DOCSLIB.ORG

Aspiration Pneumonitis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Aspiration Pneumonitis Otterbein University Digital Commons @ Otterbein Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work 7-2018 Aspiration Pneumonitis Meghan Little Otterbein University, [email protected] Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn Part of the Nursing Commons Recommended Citation Little, Meghan, "Aspiration Pneumonitis" (2018). Nursing Student Class Projects (Formerly MSN). 311. https://digitalcommons.otterbein.edu/stu_msn/311 This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Aspiration Pneumonitis MeGhan Little BSN, RN, CCRN Otterbein University, Westerville, Ohio Introduction Presentation of Process Underlying Pathophysiology Implications for Nursing Care References As Bartlett (2018) explains, there are many extensive experimental animal studies on the • The certified reGistered nurse anesthetist (CRNA) plays a larGe role in • Bartlett, J. G. (2018, May 18). Aspiration • Anesthesia is an essential Signs and Symptoms Additional medications routinely used pathophysioloGy of aspiration pneumonitis. In these test animals, the inoculum used must have preventing anesthesia-related aspiration pneumonitis. during anesthesia that are known to pneumonia in adults. Retrieved from element of healthcare today, • The primary siGn of intraoperative a pH of ≤2.5, and a larGe amount must be used – approximately 1-4ml/kG. This converts to an decrease lower esophaGeal sphincter • https://www.uptodate.com/contents/aspiratio however, it is not without its aspiration is visualization of Gastric amount 25 mL of Gastric acid in human adults. Bartlett (2018) states that it is likely that when The CRNA should always conduct a preoperative risk assessment so that tone include: propofol, β-aGonists, n-pneumonia-in-adults complications. One major contents in the oropharynx or passinG lesser amounts of Gastric acid are aspirated in humans, the process of pneumonitis is more they are aware of any conditions that the patient has that may increase opiods, atropine, thiopental, tricyclics, DeGuchi, S., Komasawa, N., Ueno, T., Omori, M., & complication of anesthesia is into the airway durinG intubation subtle to where is escapes clinical detection or causes a less severe form. This concept supports their risk of aspiratinG, such as GERD, esophaGeal dysmotility, difficult glycopyrrolate (Nason, 2015). Minami, T. (2016). Evaluation of pH on aspiration pneumonitis. (Nason, 2015). the notion that patients with GERD may suffer from bouts of recurrent pneumonitis more swallowinG, diabetes, delayed Gastric emptyinG, obstructinG cancer (Nason, frequently than those who do not have GERD (Bartlett, 2018). 2015). removed tracheal tubes after General • PredisposinG conditions: anesthesia: A prospective observational study. • Inflammation of the lunG tissue • Other siGns of intraoperative AccordinG to Bartlett (2018), in the above-mentioned test animals, the pathophysioloGic GastroesophaGeal reflux disease (GERD), • Journal of Clinical Anesthesia, 35, 346-349. caused by aspiration of a foreiGn aspiration include persistent hypoxia, chanGes that occur in aspiration pneumonitis occur rapidly. In as little as three minutes of The CRNA must educate their patients on the importance of fastinG esophaGeal dysmotility, difficulty doi:10.1016/j.jclinane.2016.08.016 substance, such as, food, hiGh airway pressures, bronchospasm, aspiratinG, patholoGic processes such as atelectasis, peribronchial hemorrhaGe, pulmonary before surGery to reduce their risk of aspirating. According to Nason swallowinG, diabetes, delayed Gastric Dibardino, D. M., & Wunderink, R. G. (2015). meconium, or secretions, can be and abnormal breath sounds (Nason, edema, and deGeneration of bronchial epithelial cells beGin to take place. The alveolar sacs (2015), the American Society of AnesthesioloGists Committee on Standards emptyinG, Gastrointestinal obstruction, Aspiration pneumonia: A review of modern referred to as aspiration 2015). become filled with polymorphonuclear leukocytes and fibrin by hour four. At this point, alveolar and Practice Parameters currently allow: need for emerGent surGery, previous trends. Journal of Critical Care, 30(1), 40-48. pneumonitis (McCance, Huether, consolidation occurs due to the lunG’s Gross edema and hemorrhaGe. CausinG further injury to • Consumption of a liGht meal up to 6 hours prior to surGery esophaGeal surGery, lack of coordination doi:10.1016/j.jcrc.2014.07.011\ Brashers, & Rote, 2014). • AccordinG to DiBardino& Wunderlink lunG tissue, proinflammatory cytokines, includinG tumor necrosis factor (TNF)-alpha and • Clear liquids up to 2 hours prior to surGery of swallowinG, esophaGeal cancer, hiatal interleukin (IL)-8 are released. These findinGs have also been found on autopsy of patients have McCance, K. L., Huether, S. E., Brashers, V. L., & (2015), additional clinical features that Rote, N. S. (eds.). (2014). Pathophysiology: The • Anesthetic aGents can cause hernia, obesity (Nason, 2015) died from aspiration pneumonia. (Bartlett, 2018). can be seen with aspiration • The CRNA should utilize current preoperative medication Biologic Basis for Disease in Adults and reduced couGh and GaG reflexes, recommendations such as the use of H2 blockers, proton pump inhibitors pneumonitis: • Children (7th ed.). St. Louis, MO: which in turn interferes with an Lack of provider experience and • Fever and prokinetics, which are effective in increasinG the pH and reducinG the Elsevier/Mosby. individual’s ability to handle expertise (Nason, 2015): • Tachycardia volume of Gastric contents, as well as promotinG Gastric emptyinG (Nason, Metheny, N. A. (2016). Prevention of Aspiration in oropharynGeal secretions and 2015). • Abnormal chest radioGraph • Adults. Critical Care Nurse, 36(1), E20-E24. refluxed Gastric contents “In the retrospective review of anesthesia-related aspirations by doi:10.4037/ccn2016831 (Metheny, 2016). • The CRNA may utilize the rapid sequence induction technique on Sakai and colleaGues, 10 of the 14 Morehead, R. S. (2009, December 01). Gastro- Risk Factors patients who are considered hiGh-risk cases to minimize the risk of cases were attributed to improper oesophaGeal reflux disease and non-asthma • “Anesthesia-related aspiration aspiratinG durinG intubation (Nason, 2015). This technique includes: • “Causes of aspiration pneumonia lunG disease. Retrieved from occurs when patients without anesthesia technique “ (Nason, during the perioperative period can be • PreoxyGenation, rapid administration of induction and paralytic http://err.ersjournals.com/content/18/114/23 sufficient larynGeal protective 2015). divided into anesthesia-, surGery-, and aGents, cricoid pressure, avoidance of baG and mask ventilation, and 3 reflexes passively or actively device- related factors. The most transoral insertion of an endotracheal tube usinG direct or video Nason, K. S. (2015). Acute Intraoperative reGurgitate Gastric contents” consistent risk factors related to Diagnosis larynGoscopy (Nason 2015). Pulmonary Aspiration. Thoracic Surgery Clinics, (Nason, 2015). anesthesia are liGht anesthesia, 25(3), 301-307. • Is typically presumptive based on the residual neuromuscular blockade after • In cases where cricoid pressure durinG intubation is contraindicated, doi:10.1016/j.thorsurG.2015.04.011 • Anesthesia-related aspiration clinical feature noted above (Bartlett, anesthesia, and prolonGed other options to reduce the risk of aspiration durinG intubation include Salem, M. R., Khorasani, A., Zeidan, A., & Crystal, occurs in as many as 1 in every 2- 2018) Figure 2. CT scan from an individual with aspiration revealing nodular airspace anesthesia.” (DeGuchi, Komasawa, awake intubation and the use of 40° head-up positioning during induction G. J. (2017). Cricoid Pressure Controversies. 3,000 surGical procedures requirinG infiltration (#), focal ground-glass opacification (arrow) and centrilobular Ueno, Omori & Minami, 2016). (Salem, Khorasani, Zeidan & Crystal, 2017) Anesthesiology, 126(4), 738-752. anesthesia, and consequently, • Chest radioGraphy abnormalities may nodules with tree-in-bud changes (arrowheads) (Morehead, 2009). doi:10.1097/aln.0000000000001489 approximately half of those appear within two hours after • Medications: Sethi, S. (2017, March). Aspiration Pneumonia and patients who aspirate during their suspected aspiration (Bartlett, 2018). Conclusions • Anesthesia itself puts patients Chemical Pneumonitis - LunG and Airway operation develop a lunG-related Significance of Pathophysiology at risk for aspiration by reducinG Anesthesia-related aspiration pneumonitis is a potentially fatal Disorders - Merck Manuals Consumer Version. injury such as aspiration • If a bronchoscopy is obtained, it may level of consciousness and by • UnderstandinG the pathophysioloGy behind anesthesia-related aspiration will aid in the perioperative complication that is preventable in many cases. Understanding Retrieved from pneumonitis or pneumonia (Nason, show erythema of the bronchi, causinG loss of protective prevention of its occurrence and minimization of its harmful effects. the pathophysioloGic process of aspiration pneumonitis is essential in https://www.merckmanuals.com/home/lunG- 2015). indicatinG acid injury (Bartlett, 2018). reflexes
Load more

Recommended publications
  • Siphoning Diesel: a Fatal Mistake
    CASE REPORT Siphoning diesel: a fatal mistake Leong Wei Cheng, MRCP, Brian Cheong Mun Keong, FRCP Department of Medicine, Hospital Teluk Intan cervical lymphadenopathy and auscultation of his lungs SUMMARY revealed normal findings. Examination of other systems did Diesel is commonly used as fuel for engines and is distilled not reveal any abnormalities. from petroleum. Diesel has toxic potential and can affect multiple organs. Exposure can occur after ingestion, Initial blood investigations showed evidence of acute kidney inhalation or through the dermal route. The practice of injury (urea: 16.7 mmol/l, sodium 129 mmol/l, potassium 3.7 siphoning diesel using a rubber tubing and the mouth is mmol/l and creatinine 937 µmol/l). There was presence of common in rural communities. This can lead to accidental protein and erythrocytes (2+) in his urine. His full blood count ingestion and aspiration. Here we report a case of a patient showed elevated white cell count of 11,600/µl (neutrophil who accidentally ingested diesel during siphoning, which 85%) with normal haemoglobin concentration (15.9 g/dl) caused extensive erosion of the oral cavity and oesophagus and platelets (185,000/µl). Liver transaminases were normal. leading to pneumomediastinum and severe chemical lung Chest radiograph showed clear lung fields. His provisional injury. The patient responded well initially to steroids and diagnosis was acute tonsillitis with post- infectious Rapidly supportive care but required prolonged hospitalisation. He Progressive Glomerolonephritis (RPGN). Intravenous (IV) developed complications of nosocomial infection and Ceftriaxone 2 g daily was started. succumbed 23 days after admission. He became progressively more tachypnoeic in the ward with KEY WORDS: Diesel; siphon; chemical pneumonitis; oesophageal perforation; worsening renal function and metabolic acidosis.
    [Show full text]
  • Occupational Dusts Other Than Silica* by Kenneth M
    Thorax: first published as 10.1136/thx.2.2.91 on 1 June 1947. Downloaded from Thorax (1947), 2, 91. DISEASES OF THE LUNG RESULTING FROM OCCUPATIONAL DUSTS OTHER THAN SILICA* BY KENNETH M. A. PERRY London It is only in recent years that considerable interest has been given to the dusts to which men are exposed at their work, even though silicosis is known to have occurred in prehistoric times. Many dusts are now recognized as dangerous, and in the extreme it may even be doubted whether any dust can be regarded as harmless. It is rational at least to suppose that the lung cannot become a physiological dust trap and yet retain its elasticity. It seems possible that any dust, no matter how innocuous in small concentrations, would in large enough quantity eventually overwhelm the defences of the lung and accumulate in such amounts as to impair function; such a form of lung disease would be the result of causes of a mechanical nature-the physical presence of large amounts of inert foreign material. The term "benign pneumoconiosis " has been given to this type of disease in order to contrast it with diseases resulting http://thorax.bmj.com/ from the inhalation of siliceous matter. But besides this group of conditions occupational dust may give rise to inflammatory lesions, allergic responses, and neoplastic changes. INFLAMMATORY CHANGES Inflammatory changes may be caused by inorganic metals, such as manganese, on September 24, 2021 by guest. Protected copyright. beryllium, vanadium, and osmium, giving.rise to a chemical pneumonitis; and by organic matter, such as decaying hay and grain, bagasse, cotton fibre, and similar substances where the aetiology is somewhat obscure, though fungi are frequently blamed.
    [Show full text]
  • Airbag Pneumonitis
    Hindawi Publishing Corporation Case Reports in Medicine Volume 2010, Article ID 498569, 2 pages doi:10.1155/2010/498569 Case Report Airbag Pneumonitis Raghav Govindarajan, Gustavo Ferrer, Laurence A. Smolley, Eduardo Araujo Oliveira, and Franck Rahaghi Department of Pulmonary Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA Correspondence should be addressed to Raghav Govindarajan, [email protected] Received 29 June 2010; Accepted 13 September 2010 Academic Editor: Steven A. Sahn Copyright © 2010 Raghav Govindarajan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The widespread and mandatory use of airbags has resulted in various patterns of injuries and complications unique to their use. Airbags have been implicated in a spectrum of pulmonary conditions ranging from exacerbation of asthma, reactive airway diseases to new onset asthma. We report a case of inhalational chemical pneumonitis that developed after exposure to the airbag fumes. 1. Introduction room air. There were no significant electrolyte abnormalities. Chest X-ray PA and lateral view revealed left lower lobe and ffi The 2001 United States national highway tra csafety retocardiac infiltrate. CT chest noncontrast revealed tree in administration report estimated that airbags reduce driver bud opacities in the right middle lobe, left lingual. Ground fatality by 12%–14% [1].The widespread and mandatory glass opacity was also seen in the posterior basal segment of use of airbags has resulted in various patterns of injuries the left lower lobe (Figure 1).
    [Show full text]
  • Thirty Workers in Missouri Popcorn Plant Diagnosed With
    Occupational Lung SSSEEENNNSSSOOORRR Disease Bulletin Massachusetts Department of Public Health Occupational Health Surveillance Program, 250 Washington Street, 6th Floor, Boston, MA 02108 Tel: (617) 624-5632 Fax: (617) 624-5696 www.mass.gov/dph/ohsp June 2006 Dear Health Care Provider, An investigation of the workplace revealed that diacetyl, Welcome to the June issue of the SENSOR an artificial butter flavoring ingredient, was linked with the Occupational Lung Disease Bulletin! In this issue, we employees’ symptoms. Animal studies conducted by focus on the topic of bronchiolitis obliterans, a severe lung flavoring manufacturers as early as 1993 showed that disease that can occur in workers that make or handle inhalation of diacetyl resulted in severe lung injury. food flavoring. Bronchiolitis obliterans has been linked to Additional studies completed in 2002 confirmed these diacetyl, an artificial butter flavoring ingredient. The findings1. The National Institute for Occupational Safety illness has been called “popcorn lung disease” because of and Health (NIOSH) issued an alert in 2004, warning of the clusters of workers in popcorn plants that have been the danger posed by vapors, dusts or sprays of flavorings diagnosed with the disease. However, workers in plants and recommending controls to ensure worker safety in making food ranging from pastries and frozen food to plants using or making flavorings. NIOSH recommended nacho chips and candy may be exposed to the chemicals substituting less hazardous flavoring ingredients as the in food flavorings, and therefore may be at risk for best option for controlling health risks to workers. bronchiolitis obliterans. In addition, workers who use Additional options include local exhaust ventilation or, if diacetyl to produce artificial flavorings are also at risk.
    [Show full text]
  • Occupational Lung Disease Bulletin
    Occupational Lung Disease Bulletin Massachusetts Department of Public Health Winter 2017 The objective of the IARC is to identify hazards that are Dear Healthcare Provider, capable of increasing the incidence or severity of malignant neoplasms. The IARC classifications are not Dr. Neil Jenkins co-wrote this Occupational Lung Disease based on the probability that a carcinogen will cause a Bulletin, during his rotation at MDPH from Harvard School cancer or the dose-response, but rather indicate the of Public Health. He brought expertise in welding from a strength of the evidence that an agent can possibly cause materials science and occupational medicine background, a cancer. as well as involvement in welding oversight with the The IARC classifies the strength of the current evidence American Welding Society. that an agent is a carcinogen as: Remember to report cases of suspected work-related lung Group 1 Carcinogenic to humans disease to us by mail, fax (617) 624-5696 or phone (617) Group 2A Probably carcinogenic to humans 624-5632. The confidential reporting form is available on Group 2B Possibly carcinogenic to humans our website at www.mass.gov/dph/ohsp. Group 3 Not classifiable as to carcinogenicity To receive your Bulletin by e-mail, to provide comments, Group 4 Probably not carcinogenic to humans or to contribute an article to the Bulletin, contact us at [email protected] In 1989, welding fume was classified as Group 2B Elise Pechter MPH, CIH because of "limited evidence in humans" and "inadequate evidence in experimental animals." Since that time, an additional 20 case-control studies and nearly 30 cohort studies have provided evidence of increased risk of lung Welding—impact on occupational health cancer from welding fume exposure, even after Neil Jenkins and Elise Pechter accounting for asbestos and tobacco exposures.3 Studies of experimental animals provide added limited evidence 3 Welding joins metals together into a single piece by for lung carcinogenicity.
    [Show full text]
  • RESPIRATORY TRACT RELATED INFECTIOUS SYNDROMES Acute
    RESPIRATORY TRACT RELATED INFECTIOUS SYNDROMES Acute or Acute on Chronic Bronchitis Antibiotics are NOT RECOMMENDED as >99% of acute bronchitis is caused by viruses. Asthma Exacerbation Supportive care. Antibiotics are NOT RECOMMENDED in the absence of pneumonia. COPD Exacerbation (COPDE) without evidence of pneumonia Per GOLD Guidelines, only the following patients presenting with COPDE may benefit from antibiotics - Increased sputum purulence WITH increased dyspnea or sputum volume - Severe exacerbation requiring invasive or non-invasive (e.g. BIPAP) mechanical ventilation - Pneumonia as indicated by symptoms and imaging findings Common causative pathogens: S. pneumoniae, H. influenzae, M. catarrhalis, viruses Antibiotics, in order of preference Comments Doxycycline 100 mg PO/IV BID x 5 days Has MRSA and atypical activity, some anti-inflammatory effects, may be protective against C. difficile Azithromycin 500 mg PO/IV Q24 x 5 days Has atypical activity Some anti-inflammatory effects Levofloxacin* 750 mg PO/IV Q24 x 3-5 days Increased risk of C. difficile and MRSA Black box warning for tendonitis, especially if >60 years old or concomitant steroids *Routine use levofloxacin is discouraged. Levofloxacin may be considered in patients at high risk of adverse events from COPDE such as those with poor baseline functional status, >3 exacerbations/year, FEV1 <50%. PNEUMONIA Signs/symptoms: cough +/- purulent sputum, shortness of breath, hypoxia/hypoxemia, fever >38⁰C, leukocytosis, wheezing, diminished breath sounds, pleuritic chest pain, rales/rhonchi,
    [Show full text]
  • Community-Acquired Pneumonia ©Adam Spivak/Ambulatory Curriculum 2014
    Community-Acquired Pneumonia ©Adam Spivak/Ambulatory Curriculum 2014 Section 1: Diagnostic criteria of community-acquired pneumonia (CAP) Radiographic finding of new infiltrate plus at least two of: fever; cough; chest pain; dyspnea. To qualify as "community- acquired", patient should not o have been hospitalized in an acute care hospital for >2D in past 90 days o be a nursing home or long-care facility resident o received intravenous antibiotic therapy/chemo/wound care in past 30 days o attended a hospital or hemodialysis clinic. Section 2: Most common etiologic agents of CAP Streptococcus pneumoniae Haemophilus pneumoniae Mycoplasma pneumoniae Chlamydophila pneumoniae Staphylococcus aureus Moraxella catarrhalis Section 3: Common pathogens in specific clinical scenarios Alcoholism Streptococcus pneumoniae and anaerobes COPD / smoking S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Legionella Nursing Home residency S. pneumoniae, gram-negative bacilli, H. influenzae, Staphylococcus aureus, anaerobes, and Chlamydophila pneumoniae Poor dental hygiene Anaerobes HIV infection (early stage) S. pneumoniae, H. influenzae, and Mycobacterium tuberculosis HIV infection (late stage) Above plus P. jiroveci, Cryptococcus, and Histoplasma species Travel to southwestern US Coccidioides species Influenza active in community Influenza, S. pneumoniae, S. aureus, S. pyogenes, and H. influenzae Suspected large volume aspiration Anaerobes (chemical pneumonitis, obstruction) Structural disease of lung Pseudomonas aeruginosa, Burkholderia (Pseudomonas) cepacia, S. aureus Injection drug use S. aureus, anaerobes, M. tuberculosis, and S. pneumoniae Airway obstruction Anaerobes, S. pneumoniae, H. influenzae, and S. aureus Section 4: Risk stratification in CAP management Step 1: If none of below present, outpatient mgmt. Step 2: Use if any positives in Step 1. Admit if score>70 ok Predictors of increased risk 1 pt.
    [Show full text]
  • Airborne Dust WHO/SDE/OEH/99.14 Chapter 1 - Dust: Definitions and Concepts
    Hazard Prevention and Control in the Work Environment: Airborne Dust WHO/SDE/OEH/99.14 Chapter 1 - Dust: Definitions and Concepts Airborne contaminants occur in the gaseous form (gases and vapours) or as aerosols. In scientific terminology, an aerosol is defined as a system of particles suspended in a gaseous medium, usually air in the context of occupational hygiene, is usually air. Aerosols may exist in the form of airborne dusts, sprays, mists, smokes and fumes. In the occupational setting, all these forms may be important because they relate to a wide range of occupational diseases. Airborne dusts are of particular concern because they are well known to be associated with classical widespread occupational lung diseases such as the pneumoconioses, as well as with systemic intoxications such as lead poisoning, especially at higher levels of exposure. But, in the modern era, there is also increasing interest in other dust-related diseases, such as cancer, asthma, allergic alveolitis, and irritation, as well as a whole range of non-respiratory illnesses, which may occur at much lower exposure levels. This document aims to help reduce the risk of these diseases by aiding better control of dust in the work environment. The first and fundamental step in the control of hazards is their recognition. The systematic approach to recognition is described in Chapter 4. But recognition requires a clear understanding of the nature, origin, mechanisms of generation and release and sources of the particles, as well as knowledge on the conditions of exposure and possible associated ill effects. This is essential to establish priorities for action and to select appropriate control strategies.
    [Show full text]
  • Foreign Body Management
    Foreign Body Management NYSGE Fellows Summer Course Susana Gonzalez, MD Assistant Professor of Medicine 1 Objectives • Timing of endoscopy When ? • Anatomic location Where ? • High risk objects What ? • Choosing accessories Which ? • Airway protection Who ? 2 Foreign Bodies in the GI Tract • 1500 people die annually • High risk: – Pediatric age group (80%) – Edentulous adults – Eosinophilic esophagitis – Alcoholics – Prisoners – Psychiatric patients 3 Ingested Foreign Bodies Outcomes: – Pass spontaneously 80-90% – Endoscopy 10-20% – Surgery ~1% Complications: Perforation <1% Mediastinitis Lung abscess Fistula Aspiration Always consider the possibility of more than one foreign body 4 Commonly Ingested Objects Children Adults • Coins • Food impaction* – Meat • Toys/ Magnets – Bones • Crayons – Fibrous husks • Ball point pen – Fish and chicken bones caps • Dentures • Batteries • Sharp Objects 5 Patient Presentation • Symptoms – 92% Dysphagia: location of object – 60% Neck tenderness – Odynophagia: impaction, esophageal tear, spasm – Hypersalivation/inability to tolerate oral secretions – Regurgitation – Abdominal pain • History – Objects swallowed – Timing of object swallowed 6 Patient Presentation • Physical examination: – Mental Status – Respiratory status • Airway compromise – Subcutaneous emphysema • esophageal perforation – Drooling • complete esophageal obstruction – Peritoneal signs • gastrointestinal perforation 7 Patient Presentation • Radiologic imaging – Location of object – Subcutaneous air – Pneumomediastinum – Pleural effusion
    [Show full text]
  • Occupational Chemical Respiratory Exposures & Asthma
    Occupationally Related Asthma, Bronchitis or Respiratory Hypersensitivity Reaction (Occupationally related respiratory conditions due to inhalation of chemicals, gases, fumes, and vapors; Occupationally Related Asthma) Other Names/Conditions: Work-related chemical pneumonitis, chemical bronchitis, or toxic pneumonitis. Work-related asthma, work-aggravated asthma, and reactive airways dysfunction syndrome are conditions that will also be described in this reference. Responsibilities: Hospital: Report by phone, fax, or mail Lab: Report by phone, fax, or mail Physician/Health care providers: Report by phone, fax, or mail Medical Examiners: Report by phone, fax, or mail Poison Control Centers: Report by phone, fax, or mail Occupational Nurses: Report by phone, fax, or mail Local Public Health Agency (LPHA): No follow-up required, unless outbreak occurrence Report to the IDPH Bureau of Environmental Health Services: Iowa Department of Public Health Bureau of Environmental Health Services Lucas State Office Building 321 E. 12th Street Des Moines, Iowa 50319-0075 Phone (Mon-Fri 8 am - 4:30 pm): 800-972-2026 Fax: 515-281-4529 24-hour Disease Reporting Hotline: (For use outside of EHS office hours) 800-362-2736 Web: https://idph.iowa.gov/ehs/reportable-diseases Report Form: Environmental & Occupational Report Form on web Note: This revised document reflects provisional language in reference to the current Iowa Administrative Code [641] Chapter 1: “Occupationally related asthma, bronchitis or respiratory hypersensitivity reaction” means any extrinsic asthma or acute chemical pneumonitis due to exposure to toxic agents in the workplace. (ICD-10 codes J67.0 to J67.9).” The diagnostic coding currently listed is inappropriate for the narrative of the condition described.
    [Show full text]
  • Chemical Pneumonia Due to Paint Thinner Ingestion: a Case Report and Literature Review
    EURASIAN JOURNAL OF EMERGENCY MEDICINE DO I: 10.4274/eajem.galenos.2018.24482 Case Report Eurasian J Emerg Med. 2019;18(1): 55-7 Chemical Pneumonia Due to Paint Thinner Ingestion: A Case Report and Literature Review Mehmet Koçak1, Kurtuluş Açıksarı2 1Clinic of Emergency Medicine, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey 2Department of Emergency Medicine, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey Abstract Paint thinner is an organic solvent which includes aromatic hydrocarbons and is widely used in the paint, varnish, and plastic products industries. Regular inhalation of such solvents is known to cause chronic intoxication. Oral thinner over-exposure is rare but quite fatal. Volatile liquids can cause pulmonary complications even with oral ingestion. Therefore, in patients with oral volatile liquid thinner intake, emergency physicians should be aware of local complications as well as the systematic effect even with initial normal physical or radiological findings. In this report, we present a patient with chemical pneumonia due to self-vomiting after accidentally drinking paint thinner. Keywords: Chemical pneumonitis, thinner, hydrocarbons, ingestion Introduction admitted to our hospital with complaint of fever with the history of paint thinner ingestion. Exposure to hydrocarbons is common in modern society. Thinner is an organic solvent that contains aromatic hydrocarbons such Case Report as toluene and xylene and is easily accessible in products such as gasoline, paint, varnish, and plastic production industries. A 54-year-old male patient presented to the emergency Types of exposure include unintentional ingestion, intentional department (ED) with fever. He had drunk half bottle of paint recreational abuse, unintentional inhalation, and dermal thinner (approximately 100 mL) accidentally 9 hours before exposure or oral ingestion in a suicide attempt.
    [Show full text]
  • Vaping Induced Pathological Changes in the Lung Comparing with Imaging Finding-A Case Report Study
    Bhuyan RR, et al., J Clin Stud Med Case Rep 2020, 7: 092 DOI: 10.24966/CSMC-8801/100092 HSOA Journal of Clinical Studies and Medical Case Reports Case Study and Prevention (CDC) website posted on January 20, 2020 [1]. 27 Vaping Induced Pathological confirmed death cases have been reported due to severe and acute pulmonary disease associated with e-cigarettes in all 50 states, the Changes in the Lung Comparing District of Columbia, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands) [1]. with Imaging Finding-A Case Although chemical exposure has been postulated as a definitive cause, the acute incidence of pulmonary disease has brought national Report Study attention to this epidemic and warrants more studies of clinical course, radiological findings and unique pathological changes in the Rashmi R Bhuyan*, Kumkum Vadehra and Ningdong Kang lungs, that will help in immediate medical management for VAPI with appropriate support, as reported in the case below [2]. Department of Pathology and Department of Surgery, Harbor-UCLA Medical Center, California, USA Case Report A 30 year old female with history of anxiety, depression and marijuana use presented in the ED with dyspnea and hypoxic respiratory Abstract failure with presumed How did the author know if it is ‘presumed Vaping Associated Pulmonary Injury (VAPI) is a group of respi- etiology’? etiology of inhalation of injury vs hypersensitivity ratory symptoms like shortness of breath and tachypnea and, often- pneumonia. CT chest showed diffuse bilateral ground-glass changes times, it is associated with non-specific symptoms like generalized with differential diagnosis of multifocal pneumonia vs interstitial fatigue, body ache, fever, nausea, diarrhea, vomiting and chills.
    [Show full text]