DOCSLIB.ORG

Diagnostic Approach to Pediatric Emergencies

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnostic Approach to Pediatric Emergencies Aims Diagnostic Approach to Pediatric • Pediatric Assessment Emergencies • Respiratory Emergencies • Shock 新光醫院急診醫學科 • Cardiac Rhythm Disturbances 吳柏衡醫師 • Emergency Procedures 103.09.11 Pediatric assessment • Initial assessment –PAT Pediatric Assessment –ABCDE • Cardiovascular assessment – Vital signs – End-organ perfusion Pediatric Assessment Triangle Appearance Work of • Tone Appearance Breathing • Interactiveness • Consolability • Look/Gaze • Speech/Cry Circulation to skin Work of Breathing Circulation to Skin • Abnormal airway • Pallor sounds • Mottling • Abnormal • Cyanosis positioning • Retractions • Nasal flaring • Head bobbing Case Study 1: Pediatric Assessment Triangle “Cough, Difficulty Breathing” Breathing • One-year-old boy presents with complaint Appearance Audible of cough, difficulty breathing. Alert, smiling, inspiratory • Past history is unremarkable. He has had nontoxic stridor at rest nasal congestion, low grade fever for 2 days. Circulation Pink Pediatric Assessment Triangle: Questions Respiratory Distress What information does the PAT tell you Breathing Appearance about this patient? Abnormal Normal What is your general impression? Circulation Normal General Impression • Stable • Respiratory distress • Respiratory failure • Shock (compensated/decompensated) • CNS or Endocrine dysfunctions • Cardiopulmonary failure/arrest Case Progression/Outcome Initial assessment-ABCDE • Initial assessment: Respiratory distress • Airway with upper airway obstruction • Breathing • Initial treatment priorities: • Circulation – Leave in a position of comfort. • Disability – Obtain oxygen saturation. • Exposure – Provide oxygen as needed. – Begin specific therapy. Airway Breathing: Respiratory Rate Age Respiratory Rate • Manual airway opening maneuvers: Head tilt- Infant 30 to 60 chin lift, jaw thrust Toddler 24 to 40 • Suction: Can result in dramatic improvement in Preschooler 22 to 34 infants School-aged child 18 to 30 • Age-specific obstructed airway support: Adolescent 12 to 16 – <1 year: Back blow/chest thrust – >1 year: Abdominal thrust • Slow or fast respirations are worrisome. • Advanced airway techniques Breathing: Auscultation Circulation: Heart Rate Age Normal Heart Rate • Listen with stethoscope over midaxillary line and Infant 100 to 160 above sternal notch – Stridor: Upper airway obstruction Toddler 90 to 150 – Wheezing: Lower airway obstruction Preschooler 80 to 140 – Grunting: Poor oxygenation; pneumonia, drowning, pulmonary contusion School-aged child 70 to 120 – Crackles: Fluid, mucus, blood in airway Adolescent 60 to 100 – Decreased/absent breath sounds: Obstruction Circulation Hypotension (SBP, mmHg) • Newborn (0-28 days): < 60 • Pulse quality: Palpate central and • Infant: < 70 peripheral pulses • Child (1-10): < 70 + (age x 2) • Skin temperature: Reverse thermometer • Child (> 10): < 90 sign • Capillary refill • Blood pressure: Minimum BP = 70 + (2 X age in years) Pediatric Vital signs Disability HR RR BP 0-1 y/o 100-160 30-60 60-70 • Quick neurologic exam 1-6 y/o ~140 20-40 70 + Age*2 6-12 y/o ~120 15-30 70 + Age*2 • AVPU scale: >12 y/o 60-100 20 > 90 –Alert – Verbal: Responds to verbal commands – Painful: Responds to painful stimulus – Unresponsive • (Pediatric) Glasgow Coma Scale Exposure End-organ perfusion • Proper exposure is necessary to evaluate • Skin: temperature, color, capillary refilling physiologic function and identify anatomic time abnormalities. • Brain: level of consciousness • Maintain warm ambient environment and minimize heat loss. • Kidney: urine output • Monitor temperature. • Warm IV fluids. Respiratory Emergencies Case Study 1 Initial Assessment (1 of 2) • Mother of 13-month-old boy found him PAT: choking and gagging next to container of – Normal appearance, abnormal breathing, spilled nuts. normal circulation • Paramedics noted appearance is alert; Vital signs: work of breathing is increased with – HR 160, RR 60, BP 88/56, T 37.1C, O2 sat 93%, Wt audible stridor; subcostal retractions; color 11 kg is normal. Question General Impression What is your general impression of this • Respiratory distress: patient? – Upper airway obstruction – Foreign body aspiration What are your initial management priorities? Initial Assessment (2 of 2) Management Priorities A: Stridor • Patient is brought to monitored bed and B: Tachypneic with retractions, reduced tidal volume allowed to remain in position of comfort. C: Color is normal, skin is warm and dry, • Supplemental oxygen is provided. pulse is rapid but strong and regular. D: Alert with no focal neurologic signs; • IV access is deferred to avoid agitation. GCS 15 • Specialists are contacted. E: No obvious signs of injury Your First Clue: Discussion: Foreign Body Aspiration Foreign Body Aspiration • A history of choking is the most reliable • Background: predictor of FB aspiration. – 150-300 fatalities in young children each year. • Other signs and symptoms include: – 2/3 of cases are in children 1-2 years of age. – Upper airway: Stridor, respiratory or cardiopulmonary arrest – Lower airway: Coughing, wheezing, retractions, decreased breath sounds, cyanosis Background: Background: Foreign Body Aspiration (1 of 2) Foreign Body Aspiration (2 of 2) • Foreign objects can be lodged in the • Food items are the upper or lower airway, or esophagus. most commonly Differences in the pediatric airway make aspirated FB. • evaluation and management of foreign • Balloons are the body aspiration challenging. most common FB to result in death. Diagnostic Studies • Radiology – Radiopaque FBs are seen in about 15% of cases. – Other findings seen in lower airway FB aspiration on chest radiograph • Air trapping/hyperinflation • Pulmonary consolidation • Barotrauma Radiology Management (1 of 6) • In this chest • Upper airway FB: radiograph, FB – If patient is able to cough or speak: aspiration is suggested • Leave in a position of comfort. as the left side of the • Provide supplemental oxygen. chest is hyperlucent • Consider heliox therapy from air trapping. • Priority to get patient to operating room for removal Management (2 of 6) Management (3 of 6) • Upper airway: • BLS: – With severe partial or complete airway – Infant: 5 back blows/5 chest thrusts obstruction, management depends on age. – Management options can be divided into basic life support (BLS) and advanced life support (ALS). Management (4 of 6) Management (5 of 6) • BLS: –Child: 5 abdominal • ALS: thrusts – Laryngoscopy and removal with pediatric Magill forceps Management (6 of 6) Case Progression/Outcome • Lower airway FB: • Patient was taken to operating room – Heliox may be tried as a temporizing measure where rigid bronchoscopy was performed prior to removal for patients in severe and a peanut was removed from the respiratory distress. subglottic airway. – Bronchoscopy and removal of FB in operating room • FB retrieval rate approaches 100%. Case Study 2 Initial Assessment (1 of 2) • 15-month-old boy with a history of cold PAT: for 2 days develops a barking cough. – Normal appearance, abnormal breathing, • He tracks you with his gaze as you normal circulation approach. Vital signs: • He has stridor at rest, retractions, and has – HR 180, RR 60, T 38.4C, O2 sat 91% on cyanosis around his lips. blow-by oxygen, Wt 10 kg Question General Impression What is your general impression of this • Respiratory distress: patient? – Upper airway obstruction –Croup What are your initial management priorities? Initial Assessment (2 of 2) Management Priorities A: Stridor at rest • Leave patient in a position of comfort. B: Tachypnea, retractions • Place patient on cardiorespiratory monitor. C: Slight cyanosis around the lips, • Administer nebulized epinephrine. otherwise color is normal, capillary refill • Administer corticosteroids IM. <2 seconds, skin warm and dry, pulse strong and rapid D: Alert, GCS 15 E: No signs of injury, no rash Your First Clue: Croup Background: Croup • Prodromal symptoms mimic upper • Croup, or laryngotracheobronchitis, is respiratory infection. common in infants and children. • Fever is usually low grade (50%). – Affects children 6 months to 6 years – Incidence 3-5/100 children • Barky cough and stridor (90%) are – Peak in second year of life common. – Seasonal: Occurs in fall and early winter • Hoarseness and retractions may also occur. – Viral etiology most common: Parainfluenza virus Diagnostic Studies • The diagnosis of croup is made clinically. • Routine laboratory or radiological studies are not necessary. • Plain radiography of neck performed on cases in which diagnosis was in question may show a Steeple sign. Steeple Sign Differential Diagnosis: What Else? • Epiglottitis (rare) • Bacterial tracheitis • Peritonsillar abscess • Uvulitis • Allergic reaction • Foreign body aspiration • Neoplasm Management Options: Croup Management Options: Croup (1 of 3) (2 of 3) • Humidified oxygen • Steroids – Theoretical benefit – literature suggests NO – No significant difference in outcome between significant benefit dexamethasone and budesonide • Steroids – Dexamethasone – Faster improvement with croup score, • Doses 0.15-0.6 mg/kg PO or IM are effective. decrease in endotracheal intubation, and –Budesonide shorter hospital stays • Dose 2mg/2mL nebulized Management Options: Croup Case Progression/Outcome (3 of 3) • Epinephrine • 15-month-old patient received inhaled – Begin epinephrine for signs of moderate to epinephrine and dexamethasone IM. severe respiratory distress. • He was observed in the ED for 3 hours. • Racemic 0.05 mL/kg (max 0.5 mL) At the time of discharge, his respiratory
Load more

Recommended publications
  • 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.
    [Show full text]
  • Mantke, Peitz, Surgical Ultrasound -- Index
    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
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • JOURNAL Previously Revista Portuguesa De Pneumologia
    JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 ISSN 2531-0429 www.journalpulmonology.org Portada_25_3.indd 1 29/10/19 14:56 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org Volume 25. Especial Congresso 3. Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 Contents Oral communications . 1 Commented posters . 45 Exposed posters . 122 00 Sumario 25-3.indd 1 29/10/19 14:58 Pulmonol. 2019;25(Esp Cong 3):1-44 JOURNAL Previously Revista Portuguesa de Pneumologia volume 25 / especial congresso 3 /Novembro 2019 35th CONGRESS OF PULMONOLOGY Praia da Falésia – Centro de Congressos Epic Sana, Algarve, 7th-9th November 2019 www.journalpulmonology.org ISSN 2531-0429 www.journalpulmonology.org ORAL COMMUNICATIONS 35th Congress of Pulmonology Praia da Falésia – Centro de Congressos Epic Sana Algarve, 7th‑9th November 2019 CO 001. NONSPECIFIC VENTILATORY PATTERN: Conclusions: Interpretation of PFT using fixed percentages may EVALUATION BY FIXED PERCENTAGES VERSUS LIMITS lead to an overvaluation of functional changes, particularly in fe- OF NORMALITY male gender and older ages. This work attests the importance of using LLN versus fixed percentage as recommended in international C. Rijo, M. Silva, T. Duarte, S. Sousa, P. Duarte guidelines. Centro Hospitalar de Setúbal, EPE-Hospital de São Bernardo.
    [Show full text]
  • Can Chest CT Features Distinguish Patients with Negative from Those with Positive Initial RT-PCR Results for Coronavirus Disease (COVID-19)?
    Cardiopulmonary Imaging • Original Research Chen et al. Chest CT of COVID-19 Cardiopulmonary Imaging Original Research Can Chest CT Features Distinguish Patients With Negative From Those With Positive Initial RT-PCR Results for Coronavirus Disease (COVID-19)? Dandan Chen1 OBJECTIVE. The purpose of this study was to explore the value of CT in the diagnosis of Xinqing Jiang1 coronavirus disease (COVID-19) pneumonia, especially for patients who have negative initial Yong Hong2 results of reverse transcription–polymerase chain reaction (RT-PCR) testing. Zhihui Wen1 MATERIALS AND METHODS. Patients with COVID-19 pneumonia from January Shuquan Wei3 19, 2020, to February 20, 2020, were included. All patients underwent chest CT and swab Guangming Peng4 RT-PCR tests within 3 days. Patients were divided into groups with negative (seven patients) Xinhua Wei1 and positive (14 patients) initial RT-PCR results. The imaging findings in both groups were recorded and compared. Chen D, Jiang X, Hong Y, et al. RESULTS. Twenty-one patients with symptoms (nine men, 12 women; age range, 26–90 years) were evaluated. Most of the COVID-19 lesions were located in multiple lobes (67%) in both lungs (72%) in our study. The main CT features were ground-glass opacity (95%) and consolidation (72%) with a subpleural distribution (100%). Otherwise, 33% of patients had other lesions around the bronchovascular bundle. The other CT features included air bron- chogram (57%), vascular enlargement (67%), interlobular septal thickening (62%), and pleural effusions (19%). Compared with that in the group with positive initial RT-PCR results, CT of the group with negative initial RT-PCR results was less likely to show pulmonary consolida- tion (p < 0.05).
    [Show full text]
  • Differential Diagnosis of Coronavirus Disease 2019 from Community
    Liu et al. Infectious Diseases of Poverty (2020) 9:118 https://doi.org/10.1186/s40249-020-00737-9 RESEARCH ARTICLE Open Access Differential diagnosis of coronavirus disease 2019 from community-acquired-pneumonia by computed tomography scan and follow- up Kai-Cai Liu1, Ping Xu2*, Wei-Fu Lv3* , Lei Chen4, Xiao-Hui Qiu5, Jin-Long Yao6, Jin-Feng Gu4,BoHu7 and Wei Wei3 Abstract Objective: Coronavirus disease 2019 (COVID-19) is currently the most serious infectious disease in the world. An accurate diagnosis of this disease in the clinic is very important. This study aims to improve the differential ability of computed tomography (CT) to diagnose COVID-19 and other community-acquired pneumonias (CAPs) and evaluate the short-term prognosis of these patients. Methods: The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province, China from January 21 to February 28, 2020 were retrospectively analysed. The CT manifestations of the two groups were recorded and compared. A correlation analysis was used to examine the relationship between COVID-19 and age, size of lung lesions, number of involved lobes, and CT findings of patients. The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity. Results: The typical CT findings of COVID-19 are simple ground-glass opacities (GGO), GGO with consolidation or grid-like changes. The sensitivity and specificity of the combination of age, white blood cell count, and ground- glass opacity in the diagnosis of COVID-19 were 92.7 and 66.1%, respectively.
    [Show full text]
  • Chest Imaging Using Signs, Symbols, and Naturalistic Images
    Chiarenza et al. Insights into Imaging (2019) 10:114 https://doi.org/10.1186/s13244-019-0789-4 Insights into Imaging EDUCATIONAL REVIEW Open Access Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists Alessandra Chiarenza1, Luca Esposto Ultimo1, Daniele Falsaperla1, Mario Travali1, Pietro Valerio Foti1, Sebastiano Emanuele Torrisi2,3, Matteo Schisano2, Letizia Antonella Mauro1, Gianluca Sambataro2,4, Antonio Basile1, Carlo Vancheri2 and Stefano Palmucci1* Abstract Several imaging findings of thoracic diseases have been referred—on chest radiographs or CT scans—to signs, symbols, or naturalistic images. Most of these imaging findings include the air bronchogram sign, the air crescent sign, the arcade-like sign, the atoll sign, the cheerios sign, the crazy paving appearance, the comet-tail sign, the darkus bronchus sign, the doughnut sign, the pattern of eggshell calcifications, the feeding vessel sign, the finger- in-gloove sign, the galaxy sign, the ginkgo leaf sign, the Golden-S sign, the halo sign, the headcheese sign, the honeycombing appearance, the interface sign, the knuckle sign, the monod sign, the mosaic attenuation, the Oreo- cookie sign, the polo-mint sign, the presence of popcorn calcifications, the positive bronchus sign, the railway track appearance, the scimitar sign, the signet ring sign, the snowstorm sign, the sunburst sign, the tree-in-bud distribution, and the tram truck line appearance. These associations are very helpful for radiologists and non-radiologists and increase learning and assimilation of concepts. Therefore, the aim of this pictorial review is to highlight the main thoracic imaging findings that may be associated with signs, symbols, or naturalistic images: an “iconographic” glossary of terms used for thoracic imaging is reproduced— placing side by side radiological features and naturalistic figures, symbols, and schematic drawings.
    [Show full text]
  • Juerg Hodler Rahel A. Kubik-Huch Gustav K. Von Schulthess Editors Diagnostic and Interventional Imaging
    IDKD Springer Series Series Editors: Juerg Hodler · Rahel A. Kubik-Huch · Gustav K. von Schulthess Juerg Hodler Rahel A. Kubik-Huch Gustav K. von Schulthess Editors Diseases of the Chest, Breast, Heart and Vessels 2019–2022 Diagnostic and Interventional Imaging IDKD Springer Series Series Editors Juerg Hodler Department of Radiology University Hospital of Zürich Zürich, Switzerland Rahel A. Kubik-Huch Department of Radiology Kantonsspital Baden Zürich, Switzerland Gustav K. von Schulthess Deptartment of Nuclear Medicine University Hospital of Zürich Zürich, Switzerland The world-renowned International Diagnostic Course in Davos (IDKD) represents a unique learning experience for imaging specialists in training as well as for experienced radiologists and clinicians. IDKD reinforces his role of educator offering to the scientific community tools of both basic knowledge and clinical practice. Aim of this Series, based on the faculty of the Davos Course and now launched as open access publication, is to provide a periodically renewed update on the current state of the art and the latest developments in the field of organ- based imaging (chest, neuro, MSK, and abdominal). More information about this series at http://www.springer.com/series/15856 Juerg Hodler • Rahel A. Kubik-Huch Gustav K. von Schulthess Editors Diseases of the Chest, Breast, Heart and Vessels 2019–2022 Diagnostic and Interventional Imaging Editors Juerg Hodler Rahel A. Kubik-Huch Department of Radiology Department of Radiology University Hospital of Zürich Kantonsspital Baden
    [Show full text]