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Diagnosis and Treatment of Inhalation Injury in Burn Patients
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Khan Z. Shirani, Joseph A. Moylan, Basil A. Pruitt
The mainstay of the therapy of inhalation injury is the support of ventilation, although not all patients require this prescription. A vast majority of patients sustain minimal to moderate airway damage and can be managed by general supportive measures that reduce laryngeal edema formation and by vigilant observation to detect early signs of pulmonary insufficiency that require prompt intervention. Prophylactic intubation of patients with inhalation injury of the upper airway has been advocated (Venus et al., 1981) to avoid possible complications of upper airway obstruction, but we believe that an otherwise unimpaired patient, even with hoarseness of voice due to nonobstructing laryngeal edema, may be safely observed. In these individuals, nebulization of 0.5% racemic epinephrine or neosynephrine every 4 hr appears to be beneficial in reducing vocal cord edema and preventing the development of complete airway obstruction. Another frequently used effective measure that optimizes lymphatic drainage of the head and neck region is the nursing of a hemodynamically stable patient in a head propped-up position.
Neonatal and pediatric inhalation drug delivery
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Many pediatric conditions are treated with inhaled medications. Albuterol, ipratropium bromide, and inhaled corticosteroids are used for the treatment of asthma (19). Hypertonic saline is used in cystic fibrosis, and in bronchiolitis (20,21). Antibiotics are used in cystic fibrosis, in tracheostomized patients experiencing tracheitis, and in intubated patients suffering pneumonia (20,22). Dornase alfa is used in cystic fibrosis patients, but also off label for the treatment of atelectasis (20,23). Vasodilators are used in the treatment of pulmonary hypertension (17). Racemic epinephrine and budesonide are used in croup (24,25).
Acute Laryngeal Infections
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The administration of epinephrine does not alter the natural history of the disease but it may postpone or eliminate the need for an artificial airway, or give symptomatic relief until effective treatment can be given.13 It can be administered at the same time as glucocorticoids.10,13 In a recent systematic review evidence did not favour racemic epinephrine versus L-epinephrine or epinephrine delivered by intermittent positive pressure breathing (IPPB) over simple nebulization.13
History of asthma in Canada
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Chronic asthma pharmacologic management was limited and included treatments such as potassium iodide39,40,42 and arsenic.39 Ephedrine, orally administered, was studied in Canada in the mid-1920s45,46 and by the 1940s was available either alone or in combination with a barbiturate for chronic use.43 Throughout this period, asthma burning powders and asthma cigarettes containing anti-muscarinic belladonna alkaloids, mainly from Datura stramonium, were widely used but received only passing mention in the academic literature.40,41 Kellogg’s asthma burning powder and cigarettes, one of the more popular brands, were made in Canada (Figure 1). By the 1940s, hand-held glass nebulizers were in use for ambulatory administration of racemic epinephrine.41
Acute epiglottitis due to Pasteurella multocida after contact with a feral cat
Published in Baylor University Medical Center Proceedings, 2019
Lauren Sisco, Lizbeth Cahuayme-Zuniga
On arrival the patient appeared acutely ill. He was febrile and dyspneic with a muffled voice. His temperature was 101.1°F; heart rate, 113 beats per minute; blood pressure, 180/115 mm Hg; and respiratory rate, 25 breaths per minute. Scratches and erythema were visible on both hands and forearms. The skin over the neck and chest was flushed. Cervical lymphadenopathy was present. Lung auscultation revealed rhonchi in the left lower lobe. He had no stridor but developed worsening shortness of breath and difficulty swallowing. Racemic epinephrine and dexamethasone were administered due to concern for airway edema, but his respiratory distress progressed. Laryngoscopy was then performed. This revealed an erythematous and edematous epiglottis with leftward deviation, edema, and erythema of the supraglottic tissues with purulent drainage in the oropharynx. Endotracheal intubation was unsuccessful due to severe oropharyngeal edema. An emergent cricothyrotomy was performed.
Therapeutic strategies for pediatric bronchiolitis
Published in Expert Review of Respiratory Medicine, 2019
Numerous studies, as summarized in meta-analyses and systematic reviews, have proved the ineffectiveness of beta-agonists, anticholinergics, antibiotics, and inhaled corticosteroids in infants with bronchiolitis. However, age limits and clinical definitions of bronchiolitis differ substantially between different studies, which makes the comparisons of the results and their appropriate incorporations in the meta-analyses difficult. An RCT study from Norway suggested that there probably are some bronchiolitis patients, who may benefit from well-timed, on-demand inhalations of racemic epinephrine. In two RCT studies from Qatar and the United States, the effect of systemic corticosteroids was marginal and repeated doses were needed, which means a risk of adrenal suppression. Based on recent meta-analyses, inhalations of hypertonic saline do not shorten the LOS in hospital, but such inhalations may decrease the hospitalization rates when given more than three times in the emergency department. In two large, prospective, well-designed RCT studies from Australia and New Zealand, HFOT with warmed and humidified air-oxygen mixture was more effective than the standard low-flow oxygenation in infants with bronchiolitis. However, HFOT did not shorten the duration of oxygen supplementation or the LOS in hospital. In addition, two-thirds of infants, who were hospitalized for bronchiolitis and who needed oxygen supplementation, could be treated with standard low-flow oxygen administration, and over half of those who failed with standard oxygen therapy could be rescued with HFOT on the pediatric ward. Currently, HFOT is the only new and promising approach for the treatment of infants with bronchiolitis.