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Medical Management of Chemical Warfare Agents
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
There are common acronyms that are used in discussion of this syndrome. Muscarinic receptors cause leaking symptoms of “SLUDGE”: S (salivation, sweating, airway secretions), Lacrimation, Urination, Defecation, Gastrointestinal (upset), and Emesis. Nicotinic symptoms are the weekdays “MTWHF”: Miosis, Tachycardia, Weakness, H (hypertension, hyperglycemia), and Fasciculations. In addition, there is a progressive spectrum of central nervous system “C’s: Confusion to Convulsions to Coma. As the syndrome progresses, there can at first be excitatory symptoms of tachypnea and tachycardia, then bradypnea and bradycardia, as weakness, then flaccid paralysis and resulting hypoxemia, develops. Bronchospasm and bronchorrhea can also be a feature. (Another acronym, DUMBBELS with the letter Bs, includes these.)
Thorax
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Are the following statements true or false? Broncho-alveolar carcinoma: typically occurs peripherally.may cause the computed tomography (CT) angiogram sign.occurs most commonly in a multicentric form.is negative on fluorodeoxyglucose positron emission tomography (FDG PET) in more than 50% of cases.can present with bronchorrhea.
Bronchiectasis
Published in Louis-Philippe Boulet, Applied Respiratory Pathophysiology, 2017
Pulmonary function of patients with bronchiectasis declines more rapidly with time than in normal subjects and we often observe the development of an obstructive syndrome of variable magnitude [63]. In regard to the clinical outcomes, there are four principal patterns [64]: Rapidly progressive bronchiectasis: In general, these patients present with a rapid progression of the bronchiectasis with a development of bilateral cystic changes. These patients are usually young and have a marked bronchorrhea with systemic involvement.Slowly progressive bronchiectasis: These patients have a slow progression of bronchiectasis over many decades with an increase in the frequency of exacerbations and an increasing volume of phlegm produced over time.Indolent disease: Bronchiectasis often located in the right middle lobe, often asymptomatic and showing no progressive deterioration of the condition. This is probably a sequela of previous problem for which there is no residual inflammatory process.Hemoptysis: Some patients have hemoptysis of variable quantities of blood as a main manifestation of their disease. This can require an intervention such as bronchial arterial embolization, and episodes of hemoptysis can be triggered by an underlying infection.
Mistaken identity: acute respiratory arrest from accidental ingestion of poison hemlock
Published in Clinical Toxicology, 2022
Kai Li, Hillary Bassett, Briana Fitch, Kara Lynch
Poison Hemlock (Conium maculatum) is a commonly occurring member of the parsley family and misidentification of the plant may lead to accidental ingestion. The stem is characteristically hollow with purple-red splotches [1] (Figure 1). Toxicity occurs as a result of its eight nicotinic alkaloids, the most potent being coniine. These alkaloids are selective nicotinic-type acetylcholine receptor (nAChRs) agonists that have effects on both the autonomic and skeletal muscles. Initial symptoms include nausea, vomiting, salivation, bronchorrhea, tachycardia, hypertension, agitation, confusion, and muscle fasciculations. With a higher dose, the nicotinic alkaloids can cause a delayed phase of toxicity characterized by a paradoxical blockage of the nicotinic receptors. This results in bradycardia, hypotension, muscle paralysis, lethargy, and respiratory muscle paralysis [2].
Adrenaline is effective in reversing the inadequate heart rate response in atropine treated organophosphorus and carbamate poisoning
Published in Clinical Toxicology, 2021
Abhishek Samprathi, Binila Chacko, Shilpa Reynal D’sa, Grace Rebekah, C. Vignesh Kumar, Mohammad Sadiq, Punitha Victor, John Prasad, Jonathan Arul Jeevan Jayakaran, John Victor Peter
A modified protocol of atropinization was followed [3]. The mandatory clinical targets for atropinization that were used in the study included (a) clear lung fields on auscultation (indicated by the absence of bronchorrhea, bronchospasm and increased salivation), (b) target HR >100/minute on day 1 and (c) systolic BP >90 mm Hg. The higher targets for HR and BP were based on prior experience of management of patients with severe poisoning and late presentations. Following atropinization, atropine infusion was titrated to maintain the above targets on day one. The target HR was reduced to >90/min on day two and >80/min on subsequent days. The other secondary targets for atropinization that were monitored routinely in these patients included pupils (aiming for mid-size pupils) and bowel sounds (bowel sounds being just present rather than absent).
Personalized approaches to bronchiectasis
Published in Expert Review of Respiratory Medicine, 2021
Rosa Maria Girón Moreno, Adrián Martínez-Vergara, Miguel Ángel Martínez-García
Health-related quality of life (QoL) is an important item for evaluating the overall impact of bronchiectasis, and in fact it is one of the main outcomes in many clinical trials on bronchiectasis [60]. QoL is usually evaluated with questionnaires that cover impact on various spheres (social, labor, personal and psychological). Some authors have shown that bronchiectasis patients have a poorer QoL than the general population due to the following factors: age [60,61], chronic colonization by P. aeruginosa [62], high degree of dyspnea [59], high number of exacerbations [60–64], poor lung function [59,60,64], bronchial hyperreactivity [65], greater structural damage [11,60,64], daily bronchorrhea [59], respiratory failure [60–64] and depression-anxiety symptoms [66,67].