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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
Malnutrition is a concern for anybody admitted to hospital for a prolonged period (see page 7). In addition, dysphagia is common after stroke (affecting 40–80%) but most people will recover over the next six months.6 The normal swallowing process and treatment methods are discussed on page 25. Swallow screening is an important part of the initial stroke assessment. If unsafe then initial intravenous fluids are appropriate. Insertion of a nasogastric tube should be considered within the first 24 hours.6 Specialist SLT assessment should be performed, sometimes including videofluoroscopy or fibre-optic endoscopy. Compensatory strategies (e.g. chin tuck), modified diet and fluids may be appropriate.
Airway Surgery
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Establish whether the child suffers from sleep apnoea. This will not have been cured by the tonsillectomy. Consider the use of atropine and an antiemetic. Intravenous access prior to induction is essential. The nasogastric tube is aspirated and removed. There are two choices of induction technique. Inhalational with halothane or sevoflurane and O2 in the lateral position with head down tilt and wide bore suction. Intubation is performed when sufficient depth of anaesthesia is achieved. However, deep volatile anaesthesia causes hypotension. Attempts to intubate the trachea too soon will cause coughing and laryngospasm.Conventional rapid sequence induction, although the dose of induction agent required is likely to be reduced.
Acute Esophageal Necrosis in Prader–Willi Syndrome
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Danuel V. Laan, Betty Allen, John Agzarian, Phillip G. Rowse, Shanda H. Blackmon
Pillars of nonoperative management of AEN include prompt resuscitation to correct hypoperfusion or low flow state, nil per os to avoid esophageal perforation, intravenous proton pump inhibitor or histamine receptor blocker to neutralize mucosal barrier injury, and correction of any underlying critical illness [2]. Nasogastric tube insertion should be avoided due to the risk of perforation. Empiric broad-spectrum antibiotics are appropriate in the setting of underlying sepsis, immunocompromise, rapid deterioration, or suspected perforation. A review of AEN by Gurvits et al. estimated that one-third of patients with AEN expire; however, the majority of deaths are related to an underlying critical illness. The rate of esophageal perforation in AEN approaches 7% and is the primary reason for AEN-specific mortality [4].
“All in One: Fear, Happiness, Faith” A Qualitative Study on Experiences and Needs of Turkish Mothers of Infants with Congenital Heart Disease
Published in Comprehensive Child and Adolescent Nursing, 2023
Ayşe Ay, Sevil Çınar Özbay, Handan Boztepe, Eda Gürlen
The experiences of mothers showed variability according to whether the infant was in the preoperative period or underwent the first or repetitive surgery. For example, during the preoperative period, the information regarding the surgery was their primary need; however, the primary need of mothers whose infants underwent the first and repetitive surgery was their care needs. Today, I asked many times to doctors if the blood test results were available, but I could not get the information. There is no the flow of information about the examination and treatment process (M8, mother of an infant in the preoperative period).I cannot get much help from nurses while washing my baby. For example, they asked me to hold the child, I was worried about his surgical sutures. We gave him a bath on the first day after the surgery, and no one stayed with me while dressing him. I’m so scared to hurt her sutures (M10, mother of an infant who underwent surgery for the first time).I need to get support about nutrition; which formula to feed? How much to feed my baby? How to care nasogastric tube? I want them to show me these in practice. (M9, mother of an infant who had repetitive surgery).
Nutrient infusion evoked magnetic resonance imaging signal in the human hypothalamus
Published in Nutritional Neuroscience, 2022
Yuko Nakamura, Mariko Takahashi, Yukiko Inoue, Shintaro Yanagimoto, Kazuo Okanoya, Shinsuke Koike
All participants underwent four fMRI sessions to assess brain responses to each of the four infused solutions. Each fMRI session was performed on a different day and the order of the infusion of solutions was randomized for each participant. Four fMRI sessions were performed within 35.6 ± 24.9 days (range 6–99 days). On the session day, a participant was instructed to abstain from any food or drink except for water for more than 5 h and from water for 1 hour before the arrival. After a participant arrived at our laboratory, a physician interviewed the participant to assess whether the participant could undertake a nasogastric tube placement. If the participant was qualified for the nasogastric tube placement, the experimenter (Y.N.) placed a nasogastric tube on a participant with surface anesthetic cream (lidocaine). Following the nasogastric tube placement, an x-ray examination was performed to confirm the end of the nasogastric tube was in the corpus ventriculi. Next, a participant was escorted to the MRI scanner room to undergo a 30-min fMRI scan (Figure 2).
Bronchoscopy during the COVID-19 pandemic: effect on current practices and strategies to reduce procedure-associated transmission
Published in Expert Review of Respiratory Medicine, 2021
Fotios Sampsonas, Loukas Kakoullis, Theodoros Karampitsakos, Ourania Papaioannou, Matthaios Katsaras, Eleni Papachristodoulou, George Kyriakou, Aggeliki Bellou, Argyrios Tzouvelekis
Bronchoscopy and its related procedures like Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and BAL, pose a great risk for viral spread since they are considered as aerosol generating procedures (AGP) [10]. This is already known from previous studies in the 90’s which have clearly demonstrated that performing bronchoscopy in patients with underlying Tuberculosis poses a great risk for tuberculosis infection of the HCP, if PPE is inadequate [11] Theoretically, these procedures can produce a significant number of droplets, therefore can be very contagious for other patients and HCP [12]. Therefore, most recent guidelines advocate the use of smaller BAL fluid instillation when applicable [13]. An older metanalysis regarding the risk of transmission of acute respiratory pathogens during AGP concluded that bronchoscopy had a lower risk of viral transmission compared to other common AGP such as intubation (OR 1.9 and 6.6, respectively) that did not even reach statistical significance [14]. This risk was even lower from the risk of Noninvasive Ventilation (NIV) application and comparable to that of nasogastric tube placement [14]. On the contrary, during the previous SARS-COV-1 pandemic experience, tracheostomy was associated with a 4.2 increase in the risk of transmission [15], but with appropriate PPE and reorganization, the risk is grossly alleviated [16]. Nonetheless, a most recent analogous study has categorized bronchoscopy as a highly contagious procedure [17].