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Recognition, treatment, and prevention of systemic allergic reactions and anaphylaxis *
Published in Richard F. Lockey, Dennis K. Ledford, Allergens and Allergen Immunotherapy, 2020
Emma Westermann-Clark, Stephen F. Kemp, Richard D. deShazo
The rate of administered oxygen depends on the clinical response and the device used. A nasal cannula delivers 25%–40% oxygen with a 4–6 L/min flow. A simple plastic face mask delivers 50%–60% oxygen with an 8–12 L/min flow. By comparison, the one-way valve facemask with oxygen inlet valve (see earlier) permits ventilation with up to 50% oxygen at a flow rate of 10 L/min and approaches 90%–100% if the rescuer periodically occludes the opening of the mask with his or her tongue during mouth-to-mask ventilation.
Infection Control
Published in Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam, Clinical Atlas of Polysomnography, 2018
Ravi Gupta, S. R. Pandi Perumal, Ahmed S. BaHammam
The other common sources of infection include the nasal cannula, mask of PAP, and hosepipe of the PAP machine. It is essential that the nasal cannula is changed after every sleep study. Since the mask and the hosepipe are expensive items and cannot be discarded so often, they should be sent for autoclaving after each use. Mask straps can also transmit infection as they are applied directly to the patient’s skin/ hair. They should also be washed after each use.
Hypoxemia
Published in Lauren A. Plante, Expecting Trouble, 2018
When hypoxemia is confirmed, the initial therapeutic approach is to administer supplemental oxygen. Because the A–a gradient is widened when a pregnant woman is in a supine position, she should be moved to a sitting or semirecumbent position. Oxygen can be administered via a nasal cannula or via a face mask. At a flow rate of 10 L/min, a nasal cannula delivers about 3 percentage points (above room air FIO2 of 21% or 0.21) per liter per minute flow rate. For example, a flow rate of 1 L/min would produce an FIO2 of approximately 0.24, and a flow rate of 5 L/min, about 0.36. (This varies some depending on the size of the patient’s nasal cavity, since there is no other reservoir, and upon the respiratory demand, since higher demand entrains more room air.) A promising new development is the use of high-flow oxygen through a specialized system of nasal prongs (Optiflow™, Fisher & Paykel Healthcare), although as yet, there are no reports in pregnancy. Face masks can be fitted with a Venturi adapter, which can deliver different FIO2 between about 0.24 and 0.60, depending on the oxygen flow rate and the size of the entrainment port. Finally, a nonrebreather mask can deliver FIO2 between 0.60 and 0.90, depending on flow rates; these have both a reservoir bag inflated with oxygen and a series of one-way valves that prevent the entrainment of room air into the mask.
SARS-CoV-2 RT-qPCR Ct values in saliva and nasopharyngeal swab samples for disease severity prediction
Published in Journal of Oral Microbiology, 2023
Kristina Snipaitiene, Birute Zablockiene, Rasa Sabaliauskaite, Kristina Zukauskaite, Elzbieta Matulyte, Tautvile Smalinskaite, Mindaugas Paulauskas, Rolandas Zablockis, Mantvydas Lopeta, Julius Gagilas, Alina Puriene, Ligita Jancoriene, Sonata Jarmalaite
Demographic and clinical characteristics of patients according to the disease severity (Cohort I vs. Cohort II) are presented in Tables 1 and 2. The mean age was 56.7 ± 13.2 years (range: 25–90 years), 52.0% were male. Cohort II patients were significantly older (mean: 61.6 vs. 51.2 years, P < 0.001), had higher National Early Warning (NEW) score on admission (median: 3 vs. 1, P < 0.001) and bigger Charlson comorbidity index (median: 2 vs. 1, P < 0.001). Treatment with dexamethasone (20 vs. 8 patients, P = 0.020); dexamethasone and remdesivir combination (28 vs. 12 patients, P=0.043) or antibacterial treatment (47 vs. 22 patients, P < 0.001) was applied more often for Cohort II patients as well. Three Cohort II patients were treated with a high flow nasal cannula, one patient needed intubation and invasive mechanical ventilation and three patients died. More patients in Cohort I were included in study with a disease duration ≤10 days, while more patients in Cohort II were included in the study with a disease duration >10 days (P = 0.001). The median duration from symptoms onset to tests was significantly longer in Cohort II group compared to Cohort I (first sample median: 11 vs. 8 days, P = 0.003).
Multisystem effects of COVID-19: a concise review for practitioners
Published in Postgraduate Medicine, 2021
Gabrielle White-Dzuro, Lauren E. Gibson, Luca Zazzeron, Colin White-Dzuro, Zachary Sullivan, Daren A. Diiorio, Sarah A. Low, Marvin G. Chang, Edward A. Bittner
There has been significant debate regarding the optimal form of respiratory support for non-intubated patients with increasing oxygen requirements and dyspnea. Early intubation has been encouraged to reduce the risk of virus aerosolization and self-induced lung injury. However, early intubation may result in unnecessary intubation of patients who would have otherwise improved with less invasive support [14]. Other strategies that may improve ventilation in these patients include prone positioning and nitric oxide, which is being tested both as an antiviral agent and for its benefits as a pulmonary vasodilator. While prone positioning in awake spontaneously breathing patients is generally well tolerated and has been shown to improve oxygenation and reduce respiratory rate, the effects on clinical outcomes is unclear [15]. The use of noninvasive ventilation and high flow nasal cannula in COVID-19 patients is controversial given the potential risk for aerosolization and exposure to health care workers, and can be minimized when delivered in a negative pressure environment. In-hospital airway management is challenging and we have previously described a practical, stepwise protocol for safe in-hospital airway management in COVID-19 patients [16].
Updated recommendations for resumption of sleep clinic and laboratory testing
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Najib T. Ayas, Refika Ersu, Kristin L. Fraser, Eleni Giannouli, Patrick J. Hanly, Tetyana Kendzerska, Sherri Katz, Brandy Lachmann, Annie Lajoie, Caroline Minville, Debra Morrison, Indra Narang, Marcus Povitz, Robert Skomro, Kathy Spurr
Prior to HSAT, patients should be screened for COVID-19 within 72 hours of the scheduled test. The type of screening should be consistent with practices according to local/provincial infection control. At a minimum, this should include screening based on a questionnaire, but could also include COVID-19 testing and/or temperature check. Patients who screen positive for COVID-19 should not undergo sleep study testing.Home testing should preferably be performed with fully disposable equipment. However, if this is not feasible, then proper cleaning of the nondisposable components (e.g., monitor) should be instituted according to local/provincial infection control guidelines. Appropriate PPE should be used for all staff (e.g., surgical mask) during patient contact and cleaning of equipment. Nasal cannulas should have a manufacturer-approved filter. There is currently a minimal amount of data regarding if/how long the virus may survive within the devices (which might not be easily cleaned). Timing and handling of the reuse of nondisposable components of the devices should be directed by infection control and consultation with the manufacturers.