Memb Biol71:219-226 003 1-3998/85/1907-07 16$02.00/0 PEDIATRIC RESEARCH Vol. 19, No. 7, 1985 Copyright O 1985 International Pediatric Research Foundation, Inc. Printed in U.S.A. Defective Regulation of Immune Responses in Croup Due to Parainfluenza Virus ROBERT C. WELLIVER, MARTHA SUN, AND DEBORAH RINALDO Department ofPediatrics, State University of New York at Buffalo, and Division of Infectious Diseases, Children S Hospital, Buffalo, New York 14222 ABSTRACT. In order to determine if defects in regulation Croup is a common respiratory illness of childhood, yet fairly of immune responses play a role in the pathogenesis of little is known about its pathogenesis. -
1 Respiratory Disorders 1
SECTION 1 Respiratory Disorders 1 Sore Throat Robert R. Tanz Most causes of sore throat are nonbacterial and neither require nor are is rarely reason to test outpatients and infrequent benefit to testing inpa- alleviated by antibiotic therapy (Tables 1.1, 1.2, and 1.3). Accurate tients except to confirm and treat influenza. diagnosis is essential: Acute streptococcal pharyngitis warrants diag- Adenoviruses can cause upper and lower respiratory tract disease, nosis and therapy to ensure prevention of serious suppurative and ranging from ordinary colds to severe pneumonia and multisystem nonsuppurative complications. Life-threatening infectious complica- disease, including hepatitis, myocarditis, and myositis. The incubation tions of oropharyngeal infections, whether streptococcal or nonstrep- period of adenovirus infection is 2-4 days. Upper respiratory tract tococcal, may manifest with mouth pain, pharyngitis, parapharyngeal infection typically produces fever, erythema of the pharynx, and fol- space infectious extension, and/or airway obstruction (Tables 1.4 and licular hyperplasia of the tonsils, together with exudate. Enlargement 1.5). In many cases, the history and/or physical exam can help direct of the cervical lymph nodes occurs frequently. When conjunctivitis diagnosis and treatment, but the enormous number of potential causes occurs in association with adenoviral pharyngitis, the resulting syn- is too large to address all of them. drome is called pharyngoconjunctival fever. Pharyngitis may last as long as 7 days and does not respond to antibiotics. There are many adenovirus serotypes; adenovirus infections may therefore develop in VIRAL PHARYNGITIS children more than once. Laboratory studies may reveal a leukocytosis and an elevated erythrocyte sedimentation rate. Adenovirus outbreaks Most episodes of pharyngitis are caused by viruses (see Tables 1.2 and have been associated with swimming pools and contamination in 1.3).