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Chest
Published in Henry J. Woodford, Essential Geriatrics, 2022
Exacerbations of COPD lead to disease progression. Recovery can be slow or incomplete. They are most commonly triggered by viral infections. Management includes short-acting bronchodilators. Nebulisers can be easier to use in sicker people than inhalers but there is little evidence of increased efficacy. Systemic corticosteroids are given for five to seven days. Antibiotics should be considered, for example, when there is increased sputum volume or purulent sputum (rather than white or colourless). Antibiotic courses typically last five to seven days. A target blood oxygen saturation of 88–92% is appropriate for people with COPD. Non-invasive ventilation may be required in severe exacerbations. Suitable people typically have rising CO2 on blood gas analysis and develop acidosis despite other therapies. It can remove the need for intubation and reduce both mortality and length of stay. When used in older adults it appears to be similarly tolerated and similarly beneficial compared to its use in younger adults.57
Specific Emergency Conditions in Forced Displacement Settings
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Natalie Roberts, Halfdan Holger Knudsen, Alvin Sornum, Taha Al-Taei, Barbara Scoralick Villela, Maryam Omar, Faith Traeh, Abdulkarim Ekzayez, Clare Shortall, Eric Weerts
Non-invasive ventilation methods should be considered early in patients with falling oxygen saturations. Invasive ventilation may be more appropriate if patients are uncooperative, are less alert or are developing severe respiratory distress. In primary care facilities where these are not readily available, transfer time to secondary or tertiary care facilities should be anticipated.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Pain reduces the patient’s tidal volume, leading to inadequate ventilation of the basal segments, resulting in atelectasis. Pain also inhibits coughing, allowing secretions to obstruct bronchi and cause acute respiratory failure. Effective pain relief is therefore essential and may include the application of intercostal nerve or paravertebral blockade (see later), although these techniques are most appropriately performed in a hospital setting. Even a small flail may be a devastating injury in the frail elderly patient. Splinting is not an effective management as this will reduce respiratory movement and exacerbate the ventilatory compromise. Operative fixation of rib fractures is occasionally indicated, but its place in management has not been definitively established. In severe cases the patient will require intubation and mechanical ventilation. The use of non-invasive ventilation may also be considered.
Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study
Published in Journal of Asthma, 2023
J. L. Robinson, K. L. Gatford, C. P. Hurst, V. L. Clifton, J. L. Morrison, M. J. Stark
We analyzed the following neonatal outcomes: fetal sex, plurality (single, twin, ≥3 babies), gestational age, mode of delivery, any resuscitation or for respiratory support (aspiration, facial O2, ventilation), birth weight, LBW (<2500 g), SGA, large for gestational age (LGA), intrauterine growth restriction (IUGR), NICU or special care baby unit (SCBU) admission, RDS, TTN, congenital malformations, and perinatal death. Gestational age was treated as a categorical variable (<28, 28 to <32, 32 to <34, 34 to <37, >37 weeks). Preterm birth was defined as <37 weeks and very preterm birth as ≤32 weeks’ gestation at delivery. SGA was defined as below the 10th centile of birth weight and IUGR as below the 3rd centile of birth weight. Birth weight centiles were calculated using the UK Perinatal Institute’s Customized Centile Calculator (GROW v8.0.6.1, 2020. Gestation Network) based on maternal height, maternal weight, ethnicity, parity, neonatal sex, gestation and birth weight. Perinatal death was defined as either stillbirth (mortality after 20 weeks’ gestation) or neonatal death (mortality within the first 28 days after delivery). Resuscitation by ventilation included intermittent positive pressure ventilation with a bag and mask, Neopuff, or intubation. Invasive ventilation was defined as intermittent mechanical ventilation or high frequency oscillating ventilation. Noninvasive ventilation was defined as continuous positive airway pressure (CPAP) ventilation or nasal high flow ventilation.
Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey
Published in International Journal of Speech-Language Pathology, 2023
Sarah Rowland, Claire Mills, Margaret Walshe
Use of communication screening by nurses or other professionals across four different conditions was explored. A similar percentage of SLPs working in Ireland reported the use of communication screening tools for both patients on non-invasive ventilation (15.38%, 8/52) and intubated patients (17.31%, 9/52) in their CC units as in other international countries (15.13%, 36/238), (18.14%, 43/237). A further similarity was seen in the use of communication screening tools patients with tracheostomy (23.08%, 12/52) in Irish CC units and in other countries (21.01%, 50/238). Overall, a lower percentage of SLPs working in Ireland (7.69%, 4/52) reported the use of communication screening tools for all patients in their CC unit compared with other international SLP respondents (14.04%, 33/235).
Reduced risk of death in people with SARS-CoV-2 infection treated with remdesivir: a nested case–control study
Published in Current Medical Research and Opinion, 2022
Andrea De Vito, Mariacristina Poliseno, Agnese Colpani, Beatrice Zauli, Mariangela Valentina Puci, Teresa Santantonio, Maria Chiara Meloni, Marco Fois, Chiara Fanelli, Laura Saderi, Alessandro Fois, Vito Fiore, Giovanni Sotgiu, Sergio Babudieri, Sergio Lo Caputo, Giordano Madeddu
According to national and international guidelines, patients were treated with remdesivir, dexamethasone and low molecular weight heparin (LMWH) adjusted by body weight, kidney failure and HAS-BLED score. Treatment was started only in symptomatic patients. Treatment prescription was tailored on clinical presentation based on international and national guidelines30,31 and modified depending on clinical presentation and drug–drug interactions. According to Agenzia italiana del farmaco (AIFA) inclusion criteria for remdesivir prescriptions were: (i) having symptoms less than 10 days, (ii) having evidence of SARS-CoV-2 related pneumonia; (iii) needing oxygen therapy. Exclusion criteria were: (i) needing high-flow therapy, non-invasive ventilation; (ii) needing invasive ventilation; (iii) having an estimated glomerular filtration rate <30 mL/min/1.73 m2; (iv) having five-fold incremented alanine transaminase; (v) weight <40 Kg.