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Frontline Consideration for Paediatric Emergency and Trauma Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Respiratory rate should be compared to age-appropriate norms. Tachypnoea – more than 60 breaths per minute – is always abnormal. A respiratory rate which falls towards the expected normal is reassuring only if the patient’s clinical appearance is also improving – bradypnea is often indicative of impending respiratory arrest.
Etiology of Neonatal Respiratory Distress Syndrome and the Assessment of Lung Maturity
Published in Jacques R. Bourbon, Pulmonary Surfactant: Biochemical, Functional, Regulatory, and Clinical Concepts, 2019
Michel Dehan, Jeanne Francoual, Marie Claire Imbert, Benoit Denizot
Any RD is accompanied, at the beginning, by an acceleration of the respiratory rate (over 50 breaths per minute). This tachypnea may be extremely fast (over 100 breaths per minute). However, an exhausted infant or an infant with tracheal-bronchial obstruction may present bradypnea (below 20 breaths per minute).
Nursing care of the cardiac catheterisation patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Julie Parkinson, Jo-Anne M. Vidal, Eva Kline-Rogers
If procedural sedation is used, nurses should continuously monitor pulmonary ventilation and oxygen using pulse oximetry, combined with clinical observation of respiration to detect hypopneic hypoventilation, bradypnea, apnea or partial airway obstruction.1 Furthermore, adequacy of ventilation and oxygenation should be recorded at least every 10 minutes, with any indication of respiratory compromise promptly reported to the proceduralist and corrective interventions implemented immediately. End-tidal carbon dioxide monitoring (capnography) and respiratory rate monitoring are better indicators of respiration than SpO2 monitoring, especially in the CCL environment where the patient is almost completely covered in sterile drapes and direct visual assessment of ventilation is difficult. Capnography should be used for all patients at higher risk of impaired respiratory function, including patients with COPD, STEMI, haemodynamically unstable patients, and patients requiring higher doses of procedural sedation or any anaesthesia-supported procedure.
Recent advances in the opioid mu receptor based pharmacotherapy for rheumatoid arthritis
Published in Expert Opinion on Pharmacotherapy, 2020
Eleftherios Pelechas, Paraskevi V Voulgari, Alexandros A Drosos
Opioid misuse is the leading cause of fatal opioid overdoses [87]. Bradypnea, hypoxemia and decreased cardiac output are the main consequences. When opioids are combined with ethanol, benzodiazepines, or barbiturates, a potential opioid overdose may occur. Overdose, if diagnosed on time, may be reversed rapidly by the administration of opioid antagonists such as naloxone. In addition, breastfeeding mothers should avoid using codeine, which is a pro-drug of morphine, because infants are rapid metabolisers [88]. On the other hand, a big portion of patients with RA are elderly with renal impairment or being under treatment with selective serotonin reuptake inhibitors (SSRIs) among other medicines. In these patients, morphine could become toxic in renal impairment while tramadol in combination with SSRIs may develop seizures [89].
Cannabis intoxication after accidental ingestion in infants: urine and plasma concentrations of Δ-9-tetrahydrocannabinol (THC), THC-COOH and 11-OH-THC in 10 patients
Published in Clinical Toxicology, 2020
Charles Guidet, Matthieu Gregoire, Alexiane Le Dreau, Benedicte Vrignaud, Guillaume Deslandes, Catherine Monteil-Ganière
Ten cases of accidental cannabis poisoning were included in this study. The infants were aged from 8 to 20 months (eight females and two males). All cases occurred during autumn and winter: two between November 2016 and January 2017, three between September and November 2017 and five between October and December 2018. The cause of intoxication was ingestion hashish for eight infants, and unknown for the other 2. Clinical data and concentrations of cannabinoids are presented in Table 1. Concentrations of plasma THC, THC-COOH, 11-OH-THC and urine THC-COOH ranged from 4.4 to 127 ng/mL, 28 to 433 ng/mL, 2 to 59.8 ng/mL and 748.2 to 5689 ng/mL, respectively. Immunochemical and GUS analyses showed no co-intoxication. Clinical symptoms were cardiovascular and respiratory (tachycardia, 6/10; bradypnea, 5/10; hypotension, 1/10) and neurologic (drowsiness, 7/10; hypotonia, 6/10; behavioural disorders, 6/10; seizures, 2/10). The Glasgow coma scale (GCS) was established for 5 infants. Management consisted of monitoring and rehydration, except for the two infants who experienced seizures; they received Diazepam®. Hospital discharge was effective for all patients after 48 h except 1 at 72 h.
A cluster of 25B-NBOH poisonings following exposure to powder sold as lysergic acid diethylamide (LSD)
Published in Clinical Toxicology, 2022
Sean T. Ivory, Joe-Anthony Rotella, Jennifer Schumann, Shaun L. Greene
The second case involved a 22-year-old male who insufflated the powder, which he later recalled as causing hallucinations and distorted reality. He subsequently lost consciousness and developed uncontrolled limb movements. Paramedics noted generalised tonic-clonic seizure activity which lasted 20–25 min (consistent with status epilepticus) despite IM midazolam 15 mg and intravenous midazolam 10 mg. Progressive bradypnea, difficulty with effective bag-valve-mask ventilation and hypoxia (pulse oximetry oxygen saturation of 82%) prompted intubation with induction and neuromuscular paralysis using intravenous ketamine (150 mg) and rocuronium (100 mg). Post-intubation sedation consisted of morphine and midazolam. He was noted to be hypertensive (systolic blood pressure 165–177 mmHg), tachycardic, and afebrile with dilated pupils. Blood glucose concentration was 11.2 mmol/L. Laboratory results indicated an acute kidney injury (creatinine 133 umol/L, eGFR 65 mL/min/1.73 m2) with urine output of 1.8 mL/kg/hour during the first six hours post presentation, and a creatinine kinase of 2221 IU/L (Kidney Disease Improving Global Outcomes stage 1). Computerised tomography of the brain was unremarkable. The patient was admitted to ICU, with continued sedation using propofol and fentanyl. There was no clinical evidence of further seizures, and he was extubated the following day. Renal function improved 36 h post presentation (creatinine 102 umol/L, eGFR 89 mL/min/1.73 m2 after peaking at 157 umol/L) and creatinine kinase peaked at 3484 IU/L. He made a full recovery and was discharged home 60 h post-hospital presentation. Analysis of blood obtained within 2 h of powder insufflation detected 25B-NBOH and no other illicit or licit drugs other than therapeutically administered drugs.